JOINT REPLACEMENT SURGERIES

🦴 JOINT REPLACEMENT SURGERIES (ARTHROPLASTY) – OVERVIEW

Joint Replacement Surgery, also called Arthroplasty, involves removing a damaged joint surface and replacing it with an artificial prosthesis to relieve pain and restore function—most commonly in advanced osteoarthritis, rheumatoid arthritis, or after trauma.

🔹 Common Types of Joint Replacement Surgeries

Joint Procedure Name Notes

Knee Total Knee Replacement (TKR) / Partial Knee Replacement Most common worldwide

Hip Total Hip Replacement (THR) Gold standard for hip OA

Shoulder Total Shoulder Arthroplasty (TSA) / Reverse TSA Depends on rotator cuff status

Elbow Total Elbow Replacement Less common; for RA or severe trauma

Ankle Total Ankle Arthroplasty For end-stage ankle arthritis

Finger Joints MCP, PIP joint replacement Mostly in rheumatoid arthritis

🔹 Components of Joint Prostheses

Metal: Titanium, cobalt-chromium alloys

Plastic: Ultra-high-molecular-weight polyethylene (UHMWPE)

Ceramic: Highly biocompatible, less wear (e.g. ceramic-on-ceramic in hips)

🔹 Indications for Joint Replacement

✅ Severe joint pain affecting daily activities

✅ Advanced osteoarthritis or inflammatory arthritis

✅ Joint deformity

✅ Failure of conservative treatments (medication, therapy, injections)

✅ Post-traumatic arthritis

✅ Avascular necrosis (e.g. femoral head)

✅ Tumors involving joints (limb salvage procedures)

🔹 Types of Joint Replacement

1. Total Joint Replacement

Entire articular surface replaced (e.g. TKR, THR)

2. Partial Joint Replacement

Only a part is replaced (e.g. Unicompartmental Knee Replacement)

3. Hemiarthroplasty

Only one side of the joint replaced (e.g. hip hemiarthroplasty for femoral neck fractures)

4. Reverse Shoulder Arthroplasty

Used when rotator cuff is non-functional

🔹 Surgical Approach (Example: Hip)

Posterior approach: Most common, good exposure, higher dislocation risk

Anterior approach: Less muscle damage, quicker recovery

Lateral approach: Lower dislocation risk, possible abductor weakness

🔹 Post-operative Care

Early mobilization (within 24–48 hours)

Physiotherapy (ROM, strengthening, gait training)

Thromboprophylaxis (DVT/PE prevention)

Pain management

Monitoring for infection or implant complications

🔹 Risks & Complications

Early Late

Infection Prosthesis loosening

DVT/PE Wear of implant

Bleeding Periprosthetic fracture

Nerve injury Dislocation (hip/shoulder)

Joint stiffness Aseptic loosening or osteolysis

🔹 Lifespan of Joint Prostheses

Typically lasts 15–20 years

Younger patients may require revision surgery later

🔹 Advances in Joint Replacement

Robotic-assisted surgery

3D-printed implants (custom-fit)

Navigation systems

Minimally invasive techniques

Enhanced recovery protocols (ERAS)

🔹 Summary Chart

Feature Total Joint Replacement Partial Replacement

Invasiveness More Less

Longevity Longer Shorter

Recovery Moderate Faster

Indication Extensive damage Localized damage

Cost Higher Lower