arthroplasty

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Related to excision arthroplasty: interposition arthroplasty, Joint replacement

Arthroplasty

 

Definition

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

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.

Precautions

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

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.

Resources

Books

"Joint Replacement." In Everything You Need to Know About Medical Treatments. Springhouse, PA: Springhouse Corp., 1996.

Other

"Darrach's Procedure." Wheeless' Textbook of Orthopaedics Page. http://www.medmedia.com/ooa1/119.htm.

Key terms

Fascia — Thin connective tissue covering or separating the muscles and internal organs of the body.
Rheumatoid arthritis — A joint disease of unknown origins that may begin at an early age, causing deformity and loss of function in the joints.

arthroplasty

 [ahr´thro-plas″te]
plastic repair of a joint; called also joint replacement.
total hip arthroplasty replacement of the femoral head and acetabulum with prostheses (femoral and acetabular components) that are anchored to the bone, done to replace a severely damaged hip joint.
A, Total hip arthroplasty. A cementless prosthesis allows porous ingrowth of bone. B, Total knee arthroplasty using a tibial metal retainer and a femoral component. The femoral component is chosen individually for each person according to the amount of healthy bone present. From Polaski and Tatro, 1996.
Called also total hip replacement.
Patient Care. The most frequent complications to guard against in these patients are infection and dislocation. An interdisciplinary team helps the patient with recovery and rehabilitation after surgery. Before surgery patients are given instruction to assure that they understand the nature of the surgery, its expected outcome, procedures and exercises that will be done postoperatively, and the correct use of aids to ambulation such as a walker, crutch, or cane.

In addition to routine postoperative care to avoid respiratory and circulatory complications, special care must be taken in positioning the patient. In order to prevent subluxation (dislocation) of the prosthesis, an abduction wedge is secured between the legs (usually in the operating room) and left in place until removed by the surgeon. The head of the patient's bed should not be raised more than 45 degrees.

Patients usually are allowed to stand at the bedside the first postoperative day, supported by a walker and two persons. Specific written permission for weight-bearing on the affected joint should be obtained from the surgeon before this is allowed. Patients often need additional instruction and help in transferring from bed to chair, wheelchair, and commode. Whenever a sitting position is assumed, the chair seat should be raised so that the hips are not flexed beyond a 90-degree angle.

Discharge planning should include instructions that will enable patients to care for themselves safely at home. These include: (1) It is safe to lie on your operated side. (2) For three months you should not cross your legs. (3) Place a pillow between your legs when you roll over on your abdomen or lie on your side in bed. (4) It is safe to bend your hip, but not beyond a right (90-degree) angle. (5) Faithfully continue the exercise program started in the hospital. Patients who need assistance in self-care are referred to a home health agency, social worker, or community health nurse.
total joint arthroplasty arthroplasty in which both sides of a joint are removed and replaced by artificial implants anchored to the bones; the most common joints treated are the hip, knee, elbow, and shoulder. Called also total joint replacement.
total knee arthroplasty arthroplasty of both sides of the knee joint, with tibial, patellar, and femoral components.

ar·thro·plas·ty

(ar'thrō-plas'tē),
1. Creation of an artificial joint to correct advanced degenerative arthritis.
2. An operation to restore as far as possible the integrity and functional power of a joint.
[arthro- + G. plastos, formed]

arthroplasty

/ar·thro·plas·ty/ (ahr´thro-plas″te) joint replacement; plastic repair of a joint.

arthroplasty

(är′thrə-plăs′tē)
n.
1. The creation of an artificial joint.
2. The surgical restoration of the integrity and functional power of a joint.

arthroplasty

[är′thrəplast′ē]
Etymology: Gk, arthron + plassein, to mold
the surgical reconstruction or replacement of a painful, degenerated joint, to restore mobility in osteoarthritis or rheumatoid arthritis or to correct a congenital deformity. Either the bones of the joint are reshaped and soft tissue or a metal disk is placed between the reshaped ends, or all or part of the joint is replaced with a metal or plastic prosthesis. Preoperative care may include the typing and crossmatching of blood. After surgery the patient may be placed in traction to immobilize the affected limb. Physical therapy to increase muscle strength and range of motion is allowed in a slow, progressive schedule. When a lower extremity is involved, weight-bearing may or may not be allowed. Frequent checks of distal circulation are made and the nurse watches for bleeding, thrombophlebitis, pulmonary embolism, or fat embolism. Antibiotics are usually given to prevent infection, which is the most common cause of failure of the surgery. Also called joint replacement. See also osteoarthritis.

arthroplasty

Surgical repair of a joint. See Implantation arthroplasty, Total hip replacement, Total knee replacement, WOMAC.

ar·thro·plas·ty

(ahr'thrō-plas-tē, ahrthrō-plas-tē)
1. Creation of an artificial joint to reduce pain and/or restore mobility to a joint.
2. An operation to restore as far as possible the integrity and functional power of a joint.
[G. arthron, joint, + -plasty, reparative procedure, fr. plassō, to shape]

arthroplasty

The surgical creation of a new joint or the insertion of an artificial joint. Total hip joint replacement is a common example of arthroplasty. The operation is done to restore mobility, and relieve pain and deformity. Problems may arise from loss of firm fixation and mechanical wear of the prosthetic parts.

arthroplasty

surgical remodelling of a joint.

arthroplasty

excision of the head or base of a bone, creating a fibrous pseudojoint

ar·thro·plas·ty

(ahr'thrō-plas-tē, ahrthrō-plas-tē)
1. Creating an artificial joint to correct ankylosis.
2. An operation to restore the integrity and functional power of a joint.
[G. arthron, joint, + -plasty, reparative procedure, fr. plassō, to shape]

arthroplasty (är´thrəplas´tē),

n the surgical correction of a joint abnormality.
arthroplasty, gap,
arthroplasty, interposition,
n See interposition arthroplasty.

arthroplasty

plastic repair of a joint.

excision arthroplasty
one that involves removal of some component of the joint, e.g. femoral head or patella.
total hip arthroplasty
total hip replacement.