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Arthroplasty (Hip – Knee – Shoulder Replacement)

Total Hip Arthroplasty

It is a surgical procedure where the damaged hip joint is replaced with an artificial one in patients with a severely damaged hip joint secondary to various factors. Total hip arthroplasty is one of the revolutionary procedures both in orthopedics and in the field of medicine. Novelties that are such successful in boosting the quality of patients’ lives are very unique. Number of patients who need joint replacement and the ratio of young patients in this population increase every day. This modality ensures correction of movements in problematic hip and elimination of pain. A hip prosthesis consists of main parts produced from cobalt-chrome or titanium and from polyethylene, metal or ceramic inserts at joint points of the main parts. The correct time to implant the prosthesis is dictated by age and gender of the patient, the pain and the functional capacity.
However, it is necessary to keep in mind that as is the case with all prosthesis surgeries, total hip arthroplasty is a surgery that boosts comfort of life rather than an absolutely indicated procedure, excluding limited conditions.

A hip prosthesis is placed into the bone in two ways. The prosthesis is fixed to the bone with a filling material called “bone cement” for elderly patients with weak bone structure. For younger patients with stronger bones, the prostheses covered with a porous material are placed inside the bone very tightly and then they are tightly fixed to the bone through those pores and thus, the union is achieved.
Total hip prosthesis can be considered for patients with hip pain persisting despite resting, medications, physiotherapy or intra-articular injections or patients who have severe destruction in the articular cartilage and suffer from severe limitation in activities of daily life, such as walking and ascending stairs. The patients are generally older than 60 years of age, but, prosthesis can be placed in younger ages to treat post-traumatic arthritis, rheumatoid arthritis, osteonecrosis and femoral neck fractures.

The aim of total hip replacement (THR) is to eliminate the pain and boost the functions. A successful surgical technique employed in correct indications is the basis of good-perfect outcomes in total hip replacement practices. Moreover, the implants that are produced with suitable materials and have good design characteristics increase the success of THR. Today, many prostheses with different materials and designs have been developed.

Survival of the prosthesis and success rate of the surgery substantially improved in THR surgeries thanks to advancements in implant technologies. On the other hand, prosthesis surgery poses certain risks, as is the case with all surgical procedures. . The most significant ones are infection, laxity, migration of blood clot from veins of legs to the lungs and early removal of the prosthesis. Although the risk is below 1 percent, it cannot be zeroed despite all preventive measures.

The parts that form the total hip prosthesis wear out in time due to friction. The response of the body to the pieces that occur due to wearing out and that are too small to be seen with naked eye can detach the prosthesis from the bone, resulting in laxity. Today, the useful life of the prosthesis has pronged to 15 to 20 years thanks to developing prosthesis technology and use of appropriate surgical technique.

 

Total Shoulder Replacement

This type of shoulder prosthesis is implanted to eliminate the pain, regain the range of motion and boost the quality of life for the patients who suffer from pain and limited movements secondary to arthrosis in shoulder joint (degeneration of cartilage, calcification). In fact, shoulder joint is the most mobile joint in the body and it is known as spherical joint. The aim of total shoulder replacement surgery is to regain the normal shoulder functions and eliminate the pain. Prosthesis surgery is an effective, safe treatment method that is preferred when the pain worsens, patients wake up at night due to pain, patients cannot do the normal daily life activities and cannot use their arms. The pain is usually induced by movement at first while pain which also develops during rest and even wakes up the patient at night develops. As damage in cartilage progresses, swelling and loss of function develops in the joint. For progressive cases, the movement ability of the joint may be totally lost. The problematic shoulder can be completely or partially removed and an artificial joint is formed to replace it with this surgery.

The most important factor affecting the functional status of the patient is the preoperative status of muscles and connective tissue. If the condition is good, the patient will restore the function far easily. This is the most important difference between shoulder prosthesis and hip and knee prostheses.
However, it should be known that as is the case with all prosthesis surgeries, total shoulder replacement procedures are not “absolutely indicated” surgeries; they are performed to “ensure a comfortable life”.

Reverse shoulder prosthesis is one of the other prosthesis alternatives for a problematic shoulder. The patients who are undergone reverse shoulder prosthesis surgery have tear in muscles, called rotator cuff that moves the shoulder along with the arthrosis in shoulder. Tear of the rotator cuff leads to both pain and remarkable limitation in the range-of-motion of the shoulder. Design of the reverse shoulder prosthesis enables the prosthesis undertake functions of these muscles; it alleviates the pain and eliminates the limited movement in the shoulder. It is usually a good option for patients with arthropathy and rotator cuff tear, who are older than 70 and have low functional expectation.

While reverse shoulder prostheses are used for arthropathy of rotator cuff tear, it gained field of use also in shoulder arthroplasty revisions, shoulder involvement of rheumatic diseases, following resection of tumor and multi-fragment fracture of proximal end of the humerus. It does not only create a solution for pain, but it also changes the rotation center of the shoulder and thus, active anterior flexion and abduction of the shoulder are performed by the deltoid muscle.

Survival of the prosthesis and success rate of the surgery substantially improved in all shoulder arthroplasties thanks to advancements in implant technologies. On the other hand, prosthesis surgery poses certain risks, as is the case with all surgical procedures. The most significant ones are infection, laxity and early removal of the prosthesis. Although the risk is below 1 percent, it cannot be zeroed despite all preventive measures.

Total knee prosthesis

This surgery is performed to alleviate pain and boost quality of life in patients who suffer from severe pain and limited movement secondary to the arthrosis of the knee (degeneration of the cartilage, calcification) due to various reasons. In this surgery, the worn or damaged knee joint is replaced by an artificial joint made of specially manufactured polyethylene and metal in a surgical procedure. Total knee prosthesis (knee replacement, knee arthroplasty) is a safe treatment option frequently preferred and successfully performed by orthopedists when other treatment options do not help the patient. Total knee arthroplasty is one of the most promising procedures among the orthopedic surgeries, if basic surgical principles are strictly followed.

However, it is necessary to keep in mind that as is the case with all prosthesis surgeries, total knee arthroplasty is a surgery that boosts comfort of life rather than an absolutely indicated procedure, excluding limited conditions.

The aim of the total knee prosthesis is to eliminate pain, restore movement and correct the deformity. The correct time to implant the prosthesis is dictated by age of the patient, the pain and the functional capacity. Success of the surgery is based on knowledge and experience of the surgeon, operating theater conditions, appropriate patient selection and postoperative care.

Total knee prosthesis can be considered for patients with knee pain persisting despite resting, medications, physiotherapy or intra-articular injections or patients who have severe destruction in the articular cartilage and suffer from severe limitation in activities of daily life, such as walking and ascending stairs. Patients are usually older than 60, but knee prosthesis surgery can be performed at a younger age in case of trauma-related arthritis, rheumatoid arthritis or osteonecrosis.

A successful knee arthroplasty can be ensured through proper selection of patient and prosthesis and replacement of the articular surface with correct incision and good surgical technique. This is dependent on detailed preoperative examination of the patient and a good preoperative preparation.
Survival of the prosthesis and success rate of the surgery substantially improved thanks to advancements in implant technologies. On the other hand, prosthesis surgery poses certain risks, as is the case with all surgical procedures. The most significant ones are infection, laxity, migration of blood clot from veins of legs to the lungs and early removal of the prosthesis. Although the risk is below 1 percent, it cannot be zeroed despite all preventive measures. Today, prosthesis can be used up to 15 to 20 years due to advanced prosthesis technology and use of appropriate surgical technique.

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