Cervical Disc Replacement

The objective of Cervical Disk Replacement is to decompress nerves, give correct spine alignment and to maintain spine stability which is often caused by direct pressure from a herniated disc or degenerative changes in the cervical spine as seen with rheumatoid patients.

Artificial Disk Replacement (ADR)

Artificial disk replacement is a fairly new option and is comparable to hip or knee joint replacements, were the disk is replaced with a mechanical device, in this case an intervertebral disk in the spine.

This surgery will allow motion to continue once the degenerated disk is removed. It may restore the height between the vertebral bodies and widen the passageway through which the nerve roots leave the spinal canal. The artificial disk can alleviate pressure on surface joints and help to maintain the natural curvature of the cervical spine.

The small incision is made along the front  of the neck crease (or back depending on the type of neck problem), approximately 1 to 2 inches. The troublesome disk is removed and the artificial disc is put in its place. Made out of metal and/or plastic this implant will work just as the original did before damage.

Artificial disk replacement may not be a choice available for some patients, depending on the type and the location of the disc damage.

Risks

As with any surgery there are risks and they vary from patient to patient. Here are some of the potential risks for cervical spine surgery:

·       Infection

·       Bleeding

·       Injury to the nerves or spinal cord

·       Reactions to anesthesia

·       Symptoms still remain

·       Tear of the sac covering the nerves (dural tear)

Specific potential risks for the anterior cervical spine surgery and artificial disk replacement are:

·       Misplaced, broken, or loosened plates, screws, or implants

·       Soreness or difficulty with swallowing

·       Voice changes

·       Difficulty breathing

·       Injury to the esophagus

·       Hip pain at the site where the bone graft was taken

·       Failed vertebra fusion

All of these potential risks are rare, but do happen, and should be kept in mind when considering surgery.

After Surgery

Most patients are in the hospital 1 to 2 days after surgery and are able to get out of bed and walk and eat the first day. Each surgery is different as is each patient, so the recovery time will vary. Some patients may need to wear a soft cervical collar for the first part of the healing process.

Your doctor will want you to see a physical therapist after about 4 to 6 week to teach you the range-of-motion exercises necessary for regaining some of your neck mobility.  Most patients have returned to their normal lifestyle around 3 to 4 month after surgery. All though patients who are slow healers and those who have had spinal fusion may take up to 12 months to recover and return to their normal lifestyle.

The information on this Web site is for your general information only. You should always talk to your health care professional for diagnosis and treatment.

Finger Joint Replacement

Alfred B. Swanson, M.D., an orthopaedic surgeon and scientist from the USA, researched and created the first successful small joint implant that was approved for use in 1969. Since then, the field has opened up to several other manufacturers. Finger joint implants are made out of silicone. The goal of the original implant was to reduce pain and gain back 30-40% of movement. The newer joints are made to closely resemble the natural joint structure. This decreases the stress on the implant and increases its range of motion to a more natural movement.


The Surgery


The incision is made on the back of your hand over the joints, your old joint(s) are separated and the arthritic surfaces are removed. The remaining bone is shaped and a hole is drilled into the middle, then the new joint is fitted in place, and the surrounding tendons and ligaments are wrapped around the new finger joint tightly to protect and hold it in place. The joint is then tested for movement before the finger is closed and the finger is splinted or braced. The hand and wrist may be wrapped in a cast or large dressing depending on how many joints are replaced. The complete procedure takes about 2 hours and can be done under a local or general anaesthetic.







After Surgery


In order to prevent swelling and stiffness the hand is kept elevated for the first few days. If you had one joint replaced you most likely will be an out-patient, but if multiple finger joints were replaced you will be in in-patient for one night. Pain medication, as well as, antibiotics may be prescribed. Once the incision has healed, approximately 6 weeks, it is important to have physiotherapy to regain pain free movement of the finger.


Risks


1) Infection
2) Implant failure
3) Allergic reaction to the silicone


If you have any questions regarding finger joint replacement please talk to your doctor or an orthopaedic surgeon.

Shoulder Joint Replacement

There are two types of shoulder joint replacements; the conventional Total Shoulder Replacement surgery which has been around since 1950 in the United States and the Reverse Shoulder Joint Replacement Surgery which was approved by the FDA in 2004 and is used when the rotary cuff is also damaged. The goals of both shoulder replacement surgeries are to lessen pain and improve motion, strength and function. These shoulder replacements should last approximately 15 years.

 

The Surgeries

The Total Shoulder Replacement surgery is where the shoulder blade socket is replaced with a plastic socket and a metal ball replaces the ball at the top of the arm bone.  The Reverse Shoulder replacement surgery reverses this and put the metal ball on the top of the shoulder blade and the plastic socket at the top of the arm bone.  This allows the deltoid muscle to raise the arm instead of the weakened rotator cuff muscle. The surgeries take approximately two to three hours and are usually done under a general anesthesia.

