If the knee experiences severe damage due to arthritis or traumatic injuries, performing simple, day-to-day activities can become very difficult. An individual might even start to feel pain while sitting or lying down. If non-operative treatments such as medications, bracing, injection, and the use of assistive walking devices such as walkers or crutches are no longer helpful, a partial knee replacement might be an effective option to relive pain and restore normal motion provided certain criteria are met.

Partial knee replacement also known as unicompartment knee replacement, a “uni,” or a partial knee resurfacing, involves removing damaged cartilage of the knee and covering the surfaces of the bones with prosthetic implants generally made of metal alloys and high-grade plastics or polymers. Unlike a total knee replacement which removes all of cartilage, a partial knee replacement removes cartilage from a particular region. The purpose of having a partial knee replacement is to relieve pain. This surgery can also re-align the knee and help restore function, allowing for a “normal” range of motion. Partial or uni knee replacement surgery is typically performed on individuals with advanced osteoarthritis that is limited to just one part of the knee. A partial knee replacement is known to feel more “natural” than a total knee replacement since the healthy part of the bone, ligaments, and cartilage are kept. Additionally, a partial knee replacement is associated with a quicker recovery, less post-operative pain, and less blood loss as compared to a total knee replacement. On the other hand, the disadvantage of a uni or partial knee replacement is the potential need for more surgery in the future.

A partial or uni knee replacement primarily replaces the affected surface of the bones and cartilage as opposed to the bones themselves. Generally, the operative process takes anywhere between one to two hours to complete and occurs in the following order:

• Exposure and Evaluation of the Knee – The first step in unicompartmental knee replacement is to view the arthritic part  as well as all other portions of the knee. On occasion, the physician may find more advanced arthritis than expected in the portions of the knee thought to be normal. In these instances, the physician may elect to convert to a total knee replacement.e
• Bone Preparation – During this step, the damaged cartilage along with a thin layer of the underlying bone is removed from the end of the femur and the tibia.
• Positioning of the Implants – The cartilage and bone removed from the previous step is then replaced with a femoral component and a tibial component to recreate the surface of the joint. Depending on the integrity of the bones and the physician’s preference, these components may be cemented or “press-fit” into the bone.
• Inserting a Spacer – In order to create a smooth, gliding surface, a medical-grade plastic spacer is inserted between the femoral and tibial component.

After partial knee replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and knee movement will being soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore knee movement to allow for walking and other activities post operatively. A majority of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone total knee replacement surgery generally resume most activities four to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to resume; this should be discussed with the physician as well as the physical therapist.

The anterior approach to total hip replacement is a surgical technique where the removal and replacement of a diseased or damaged hip joint is made through a small incision in the front of the hip near the upper thigh. The normal incision is about four inches but may vary according to a patient’s body size. Though small incisions are often considered desirable by patients, it should be kept in mind that the degree and type of tissue disturbance beneath the skin is a more important factor. Using the anterior approach, the hip joint is exposed by spreading muscle groups through their natural intervals, without cutting through muscles, or detaching tendons from bone. In the anterior approach, the gluteal and abductor muscles that attach to the posterior and lateral pelvis and femur are left undisturbed.

Lack of disturbance of the lateral and posterior soft tissues accounts for immediate stability of the hip and a low risk of dislocation. Rehabilitation is accelerated and recovery time decreased because the hip is replaced without detachment of muscle from the pelvis or femur. Following the anterior approach, patients are immediately allowed to bend their hip freely. Should a patient require bilateral hip replacements, this can be performed during a single operative session. Possible complications of anterior hip replacement surgery include infection, injury to nerves or blood vessels, fractures, hip dislocation, and the need for revision surgery.

When an individual has arthritis of the hip, the underlying bone develops spurs and irregularities which can cause severe pain and loss of motion. A total hip replacement (also referred to as total hip arthroplasty) has the ability to relieve pain and restore normal function in patients whose hip joint has been significantly damaged by overuse or trauma. In this type of surgery, the damaged hip ball-and-socket of the femur is replaced by man-made, prosthetic implants. Total hip replacement surgery has been done routinely for the past 50+ years with the main objective being to restore the natural, pain-free movement of the hip joint and allowing patients to return to their desired level of activity. Of all the joints currently replaced in the human body, total hip replacement has had the most success, is the most durable (lasting upwards of 30 years), and has the quickest recovery period.

