Joint Replacement the word says it all, every day during various activities the cartilage (a natural lubricant acting tissue between two or more bones) passes through wear and tear, so it causes pain in joints when the cartilage rubs off completely. Joint pain can be caused by several other reasons too. All these reasons combine and other deformities, deficiencies are the reason for Joint Replacement. Old Age is one of the most common factors for Joint Replacement in India, other than that every year several foreigners seek and receive Joint Replacement Surgery in India. We at Femicure have a distinct specialist Doctors & Hospitals for joint replacement, orthopedics, and sports medicine. In this blog, we will be focusing on Knee Replacement and Hip Replacement Surgery in India, which are among the most common joint replacement surgeries. The shoulder, ankle, and fingers are other options.

Definition(s)

  • Joint Replacement Surgery- When severe joint pain or dysfunction isn't alleviated by basic medications, this procedure is used in which a dysfunctional joint surface is replaced with a prosthesis.  
  • Hip Replacement Surgery- In this, the surgeon removes the damaged parts of the hip joint and replaces them with artificial parts, usually constructed of metal, ceramic and very hard plastic. 
  • Knee Replacement Surgery- In this, the damaged bone is cut off and affected cartilage of all three connecting bones is removed and replaced with an artificial joint. This joint is made of metal alloys, high-grade plastics and polymers. It is also known as TKR (Total Knee Replacement)
  • Orthopedic- Medical branch concerning to bones and muscles, studying and treating joints is part of it.
  • Orthopedic Surgeon- Specialists surgeon who Operates in Joint Replacement and other such surgeries.

Eligible for the following surgeries:

Knee Replacement Surgery:

  • Consistent knee pain, surgery is done when this pain doesn't get cured with nonsurgical treatments, such as exercise, weight loss, physical therapy, medications and other methods.
  • Moderate to severe arthritis in the knee.
  • Difficulty walking, going upstairs, and getting in and out of chairs. (no pain but difficulty while doing such activities)
  • Knee deformity, such as bow-legs or knock-knees, which has been resulted by knee joint degeneration
  • Knee swelling and inflammation that is persistent and can't be controlled otherwise.
  • High knee damage from an accident.

Hip Replacement Surgery:

  • Osteoarthritis, also commonly known as wear-and-tear arthritis. It damages the cartilage.
  • Rheumatoid arthritis, caused by an overactive immune system and it causes a type of inflammation. The inflammation damages cartilage damages bones and deforms joints.
  • Osteonecrosis, the inadequate blood supply to the ball portion of the hip joint, can cause the bone to collapse and deform.
  • Persistent pain which can't be cured by non-surgical methods.
  • Pain during walking, sitting in a certain position, or while resting.

Procedures and Advancement:

Total Knee Replacement in India (TKR):

Most TKR operations have this same procedure, some little change might be because of the patient's condition. Otherwise, the standard procedure is the replacement of the affected surface(s) from the end of the thigh bone (femur) and the top of the shin bone (tibia). According to the situation, TKR may also involve replacing the under-surface of the kneecap (patella) with a smooth plastic dome. 

Most Surgeons at Joint Replacement Hospitals always prefer to preserve the natural patella, if possible. Even if the patella is already removed it won't affect the surgery. (Removed here means during surgery at any point of the patient's life) The removed patella will only affect the type of replacement part (prosthesis) the surgeon has to use. New parts are fixed by cementing, if not then the components of the surface are textured or coated in a way that it encourages the bone to grow onto it. Another common technique is to use a mobile plastic bearing, it isn’t firmly fixed to the metal parts though. 

Traditional TKR requires an incision down the center of the knee about 8 to 10 inches long. Then it is cut deeper through the tissue (even quadriceps tendon) and flipped over the kneecap to access the femur and tibia. After replacement, the surgeon has to repair the deep tissues and stitch back the skin.

Minimally Invasive TKR, instead of 8 to 10 inches deep, a 3 to 6 inches deep cut. The soft tissues and surrounding ones aren't cut but lifted or moved aside. Usually, the kneecap is twisted 180 degrees but in this case, it's just moved aside, even tibia and femur are also not dislocated then usual. For all this, the surgeon needs to have the perfect expertise and experience.

Robotic TKR is one of the recent advancements and uses robotic technology. It is more precise for implanting but for now only few can perform it.

Total Hip Replacement in India (THR):

As per the standard procedure for total hip replacement, first, the doctor will make a cut along the side of the hip. The muscles connected to the top of the thigh bone (femur) will be moved to expose the hip joint. Next, the ball portion of the joint is separated,  the thigh bone is cut by the saw to separate the ball. After that, on the top femur (thighbone) an artificial joint is attached. Cement is used to attach the new joint with bone, in some cases, a special material is used too.

Then the doctor focuses on the surface of the hipbone. He/she removes the damaged cartilage and connects the replacement socket part to the hipbone. The new ball, part of the artificial joint in the femur is then inserted into the socket part of the hip. The doctor then joins the muscles and stitches the incision.

Traditional THR, it is performed using the standard technique but incisions are 8 to 10 inches deep. While in Minimally Invasive THR surgeons make one or two cuts of 2 to 5 inches long. 

Apart from this, there is another variation. Ball-socket materials might differ according to the age of the patient. Old patients (senior citizens) are advised to stick with the basic setting, metal ball inside the metal-on-plastic socket. Another option is for younger parents, the ceramic ball is used with either a plastic socket (ceramic-on-plastic) or with a ceramic socket (ceramic-on-ceramic).

Results:

Total Knee Replacement

Pain relief, improved mobility and a better quality of life had been the target, which is achieved easily otherwise in a few cases it takes more therapies than usual. It shall be expected to last up to 15 years. You can start with daily activities from generally three to six weeks after surgery. 

Driving is also possible if your medicines aren't of high power. After one hundred percent recovery, patients can start low-impact activities like walking, swimming, golfing or biking, but avoid higher impact activities like jogging, skiing, tennis and sports that involve contact or jumping. Still, the doctor shall be consulted before taking any rigorous or stressful activities.

Total Hip Replacement

The new hip joint will result in reduced pain than before. Even the motion of the legs and the joints will be increased. Still, the patient can't do everything that he/she used to like the high impact activities mentioned above and can do all the low impact activities from the above.