Arthroplasty is the surgical reshaping or reconstruction of a diseased and dysfunctional joint to make it functional again.
The aim of this surgical method is to enable the patient to perform daily activities without pain.
- Resection arthroplasty: The diseased joint face or faces are removed. The joint is left in the joint position. Two common surgical procedures are Girdlestone resection arthroplasty, in which the femoral head is removed from the hip joint and the capsule heals, allowing the patient to walk, albeit with a limp. Or in Keller resection arthroplasty, the proximal phalanx of the first toe is removed in the case of arthritis of the toe joint faces such as Hallux Rigidus.
- Interposition arthroplasty: It is an operation to replace soft tissue after the removal of bone cartilage tissues on the joint faces that have deteriorated. For example, in the case of arthritis in the thumb, the trapezium bone is removed and replaced with a ball of palmaris longus tendon.
- Partial endoprosthetic arthroplasty: The procedure in which only one side of the joint is replaced is called endoprosthesis or partial prosthesis surgery. For example, in hip fractures of elderly patients, the articular surface (head part) of the femur bone is removed and the stem and head part of the cemented or uncemented prosthesis are inserted into the femoral medulla to complete the partial prosthesis. Thus, the newly created joint is formed with the patient's own acetabulum bone on top and the replaced femoral head on the bottom.
- Total joint arthroplasty: It is the process of replacing both sides of joint faces that are deformed and cause pain. For example, in hip joint arthritis, both the femoral head and the acetebulum are replaced. Total joint replacements are mostly applied to large joints such as the knee, hip, shoulder and ankle. Less commonly, total joint replacements are also performed between the elbow, wrist, toes and spine.
There are precautions to be taken for any type of arthroplasty. A series of precautions, starting with preoperative antibiotic prophylaxis and including sterilization methods, can prevent infection after surgery. The prosthetic components used should be sterile packaged and hand instruments should be properly sterilized. Operating room ventilation and temperature should be prepared according to standards under certain conditions. Measures that are the responsibility of the patient, the doctor and the hospital, such as covering the patient, coloring, keeping the time used for surgery short and keeping the wound clean after surgery, should be followed.
Complications that may occur after surgery
- Infection It stands out as the most common complication. Depending on the healthcare providers in various countries of the world, infection after arthroplasty is seen between 1-8%. If the infection is diagnosed in the early period, it can be treated with antibiotic treatment or simple debridement, while in chronic infections, prosthesis removal, antibiotic treatment and revision arthroplasty are performed.
- Dislocation : After arthroplasty, dislocations may occur in the joint components due to inadequate surgical method or improper use. Joint integrity can be restored with closed or open replacement or revision surgery.
- Fractures around the joint: As with simple fractures, fractures may also occur around the prosthesis due to trauma. They can be treated with revision or fixation surgeries in appropriate cases.
- Embolism: It is mostly encountered in patients undergoing knee and hip arthroplasty. With medication and mechanical prophylaxis methods, deep vein thrombosis or embolism complications may occur with a frequency of 2-24%.