Total Joint Replacement Surgery

Why do you need joint replacement surgery?

Most often, arthritis is the primary cause for problems with hips and knees.

• Osteoarthritis: OA is the most common form of arthritis. Symptoms usually occur after age 50 as a result of daily wear and tear to the joints over the years. People with obesity are at higher risk, as are those with a family history, previous surgery to the joint or previous injuries in the joint area.
• Rheumatoid Arthritis: RA is a chronic inflammatory disorder affecting joints that have synovium (a tissue lining the joints). Those joints are the hip and knee, as well as the shoulder, elbow, wrist, hands and feet. This disorder is likely caused by cells produced by the body that irritate the synovium, leading to cartilage destruction around the joint. Rheumatoid arthritis may develop at any age, and can leave the joint stiff, swollen or painful, and can decrease the range of motion in the joint.

Arthritic Knee	Arthritic Hip

Total Hip Replacement Surgery

A normal hip joint is composed of two bones, the round head of the femur (the ball) and the acetabulum (the cup or socket in your pelvis), which are coated with smooth cartilage for easy, pain free movement. This smooth articular cartilage is deteriorated in an arthritic hip, causing pain and decreasing range of motion due to the bones rubbing against one another.

Healthy Hip	Arthritic Hip

During hip replacement surgery, an artificial joint with a metal ball component (which attaches to a stem that fits into your thigh bone) and a socket component will replace your deteriorated hip. A plastic liner may or may not be used depending on your age. This liner has an outer metal shell that is secured to your pelvis. Once replaced, your artificial hip joint will work in the same way as your natural hip.

Artificial Hip

Hip Resurfacing

Hip resurfacing is a new conservative surgical procedure to total hip replacement. This procedure has been used overseas for many years. The procedure resurfaces, rather than replaces, the end of your femur (thighbone). Resurfacing preserves the bone stock on both the femoral head and neck as the surgeon reshapes the damaged joint but does not cut the natural bone of the femur. Both sides of the joint are fitted with metal prosthetics which are larger than the traditional total hip replacement prosthetics. At NMC, the Birmingham Hip™ Resurfacing System is used.

The benefits of hip resurfacing are the preservation of bone and the use of prosthetics which are almost identical in size to the natural hip. The larger diameter ball and neck allow greater range of motion in the hip and minimize the risk of joint dislocation.

Hip resurfacing is intended for young, active adults under the age of 60 or older adults with good bone quality. Your orthopedic surgeon will determine if hip resurfacing is appropriate for you. Some types of arthritis result in deformity of the head or neck of the femur and hip resurfacing is not an effective intervention.

Total Knee Replacement Surgery

Normal knees have smooth cartilage which covers three bones making up the knee: 1) the end of the femur (thigh bone), 2) the top of the tibia (shin bone), and 3) the patella (knee cap). This cartilage, which cushions the bones and allows for easy movement, is worn away in arthritic knees, causing the bones to rub against one another. This action produces pain, muscle weakness, and a decrease in the range of motion of the knee. During a total knee replacement, the bones undergo a resurfacing in which metal components are cemented to their ends and a plastic liner is inserted between them. Once in place, the metal component and the plastic liner allow for smooth, normal motion of the knee. This new alignment can also generally correct bow leg or knock knee deformities.

Healthy Knee	Arthritic Knee
Total Knee Replacement

Minimally Invasive Surgery

Minimally invasive surgeries are surgical techniques designed to work through smaller incisions which will result in less tissue trauma and blood loss. In orthopedic surgery this will generally mean less cutting of key muscles and tendons. As a patient recovering from MIS, you will spend less time in the hospital with a shorter rehabilitation period and speedier time to an active lifestyle.

At Northwest Medical Center our Orthopedic surgeons complete both minimally invasive total knee and total hip replacement surgery. Patient that require hip or knee revisions are not candidates for MIS. Your surgeon will determine if you're a candidate for MIS and discuss the risks and benefits with you. The advantages of MIS are decreased blood loss, decreased trauma to the tissue surrounding the joint, shorter length of stay and a speedier return to completing activities of daily living. Traditional total hip replacement patients must adhere to "hip precautions" to avoid hip dislocation, however patients undergoing MIS hip replacement often have no precautions whatsoever and are free to move as they would like. Your surgeon will inform of the need for hip precautions as needed post total hip replacement.

MIS total hip patients generally have a two to two and a half day in-patient hospital stay. They are seen by physical therapy on the day of surgery and are up and walking on the 2nd post operative day.

Computer Assisted Surgery

Computer assisted surgery (CAS) allows your surgeon to better align the surgical joint to improve overall function of the joint with the use of computer assisted technology. CAS is an anatomical tracking system that gives the surgeon a detailed, three dimensional view of the joint and implant specific to the patient's anatomy. It is used as an alternative to free-hand joint replacement. The guidance of CAS may improve the alignment in joint replacement especially for patients that undergo minimally invasive surgery with smaller incisions.

Infrared sensors placed on surgical instruments reflect signals of their precise location to a computer, which combines the pre-operative image to produce a map of the joint. The map of the joint imparts valuable information to the surgeon throughout the procedure and provides better visualization of the anatomy. The surgeon is provided with an exact location to make the cut and place the implant.

CAS improves the stability and range of motion of the joint with precision placement of the implant and reduced risk of revision.

Partial Knee (Unicondylar) Replacement

If arthritis has only damaged one side of the knee joint, surgeons can use a smaller incision and only resurface the one side of the affected joint, leaving the other side untouched. This preserves the anterior cruciate ligament (ACL) and allows for more normal motion of the knee with a lower incidence of stiffness.

Partial Knee (Unicondylar) Replacement