A total hip replacement entails the removal of the damaged bone and cartilage of the hip ball-and-socket and replacement with man-made prosthetic components. A total hip replacement procedure takes anywhere between one to two hours to complete and occurs in the following order:

• Entering the Joint – An incision is made near the front of the hip and the muscles, tendons, and other tissues are moved away from the joint to expose the femoral head (ball) and acetabulum (socket). The hip is then positioned to expose or open up the joint.
• Removal of Femoral Head – During this step, the head and neck of the femoral head is removed and the acetabulum is cleaned out in preparation for the replacement components.
• Femoral Canal Preparation – Once the acetabulum is cleaned out, an acetabular metal shell component is fit into the space along with a plastic liner to surround the prosthetic femoral head to allow or a smooth gliding surface. The femur is then hollowed out in preparation for the femoral stem insertion.
• Femoral Placement– The femoral stem may be secured with the use of cement or be “press-fit” into the hollow center of the femur. A carefully fitted metal or ceramic ball is then secured to the top of the femoral stem.
• Rejoining the Hip Joint – The hip joint is then rejoined and all the surrounding muscle and tissues are repaired back to position and the procedure is completed.

Recovery after a total hip replacement will depend heavily on how well the individual follows home care and precautions after the surgery. After a total hip replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and hip movement will begin soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Major part of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone total hip replacement surgery generally resume normal activities three to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

ADDITIONAL INFORMATION ON ANTERIOR APPROACH TO TOTAL HIP REPLACEMENT

FAQS ON ANTERIOR APPROACH TO TOTAL HIP REPLACEMENT

TOTAL HIP REPLACEMENT VIDEO

The posterior approach to total hip replacement is a minimally invasive surgical technique where the replacement of the damaged hip joint is made through the side of the hip, along the outer buttock area, and is the most commonly used approach. The normal incision is about five inches but may vary according to a patient’s body size. Though small incisions are often considered desirable by patients, it should be kept in mind that the degree and type of tissue disturbance beneath the skin is a more important factor. The hip joint is exposed by splitting the gluteus maximus muscle in line with its fibers. The piriformis and superior gemeli muscles, which are two of the four external rotators of the hip, are detached and later reattached to allow implantation. . The benefits of minimally invasive hip replacement include less damage to soft tissues, leading to a quicker, less painful recovery and more rapid return to normal activities. While the surgical process in a minimally invasive hip replacement is similar to the traditional approach, there is significantly less damage to the tissue surrounding the hip joint as the splitting of the muscles is greatly reduced and repaired after implantation of the prosthetics to prevent dislocation of the hip. Rehabilitation is accelerated and hospital time decreased because of the smaller incisions as well as less interference with the soft tissues. The rapid hip pathway employed by O+F surgeons allows for healthy patients to be done on an outpatient basis regardless of surgical approach. Larger femoral heads and smaller incision surgery has brought the dislocation rate to between .5-1%. The posterior approach can be extended for revision surgery with little difficulty. Possible complications of minimally invasive hip replacement include infection, injury to nerves or blood vessels, fractures, hip dislocation and the need for revision surgery.

When an individual has arthritis of the hip, the underlying bone develops spurs and irregularities which can cause severe pain and loss of motion. A total hip replacement (also referred to as total hip arthroplasty) has the ability to relieve pain and restore normal function in patients whose hip joint has been significantly damaged by overuse or trauma. In this type of surgery, the damaged hip ball-and-socket of the femur is replaced by man-made, prosthetic implants. Total hip replacement surgery has been done routinely for the past 50+ years with the main objective being to restore the natural, pain-free movement of the hip joint and allowing patients to return to their desired level of activity. Of all the joints currently replaced in the human body, total hip replacement has had the most success, is the most durable (lasting upwards of 30 years), and has the quickest recovery period.

