Arthroplasty

Definition

Arthroplasty is surgery to relieve pain and restore range of motion by realigning or reconstructing a joint.

Precautions

If both the bone and socket of a joint are damaged, joint replacement is usually the preferred treatment.


Purpose

The goal of arthroplasty is to restore the function of a stiffened joint and relieve pain. Two types of arthroplastic surgery exist. Joint resection involves removing a portion of the bone from a stiffened joint, creating a gap between the bone and the socket, to improve the range of motion. Scar tissue eventually fills the gap. Pain is relieved and motion is restored, but the joint is less stable.

Interpositional reconstruction is surgery to reshape the joint and add a prosthetic disk between the two bones forming the joint. The prosthesis can be made of plastic and metal or from body tissue such as fascia and skin. When interpositional reconstruction fails, total joint replacement may be necessary. Joint replacement is also called total joint arthroplasty.

In recent years, joint replacement has become the operation of choice for most knee and hip problems. Elbow, shoulder, ankle, and finger joints are more likely to be treated with joint resection or interpositional reconstruction.

Arthroplasty is performed on people suffering from severe pain and disabling joint stiffness that result from osteoarthritis or rheumatoid arthritis. Joint resection, rather than joint replacement, is more likely to be performed on people with rheumatoid arthritis, especially when the elbow joint is involved. Total joint replacement is usually reserved for people over the age of 60.



Description

Arthroplasty is performed under general or regional anesthesia in a hospital, by an orthopedic surgeon. Certain medical centers specialize in joint surgery and tend to have higher success rates than less specialized centers.

In joint resection, the surgeon makes an incision at the joint, then carefully removes minimum amount of bone necessary to allow free motion. The more bone that remains, the more stable the joint. Ligament attachments are preserved as much as possible. In interpositional reconstruction, both bones of the joint are reshaped, and a disk of material is placed between the bones to prevent their rubbing together. Length of hospital stay depends on which joint is treated, but is normally only a few days.

Preparation

Prior to arthroplasty, all the standard preoperative blood and urine tests are performed. The patient meets with the anesthesiologist to discuss any special conditions that affect the administration of anesthesia.

Aftercare

Patients who have undergone arthroplasty must be careful not to over stress or destabilize the joint. Physical therapy is begun immediately. Antibiotics are given to prevent infection.

Risks

Joint resection and interpositional reconstruction do not always produce successful results, especially in patients with rheumatoid arthritis. Repeat surgery or total joint replacement may be necessary. As with any major surgery, there is always a risk of an allergic reaction to anesthesia or that blood clots will break loose and obstruct the arteries.

Normal results

Most patients recover with improved range of motion in the joint and relief from pain.