After Surgery

Prior to surgery it is a good idea to see a physical therapist to receive some exercises to strengthen the muscles around the joint. Your hospital stay will be short, only 2-3 days. After surgery you will need to wear a sling to minimize movement for a few weeks. Your physical therapy will continue starting with range of motion exercises as the soft tissue heals and then you will gradually move on to strengthening exercises for your shoulder muscles.   Depending on the type of work you do you may need to take up to six months off to recover. Someone working in an office most likely can return to work after 2-3 months recuperation, where as a construction work would not be able to return to work until after 6 months of recuperation. It will take approximately six months before your shoulder will have completely recovered and the pain subsided. You will gain back most of your range of motion but not all.

Complications

Complications are rare but could include the following:  

• Unexpected reaction to the anesthetic
• Infection
• Excessive bleeding or developing a blood clot, usually in a vein in the leg
• Shoulder instability
• Tearing of the rotator cuff
• Fracture and loosening of the prosthesis
• Injury to nerves and blood vessels

Shoulder Joint Replacements surgeries are not preformed as often as hip and knee surgeries as they are not weight bearing joints, so they do not deteriorate as fast. Also, the majority of people are not aware that shoulder joint replacement is possible.  

Hip Joint Replacement

 Hip Joint Replacement

Hip joint replacement is one of the most successful and safest procedures in orthopaedic surgery performed today.  It is mainly done for people 60 or older and is rarely suggested for younger people because of the stress they can put on the replacement hip, causing it to fail sooner than anticipated. Osteoarthritis and rheumatoid arthritis are the main causes for a deteriorating hip joint, but other causes include bone tumors, injury and lack of blood supply causing loss of bone.

Hip Joint Replacement Parts

The hip joint is called a ball-and-socket joint since the spherical head from the thighbone moves inside the cup-shaped concave socket of the pelvis. To imitate this action, a total hip replacement implant has three parts: the stem, which inserts into the femur; the ball, which takes the place of the sphere-shaped head of the femur; and then the cup, which takes the place of the damaged hip socket.

The Surgery

With a total hip replacement surgeons operate from the side or the back of the hip. This extensively disturbs the joint and connecting tissues and necessitates an incision approximately 8-12 inches long. In contrast, the direct anterior hip joint replacement approach needs an incision that is only 3-4 inches in length at the front of the hip. Using this approach, the surgeon does not need to detach any of the muscles or tendons. Talk to your surgeon regarding which one is best for you.

Originally elephant ivories were used to make the artificial joint but now it is made from ceramic, metal or plastic. The operation in general is at least an hour; however the hospital stay depends upon the person's overall health but normally is between 3 to 5 days.

Risks

• Potential  blood clots in the leg
• Trouble with urination,
• Skin or joint infection,
• Bone fracture,
• Scarring and restricted hip movement,
• Loosening of the hip joint

After Surgery

To protect your hip after surgery, it is important that you do not sit past a 90-degree angle. To help with sitting, you will need a raised chair (use pillows or raised lifts for the legs of the chair) and a raised toilet (or a raised toilet seat attachment). This allows your hip to be at the same height or a little higher than your knee while sitting. An occupational therapist will show you how to dress, get in and out of bed and how to use a walker or crutches properly without hurting or dislocating your hip. At home you must continue your exercises to strengthen your leg and hip muscles.

Ankle Joint Replacement

 Total ankle replacement surgeries are on the rise due to implant improvements over the last 10 years. Previously only ankle fusion was available to those suffering from ankle pain often caused by trauma, chronic ankle sprain, rheumatoid arthritis and osteoarthritis.

Total Ankle Joint Replacement (ankle arthroplasty)

Ankle joint replacement involves removing both sides of the ankle joint and replacing them with specifically designed synthetic parts. The one that fits on the end of the tibia is made of a medical alloy covered with a long lasting medical grade plastic. The other is made of medical alloy and fits on top of the talus and slides against the tibia. These parts come in varies sizes in order to give the proper fit.   

The surgery takes a few hours and the patient will either be given a spinal anesthetic and a little something to help you relax or a general anesthesia which will put you to sleep.

Ankle Fusion

When performing an ankle fusion, the surgeon removes the damaged bone and cartilage between the tibia and talus bones and then fuses the two together using screws, plates and bone cement. When necessary a rod may also be used to help strengthen the joint as well. Mobility with an ankle fusion is never fully regained but the pain and discomfort is improved dramatically. 

Recovery

After surgery, the hospital stay will be for approximately 3-5 days depending on the support system the patient has at home. The foot will be in a cast for 4 to 6 weeks to protect the new ankle to keep it in the exact position and allow the bone to grow around the metal and cement. During this time the patient will use a walker or crutches and be able to do a little weight bearing. Gradually over the next few months with the help of a physiotherapist the ankle and surrounding muscles will become strong enough for full weight bearing.  Rehabilitation exercises, once the stitches have been removed and the incision has healed include bicycle and swimming therapy. Although it takes the ankle about a year to heal completely the patient should be able to return to their normal lifestyle within six months.  

 Risks Before, During & After Surgery

• Poor circulation in the leg
• Patients with diabetes
• Patients with nerve conditions of the leg
• Poor bone quality of the ankle possibly causing bone breaking during surgery
• Allergic reactions to medicines
• Breathing problems
• Blood clot infection
• Loosening of the artificial joint over time
• Ankle weakness, stiffness, instability dislocation of the synthetic ankle 
• Incision/ankle infection if severe may need the ankle amputated
• Joint allergic reaction to the synthetic joint

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 Which one is right for you?

