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Orthopedics is a surgical specialty that studies and treats pathology of the musculoskeletal system, bones, muscles and joints, from where the spinal column and the head is excluded. It treats two large groups of pathology; Degenerative pathology, resulting from joint wear due to aging or destructive inflammatory conditions (ex-rheumatoid arthritis); Traumatic pathology which is then divided into two large distinct groups: in a young person a traumatic injury caused by an accident, road, work or sports; in older patients, resulting from fractures in fragile bones such as proximal fractures of the femur, which are severe and very frequent.
Degenerative diseases predominantly affect the joints that support the weight of the body, especially the knees and hips resulting in arthrosis. Increase in the frequency of these two pathologies results mainly from the improvement in the life expectancy in developed societies. This has resulted in people living beyond that to which these joints are naturally prepared, especially if they are subjected to excessive loads.
Basically, arthrosis of the femoral bone and / or the knee results from the wear of the layer of the cartilage that covers the surface of the joint bones. This cartilage permits the joint to move smoothly with minimal friction and without pain. When this cartilage is worn down the bones rub together, this will then cause pain. Because science has not as yet been able to come up with the means to regenerate this cartilage, surgery is the only alternative. The joint are replaced by prosthesis which will enable the joint to move smoothly and painlessly. This type of surgery is called hip or knee arthroplasty.
Orthopedics is the surgical specialty with the greatest diversity as far as surgery is concerned. Orthoapedic surgery is by far the most rewarding interventions for both the patient and the surgeon, due to the excellent results statistic results. Artroplasty of the Knee was responsible for the only Nobel Prize in Orthopaedics having been attributed to the Orthopaedic Surgeon Sir John Charnley.
As already mentioned the dominant symptom of these pathologies is pain, worse in the first steps after a period of rest, which improves with movement and becomes particularly intolerable when it begins to interfere with sleep. Other signs and symptoms are crepitation, deformity, and increased joint volume which results in the patient seeking an orthopaedic surgeon. The key examination for diagnosis is a simple X-Ray.
Once a diagnosis is reached, the next step is to decide when the surgery should take place. The general idea is the later the better, within reasonable limits and according to the patient’s age, the pain level, the disability and interference in daily activities. The patient has to be aware that the implant is mechanical, subject to wear and tear, this depends, among many other variables, on the number of cycles to which it will be subjected to. If necessary it can be replaced with another implant known as revision surgery. The components or part thereof are replaced. The survival rate of primary implants is currently over 90% at 15 years.
Once the patient is aware of these facts it is the patient who determines the date of the surgery. This intervention lasts approximately 1 hour, with an average hospitalization of 5 days, in which the patient gets out of bed the following day, and discharged from hospital when he has acquired autonomy enough to walk with crutches. The rest of the recovery is done at home, with or without the help of physical therapy, which is more necessary in knee replacement surgery rather that hip replacement surgery. On average the patient can expect to walk without aid after 2 months.
Surgery without complications and with guaranteed results does not exist, not even the simplest ones. These complications depend on many factors related to the patient himself, surgical technique, hospital environment and even after discharge from hospital. Of all these the most feared are in fact infection, which fortunately occurs in a small percentage of cases, 1 to 2%, but when it occurs it usually requires one or more surgical interventions with a total or partial replacement of the implants.
Another complication relates to the instability of the implant, especially in the hip, resulting in the dismantling of the new joint. Pain of unknown cause, which persists and the cause is not detected, either clinically or radiologically. There might be other complications, but they are less relevant.
Both the Total Hip and Knee Replacement surgeries restore quality of life for the patient, permitting them to resume their daily living leisure activities pain free. Their success depends largely of the experience of the hospital team, surgeon, anaesthetist, nursing and physiotherapist.
The object is to relieve pain, increase the patient’s mobility and improve functionality in everyday tasks. The injured joint is removed and replaced with an artificial implant. A hip prosthesis may be total or partial. A hip prosthesis may be total or partial. A partial prosthesis is performed on hip fractures. A first time surgery is known as “Primary Surgery” and subsequent replacements are known as ”revisions”.
As hip replacement surgery is becoming more and more common revisions of prosthesis are also becoming more common.
The standard incision size for conventional surgery is between 25 and 15 centimetres. At the moment incision can measure less than 15cm. The size of the incision is determined by the surgeon and also by the patient's physical condition.