Joint Replacement Surgery - When is it Needed

Published in "Panorama"


When You Require Joint Replacement Surgery


Over 435,000 Americans undergo joint replacement surgery each year, for a new hip or knee. The objective of a joint replacement surgery is to relieve the pain in the joint caused by the damage done to the cartilage and enable individuals to live fuller, more active lives. When cartilage wears out, the pain starts because of exposure of nerve endings. And the pain may be so severe as to make a person avoid using the joint, which in turn weakens the muscles around the joint, making it even more difficult to move the joint, says Dr.H.P.C.Khincha, Director and Head of the Department of Orthopedics, Specialist in Joint Replacement, Arthroscopic Surgery and Sports Medicine, Sagar Apollo Hospital, Bangalore.

A joint, formed by the ends of two or more bones, is connected by thick tissues or cartilage. Healthy cartilage allows nearly frictionless and pain-free movement. However, when the cartilage suffers damage due to disease or injury, the joints become stiff and painful. The pain and stiffness occasioned may be so severe that a joint replacement surgery may be the only solution to a healthier, near-normal active life, says Dr.Khincha.

What is Joint Replacement and what are the joints that can be replaced? Joint replacement involves replacing the worn out parts of a natural joint by an artificial one which is anatomically fitted, explains Dr.Khincha. Hips, knees, shoulder, elbow, wrist, fingers and ankle joints can be replaced. On the incidence of such replacements, Dr.Khincha observes, “Total knee joint replacement is more common in the Indian sub continent, perhaps due to the life style with more cross-legged sitting, Indian toilet position and genetic factors. Whereas in the Western world, it is more hip joint replacement which happens.”

What are the conditions leading to joint replacement? Dr.Khincha explains, “The procedure may be required in severely degenerate, very painful joints, with or without deformities. Major weight bearing joints like the hip and knee, are worn out for a variety of reasons, a condition termed arthritis. Arthritis itself can be of different natures:

Osteoarthritis, which is the general age-related wear and tear of the joints.
Rheumatoid arthritis, which occurs due to an autoimmune disorder
Gouty Arthritis which results secondary to increased uric acid in the body.

Explaining further, the reasons for these conditions, Dr.Khincha says, “Osteoarthritis of a joint is sometimes also a result of previous injury to the cartilage. Early osteoarthritis is very painful but very gross degeneration is not very painful. This is a very important fact to understand because people think that they have no pain, they are cured. On the contrary, problems increase!”

Wear and tear of joint also gives a clinical deformity of bowlegs or knock-knees, explains Dr.Khincha. “Sometimes the deformities are gross.” Tumour may be another contributory factor to damage of cartilage and surrounding areas, necessitating joint replacement.

What about sports people requiring such a surgery? Dr.Khincha explains, “It is true that there may be constant injury to the knee in sports people. An injury to the knee at the age of 16, 17, or thereabout, particularly after a fall or a fracture, could make the joint more prone to wearing out, than in a non-sports person. While we may argue that sportsmen could have a little higher risk of arthritis in their joints on account of these injuries, the contrary is more true: they are well built in that they keep themselves physically fit and exercise in a manner where they learn to perfect the art of falling without fracturing or damaging their joints!

What is the age at which this surgery can be performed? Dr.Khincha explains, “We postpone surgery to as far as possible in age, keeping it to about 55-60 years in the Indian context and about 65-70 years in the Western world. But if the activities of daily life or life style of the concerned individual is compromised even though his general life span is good and he enjoys an otherwise good health, we may recommend the surgery even at 40 years. In these instances, we do explain to the patients that the life of these new, artificial joints is 15-20 years, at the end of which period, we may need to re-do the surgery.”

How exactly does joint replacement surgery benefit the affected individuals? Surgical treatment of the affect joint relieves pain, corrects deformities, enables the person to have pain-free movement of the joint which is now stable and allows him/her to function independently.

How long does the operation take and what are the possible complications therefrom? “The surgery takes about 1 – 1 ½ hours for total knee and total hip joint replacement and about 2 hours for total shoulder replacement. Complications from surgery including infection and damage to nearby areas are very, very rare in this age of modern technology, sterile surgical procedures and medication.”

Are there any downsides to the surgery? After a total hip or knee joint replacement, the individuals will not be able to squat on the floor or use an Eastern style toilet, admits Dr.Khincha.

What about post-surgical pain? For the first 2 – 3 days following surgery, pain is bound to be there, says Dr.Khincha, but it is well controlled by epidural analgesia or controlled pumps. However, it may take between 3-6 weeks for the pain to disappear completely.

Can knee and hip replacement surgeries be done on people who are overweight or obese? Dr.Kincha is forthright, “It is possible to operate on obese people but we explain the possible risks to them. Obese patients cannot walk before operation because of pain and hence cannot exercise. To enable them to exercise and lose weight, replacement of the painful affected joints is necessary.”

What post operative regime will the patients have to follow? Dr.Khincha elaborates: “Patients are required to do Passive or Active Knee movements on a continuous motion machine on the afternoon of the surgical day. They have to stand up with full weight on the legs on the 1st day and walk with support on the 2nd day following surgery. They are allowed full bath or shower on the 2nd or 3rd day with a waterproof dressing on the wound; allowed to use Western style toilet on the 3rd or 4th day, climb steps on the 5th day and are home within a week’s time.”

There are specific regime for different fractures, but regardless of the fracture site and type of surgery, physiotherapy at home is of utmost importance, emphasizes Dr.Khincha. “Family involvement in this regime is important. The emphasis is on muscle building exercises and mobility of the affected joints. In a hospital setup we have Continuous Passive Motion Machines wherein the patient’s limbs, joints are automatically exercised continuously by the machine, while they themselves may be reading a newspaper, magazine, et al.”

What are these artificial joints made of and how user-friendly are they? Medical steel, High Density Polyethylene, Titanium, Ceramic and highly cross-linked polyethylene are used in making these joints. All these materials are non-allergic, non-irritant and non-infective, being totally bio-compatible with the bodily tissues, explains Dr.Khincha.

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