A total hip replacement entails the removal of the damaged bone and cartilage of the hip ball-and-socket and replacement with man-made prosthetic components. A total hip replacement procedure takes anywhere between one to two hours to complete and occurs in the following order:

• Entering the Joint – An incision is made near the side of the hip and the muscles, tendons, and other tissues are moved away from the joint to expose the femoral head (ball) and acetabulum (socket). The hip is then positioned to expose or open up the joint.
• Removal of Femoral Head – During this step, the head and neck of the femoral head is removed and the acetabulum is cleaned out in preparation for the replacement components.
• Femoral Canal Preparation – Once the acetabulum is cleaned out, an acetabular metal shell component is fit into the space along with a plastic liner to surround the prosthetic femoral head to allow or a smooth gliding surface. The femur is then hollowed out in preparation for the femoral stem insertion.
• Femoral Placement– The femoral stem may be secured with the use of cement or be “press-fit” into the hollow center of the femur. A carefully fitted metal or ceramic ball is then secured to the top of the femoral stem.
• Rejoining the Hip Joint – The hip joint is then rejoined and all the surrounding muscle and tissues are repaired back to position and the procedure is completed.

Recovery after a total hip replacement will depend heavily on how well the individual follows home care and precautions after the surgery. After a total hip replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and hip movement will being soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Major part of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone total hip replacement surgery generally resume normal activities three to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

TOTAL HIP REPLACEMENT VIDEO

When an individual has arthritis of the hip, the underlying bone develops spurs and irregularities which can cause severe pain and loss of motion. Depending on the severity of the damage in the hip joint, the physician my recommend a partial hip replacement (also referred to as hip hemiarthroplasty), which has the ability to relieve pain and restore normal function in patients whose hip joint has been significantly damaged by overuse or trauma. In this type of surgery, the femoral head of the damaged hip joint is replaced by man-made, prosthetic implants. Partial hip replacement surgery is done primarily to treat injuries rather than degenerative arthritis (which often lead to a total hip replacement surgery). Partial hip replacements are ideal for “broken hips” – occasions where a fracture that is difficult to mend develops in the femoral neck, but the socket is still strong. Partial hip replacements are only seldom recommended for elderly patients who are not very active.

A partial hip replacement entails replacement the ball of the femur with man-made prosthetic components. A partial hip replacement procedure takes anywhere between one hour to 90 minutes to complete and occurs in the following order:

• Entering the Joint – Depending on the approach and the physician, an incision is made near the front, side, or back of the hip and the muscles, tendons, and other tissues are moved away from the joint to expose the femoral head (ball) and acetabulum (socket). The hip is then positioned to expose or open up the joint.
• Removal of Femoral Head – During this step, the head and neck of the femoral head is removed.
• Femoral Channel Preparation – The channel inside the femur is then hollowed out in preparation for the femoral stem insertion.
• Femoral Placement– The femoral stem may be secured with the use of cement or is “press-fit” into the hollow center of the femur. A carefully fitted metal or ceramic ball is then secured to the top of the femoral stem.
• Rejoining the Hip Joint – The hip joint is then rejoined and the surrounding muscle and tissues are repaired back to position and the procedure is completed.

Recovery after a partial hip replacement or total hip replacement for hip fractures will depend heavily on how well the individual follows home care and precautions after the surgery. After a partial hip replacement surgery, there will be some pain, but the medical team will provide the proper medication to make the patient as comfortable as possible. Walking and hip movement will being soon after the surgery where a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Major part of the recovery process will occur at home where proper care must be taken in terms of wound care, diet, and activity as prescribed by the physician and physical therapist. Patients who have undergone partial hip replacement surgery generally resume normal activities three to six weeks post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

PARTIAL HIP REPLACEMENT VIDEO

There are two joints in the shoulder, both of which can be affected by arthritis. The acromioclavicular joint (AC joint) is located where the clavicle meets the tip of the scapula. The glenohumeral joint is located where the head of the humerus fits into the scapula. There are many forms of arthritis with five major types that typically affect the glenohumeral joint:

