Arthroplasty is a surgical procedure performed on a joint. The surgical intervention is intended to restore joint function or ensure healthy joint function.
What is arthroplasty?
Arthroplasty is a surgical intervention on the joint. The surgical intervention is intended to restore joint function or ensure healthy joint function. A joint is a movable connection of two or more bones. In a true joint, there is a gap between the two ends of the bones. This is called the joint space. The surfaces of the joint are covered by articular cartilage. Around the joint is the protective joint capsule, which consists of an outer tight connective tissue layer and an inner epithelium-like layer. Joints can be damaged by various diseases. Osteoarthritis is responsible for most joint damage. The term arthrosis is used when signs of wear and tear on the joint exceed normal levels. Typical symptoms of osteoarthritis are pain on onset and load-dependent pain. Joint deformities and stiffness in the joint are also possible symptoms of arthrosis. Arthroplasty is used in particular for stiffened joints, severely painful joints and joints that are restricted in their mobility. As a rule, the damaged joint cartilage is removed during the surgical procedure. There are different subsets of arthroplasty that are used for different indications.
Function, effect and goals
In alloarthroplasty, one or more joint surfaces are replaced with material foreign to the body. These inserts are also called endoprostheses. Endoprostheses are joint implants that can remain in the body and permanently replace the defective joint. Alloarthroplasty is most commonly used in the hip joint. However, there are also endoprostheses for the knee joint, shoulder joint, ankle joint and elbow joint. Rarely, finger joint prostheses are used. Hip prostheses are usually made of titanium alloys, CoCrMo forged alloys, CoNiCrMo forged alloys, or fiber-reinforced plastics. If only the femoral head is replaced in a hip arthroplasty, it is a hemi-endoprosthesis (HEP). A replacement of the joint head and socket is called a total endoprosthesis (TEP). Restriction arthroplasty involves complete removal of the diseased joint and bone. This form of arthroplasty is used primarily for joint pain. The removal eliminates the cause of the pain. However, the missing joint severely limits the function of the affected body part. The restriction arthroplasty procedure is used, for example, on the thumb saddle joint. Here, the name Epping arthroplasty is commonly used. Chondroplasty is the term used to describe the smoothing of cartilage that has undergone degenerative changes. Friction or pridie drilling of the bone under the defective joint area also belongs to the field of chondroplasty. Pridie drilling is intended to create scar cartilage in the defect area. In transplantation arthroplasty, a distinction can be made between cartilage bone transplantation and between cartilage cell transplantation. In cartilage bone grafting, bone-cartilage cylinders are harvested from healthy areas of the damaged joint. The cylinders are then inserted into the defect areas. In cartilage cell transplantation, cartilage cells are also taken from healthy cartilage tissue. These cells are then grown on a nutrient matrix. This creates healthy cartilage that can be transplanted into the defective joint. The procedure of cartilage cell transplantation is still quite new. The procedure of joint toilet also belongs to arthroplasty. Here, the joint is cleaned and rinsed during an arthroscopy. This is to remove degenerated and / or inflamed cartilage tissue. In synovialectomy, the inflamed mucous membrane of the joint (synovium) is completely removed.
Risks, side effects, and hazards
Most arthroplasties involve the general risks of moderate surgery. Blood clots, called thrombi, can form in the legs after surgery. Without prophylaxis, the risk of thrombosis in the first three months after surgery is 1 to 6 percent.The risk of thrombosis can be reduced to 0.3 percent by prophylaxis started immediately after surgery. If the thrombus breaks loose during thrombosis, a life-threatening pulmonary embolism can occur. Wound healing problems and infections can develop during or after arthroplasty. In an average of 5 out of 30000 patients, a deep wound and prosthetic infection develops after surgery. The wound may bleed for an unusually long time and hematomas may develop. In addition, there is a possibility that nerves or blood vessels may be injured during surgery. Damage to nerves may cause insensitivity in the area of supply. Occasionally, blood loss occurs during surgery, which requires treatment with autologous or foreign blood transfusions. There are people who are allergic to the implant, which is used in some arthroplasties. In the case of such an implant allergy, the artificial joint must be replaced in a revision surgery. Depending on the surgical procedure, there are other specific risks. Implantation of an artificial hip joint, for example, can result in bone tissue being blown off the thigh. In this case, the thigh must be additionally stabilized with wires and screws. Three percent of patients develop endoprosthesis loosening within ten years. This is associated with severe pain and inflammation. In the event of endoprosthesis loosening, revision surgery must be performed. In the first few months after surgery, heterotropic ossification develops in some patients. This is when soft tissue outside the bony skeletal system remodels into bony tissue. As a result, the mobility that was gained with the operation can be lost again. Preventive X-ray irradiation before surgery is used to reduce the risk of new bone formation in high-risk patients. In addition, anti-inflammatory drugs are administered as prophylaxis.
Typical and common joint diseases
- Osteoarthritis
- Joint inflammation
- Joint pain
- Joint swelling
- Rheumatoid arthritis
