ARTHROPLASTY

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 ARTHROPLASTY

Types

 1. Excision arthroplasty
 Sufficient bone is excised to create a
gap which allows movement (eg.
Girdlestone)
 2. Partial Replacement
 One surface only is replaced
 3. Total Joint Replacement
 Convex component usually metal
bears on a concave component which
is usually polyethylene

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 ARTHROPLASTY -indications

 Disabling pain

 Functional limitations

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 ARTHROPLASTY-indications.
• Oteoarthritis or arthritis, which causes joint pain
that has failed to respond to conservative therapy
(NSAID medication for 6 months or more).

• Decreased joint function caused by arthritis

• Inability to work because of pain
• Inability to sleep through the night because of
pain
• Inability to walk more than 3 blocks because of
pain
• Loose prosthesis
• Fractures

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ARTHROPLASTY-indications.

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JOINT REPLACEMENT- HISTORY - PAIN

 Site
 Radiation
 Limiting activity
 Disturbing sleep
 Analgesics

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 JOINT REPLACEMENT- HISTORY -
FUNCTION

 Walking distance
 Walking aids
 Low chairs
 Foot care
 Stairs

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JOINT REPLACEMENT- EXAMINATION

 Gait
 Limb alignment
 Range of movement
 Stability
 Peripheral circulation
 Skin condition

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 JOINT REPLACEMENT-
INVESTIGATION
 X-ray - alignment
- deformity
- previous fractures and implants
- AVN
- osteophytes
- bone loss
 CT, MRI, bone scan - rarely

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JOINT REPLACEMENT

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JOINT REPLACEMENT

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JOINT REPLACEMENT

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 JOINT REPLACEMENT- IDEAL

 Painless joint
 Full range of movement
 Stable
 Permanent

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JOINT REPLACEMENT- IDEAL

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ARTHRITIS : Knee arthroplasty

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 JOINT REPLACEMENT -
HIP COMPLICATIONS

 Dislocation - 1%
 Loosening >90% 10y survival
 DVT / PE
 Infection - 1%

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 JOINT REPLACEMENT-
KNEE COMPLICATIONS

 Limited ROM
 Patellar instability 3-5%
 Loosening > 90% 10y survival
 DVT / PE
 Infection - 2%

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 JOINT REPLACEMENT-
WHAT TO DO OR NOT TO DO

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