• Osteoarthritis – Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of your bones wears down over time. It’s often called a degenerative joint disease where the cartilage experiences a significant amount of wear and tear over a long period of time, generally occurring in individuals over the age of 50.
• Rheumatoid Arthritis (RA) – Rheumatoid arthritis is quite possibly the most serious form of arthritis as it is a major crippling disorder. Unlike osteoarthritis, rheumatoid arthritis affects the synovial membrane (lining of the joints), causing a painful swelling, resulting in joint deformity and bone erosion. Rheumatoid arthritis is three to four times more likely to occur in women and may affect various systems of the body such as eyes, heart, lungs, skin, and the nervous system.
• Post-Traumatic Arthritis – Traumatic arthritis is caused by a major or repeated trauma to the articular cartilage. This is most common among individuals who were/are athletic or active. Injuries to joints such as a fracture or dislocation can cause major damage to the articular cartilage, which leads to arthritic changes in the joint over time.
• Avascular Necrosis – Avascular necrosis occurs when the blood supply to the head of the humerus is limited or disrupted due to an injury such as a dislocation or fracture. It can also be a complication from some medication. The lack of blood can cause the bone to breakdown and damage the articular cartilage, resulting in arthritis. This can also occur spontaneously without an injury.
• Rotator Cuff Tear Arthopathy – Rotator cuff tear arthopathy is the development of arthritis as a result of a long-standing, large tear in the rotator cuff. When this occurs, the torn rotator cuff is no longer able to hold the head of the humerus in the glenoid socket, causing the ball to ride up, out of the socket. This can damage the surfaces of the bones and cause arthritis.

As with most arthritic conditions, the initial treatment will be more-conservative, non-operative treatment. If shoulder pain persists and the non-operative treatments have been exhausted, the physician may recommend an operative approach. Shoulder replacement surgery is extremely technical; therefore, the physician will evaluate the individual’s conditions and situation and provide recommendation for the best approach.

Total Shoulder Arthroplasty – Total shoulder arthroplasty, also known as total shoulder replacement, is performed when arthritis or degenerative shoulder joint disease makes the shoulder stiff and painful. Individuals with bone-on-bone arthritis are ideal candidates for this procedure. An incision is made in front of the arm. The tendons and muscles surrounding the shoulder joint are moved away to expose the glenoid and the humeral head and the shoulder is moved to provide easy access to the joint. The humeral head is then removed and the glenoid cavity is cleaned out in preparation for the replacement prosthesis. The hollow channel inside the humerus is prepared for the humeral stem to be inserted. The physician may then either use cement to secure the stem in the hollow channel or “press-fit” the stem into the channel. A carefully fitted ball is secured to the end of the stem and a plastic insert is attached to the glenoid cavity. The shoulder joint is then repositioned and all surrounding tissue is put back into place. The incision is closed and the procedure is completed.

Stemmed Hemiarthroplasty – Depending on the condition of the shoulder the physician may recommend a stemmed hemiarthroplasty, or partial shoulder replacement. For example, individuals who have severely fractured the head of the humerus, but have maintained a normal socket, are ideal candidates for this procedure. The surgical procedure is identical to that of a total shoulder replacement, however the glenoid cavity is left alone and the metal ball that is secured to the humeral stem is positioned into the normal glenoid cavity.

Resurfacing Hemiarthroplasty – Depending on the condition of the shoulder and the humerus, the physician may recommend a resurfacing hemiarthroplasty. Younger individuals who have no fresh fractures of the humeral head or neck and a normal glenoid cavity with healthy cartilage surface may be candidates for this procedure. A resurfacing hemiarthroplasty replaces just the joint surface of the humeral head with a cap-like man-made prosthesis. There is no need for a humeral stem in this procedure since there are no fractures. The advantage of this procedure is that it is a conservative way to preserve the original bone.

Reverse Total Shoulder Replacement – In some cases, the physician may recommend a reverse total shoulder replacement. Individuals who have completely torn their rotator cuff and have osteoarthritis and have severe arm weakness, patients with fractures, or those who have previously had a total shoulder replacement that has failed may be candidates for this procedure. In a reverse total shoulder replacement surgery, the socket and the metal ball are switched. The surgical process is identical to that of a total shoulder replacement, however, the socket is secured to the end of the humeral stem and a carefully fitted ball is placed in the glenoid cavity. In other words, the ball and socket joint becomes a socket and ball joint. This allows the individual to use their deltoid muscle instead of their rotator cuff to lift and rotate the arm.

There will be pain after a shoulder replacement surgery. However, the physician will provide the necessary medication for managing pain. Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to restore range of motion. Home care with respect to wound care, diet and exercise will be critical for the first few weeks following surgery. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity they would like to return to. Recovery time after surgery depends on the complexity of the procedure, but the individual’s commitment to following all the exercises prescribed by the physical therapist is the most important factor in returning to activities.