The weighing in factors are your pre-surgery health, your lifestyle and your expectations after surgery. Ankle replacement does provide more normal movement, but the life span of the joint is only between 8-12 years and then the joint will need to be replaced again or fused depending on the damage done. Ankle fusion is permanent and does limit the range of motion. However it does add stress to other ankle/foot joints which in return may also need to be fused. The choice of total ankle replacement or ankle fusion or no surgery is a serious and complicated one. Be sure to discuss with your rheumatologist and orthopedic surgeon any concerns or questions you have. 

Knee Joint Replacement

The most common reason for people to require a knee joint replacement is chronic arthritis pain, often caused by osteoarthritis and rheumatoid arthritis. 



Most knee joint replacement surgery patients are over the age of 55, but if necessary surgery can be done at any age. The goal of knee joint replacement is to reduce joint pain, allowing increased mobility of the knee joint. The new ‘kneejoint replacement’ procedure is considered a great improvement compared to the less often used total knee replacement. There are several reasons for this. The newer knee joint replacement surgery is performed through an incision as small as 3 to 6 inches where as the total knee joint replacement requires a large incision (8 to 12 inches). The smaller incision often means less blood loss, less tissue damage, a shorter hospital stay (about 5 days), faster recovery, and much less scarring.

The Surgery

Surgeons make an incision over the front of the patella (knee cap), then the patella is drawn back out of the way in order to see the knee joint. The damaged surface of the end of the femur (thigh bone) and the top of the tibia (shin bone) are removed. The prosthesis is then placed and, using bone cement, is cemented to the ends of the bones. The surgery is often completed under general anaesthesia, but may also be completed with a spinal or epidural aesthetic and can take from one to three hours. The combined method is often used in order to give better pain relief.



Both knees (bilateral) can be replaced at the same time if required, as long as the patient has no other major health problems such as heart disease, severe asthma, etc. When bilateral knee surgery is completed, usually a longer stay in hospital is required. Out-patient physiotherapy is a vital part of the joint replacement program. You will need the  medical equipment to accommodate sitting, such as an elevated chair and commode, after the surgery. Some patients may need in-home care if they do not have someone available to assist them in their daily activities, or take them to doctor or physiotherapy appointments etc.

Complications

1. Post-surgical loosening of the implants
2. Infection ina joint that has been replaced
3. Blood clots in the legs (deep vein thrombosis) – this risk increases with the condition of your veins pre-op and the time staying in bed post-op.

If you have any pre or post operative concerns please contact your surgeon or general practitioner. In over 90% of cases, knee joint replacement is complication-free and gives considerable pain relief with improved mobility.

Joint Replacement

Do you have chronic joint pain? Do your joints click, click, click every time you move? If you answered ‘Yes’ to these questions it is possible you may need a joint replacement.

Joint replacement is one of the most impressive achievements in the history of orthopedic surgery.

Presently more than 750,000 hip and knee surgeries are performed every year. Joint replacement is an elective surgery and commonly used for hips and knees. Over the last 50 years, many great improvements have been made in the design, manufacturing, and implantation of man-made hip joints, giving an increased percentage of successful long-term outcomes. With all the improvements made to joint replacement implants most are estimated to last a approximately 15 years.

Options before Surgery

Your doctor will try a variety of medications most often including anti-inflammatory medications (aspirin or ibuprofen), gold shots, Methotrexate, Imuran and natural substances like glucosamine & chondroitin to ease pain and reduce swelling around the joints prior to surgery being considered. it is often recommended that patients use a cane/walker while walking, decrease physical activity, lose weight if necessary, join a water exercise program and do range of motion exercises. If the pain and swelling does not significantly decrease joint replacement may be the only option.

During & After Surgery

Orthopedic surgeons can replace a painful, dysfunctional joint with metal alloys, high-grade plastics, and polymeric materials making a very functional, long-lasting prosthesis. During the surgery the patient will be under general, epidural or spinal anesthesia. After surgery patients stay in the hospital for three to seven days resting and working with a physical therapist and an occupational therapist to regain their strength and mobility and to learn how to protect their new joints from unnecessary wear and tear.

Risks

With every surgery there are risks and possible complications. If you have a disease that interferes with blood clotting or if you have any lung, heart or kidney problems you may be at risk undergoing general anesthesia. Other things to think about are your physical condition before surgery, how bad your arthritis is, and what joint replacement surgery you'll be having.  Nerves in the area of the total joint replacement could possibly be damaged during the surgery. But this is rare and the nerves often improve over time and may completely recover. If you have concerns do not hesitate to talk to your surgeon or your anesthesiologist.

Joint replacement surgery is on the increase and can be attributed to baby boomers who would like to keep an active lifestyle. Also young athletic patients who repetitively injure their joints are experiencing an earlier onset of osteoarthritis that impacts their daily lives which in return will result in more joint replacement surgeries.