Surgeries for Arthritis
Although there are various treatments for arthritis
and rheumatism, even if the treatment does not cure the disease and the patient
continues to suffer from pain, they may need to have joint surgery. Removal of
unwanted affected areas in the affected joint and repair of the joint. If the
joint is severely affected, the joint is removed and a prosthesis is used to
replace the joint.
If the synovial membrane of the joint is affected, it
can be surgically removed and the joint repaired. (Eg.) The arthritic femoral
head is removed, and replaced with a metal ball. The ball has a metal stem,
which is anchored, into the hollow space inside the femur bone with bone
cement. The worn-out socket is replaced with a plastic socket.
Joint
replacement surgery for chronic joint damage:
·
Physicians will thoroughly examine
the patient’s body prior to performing joint replacement surgery. After that
various blood test, urine test, x-ray, ECG test will be done.
·
In this way the general health of the
patients will be examined. As well as does the patient have diabetes? Have
blood pressure, heart disease? Is there anemia? Are there any other
vulnerabilities? Will know. If these diseases are present, surgery can only be
done if these diseases are properly treated and controlled.
·
If the body is weak, they will not be
able to bear the surgery for a long time. After selecting patients for this
joint replacement surgery, they will be operated on under general anesthesia.
Anesthesia:
General anesthesia – General anesthesia affects the
whole body. In this the patient knows nothing about the operation taking place.
Local anesthesia – Local anesthesia numbs a small part
of the body.
Surgical
procedure:
After giving anesthesia the patient is placed supine
positioning on the OR table. Equipment will be fitted to monitor the patient’s
various movements such as pulse and breathing. Glucose, antibiotics are also
injected through intravenously. Various other medications can also be injected
intravenously as needed.
The hairs around the affected joint of patients are
removed and cleaned. After cleaning the area thoroughly with various
disinfectants, wrap a clean, sterile cloth around the joint. The blood vessels
coming to the joints should be compressed to prevent blood flow to the joints.
This makes surgery easier and reduces blood loss.
First, the orthopedic surgeon makes an incision in the
knee and moves the patella to the side. The upper, lower and bony parts of the
most affected joint are removed. Next, the two menisci between the femur and
tibia are removed, as are the anterior cruciate ligament and, in some cases,
the posterior cruciate ligament.
During the main phase of the operation, the surgeon
cuts and remove cartilage and some bone from the upper part of the tibia and
lower sections of the femur. The femoral sections removed are two knobby
protuberances called the femoral condyles. The tibia and femur are then be
capped with prosthetic implants to create new surfaces for the joint. So that
when metal implants are fitted to these two bones they will have to be drilled
in these two bones.
After fitting
the two synthetic parts, a liquid solid material called bone cement called
polymethyl methacrylate is placed between the two parts. This also helps to
close the hole made in both bones. A cemented knee replacement requires the use
of fast-drying cement for the prosthetic components to adhere to the natural
bone.
Femoral component – Metal piece that caps the end of
the femur and has a groove which allows the knee cap to move up and down as the
knee bends and straightens.
Tibial component – Flat piece of a metal with a
plastic that covers the top of the tibia.
Patellar component – Dome-shaped piece of plastic that
allows it to glide.
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The incision will be closed with stitches or surgical
staples. A drain may be placed in the incision site to remove fluid. A sterile
bandage or dressing will be applied.
After
the procedure:
·
If the patient’s blood pressure,
pulse, and breathing are normalized and the patient is alert, the patient will
be taken from the recovery room to the hospital room.
·
It is important to begin moving the
new joint after surgery. A continuous passive motion machine may be used to
begin the physical therapy. Physiotherapist will meet with the patient after
surgery and plan an exercise program for the patient. Rehabilitation will begin within 24 hours of surgery.
Knee
replacement exercise for pain and inflammation:
Heel
slide:
Lying flat on your back on the floor, keep the legs
flat. Then, slide the left heel up towards the bottom until the knee is bent at
least 90 degrees. Then, slide the left heel and leg back down to lie flat on
the floor. Repeat the right leg.
Step-ups:
Step-ups are a functional exercise that strengthen the
muscles that support the knee, including the quads, hamstrings and calves.
Start with a lower step, around 4 or 6 inches, then progress to taller steps as
your strength increases.
·
Stand tall on both feet near a chair
or railing for balance.
·
Shift the weight to the leg that
didn’t have the knee replacement and step up with the knee replacement leg.
·
Pressing into the foot on the stair,
step the other foot onto the stair.
·
Slowly let your non-knee replacement
leg lower back down to the ground.
·
Repeat 10 times. Do 3 sets.
·
Repeat on the other side as well.
Knee
push-downs:
Lie on the back with a towel rolled up and placed
under the ankles. Press the knees down toward the floor by tightening the
muscles on the front of the thigh. Hold for five seconds, and repeat 20 times.
This exercise helps to build quad strength, and it also improves knee extension
and range of motion.
Leg
raises (Exercise for strength):
To strengthen the knee and quadriceps, simply sit in a
straight chair. Keep the legs at 90 degrees, then lift the right leg straight
out, keeping the toes flexed to the sky. Hold for five seconds and then lower
the leg slowly. Repeat on the left side.
v
Pain is controlled by medication so
that the patient can participate I exercise.
v
The patient will be given an exercise
plan to follow both at the hospital and after discharge.
v At home:
To help reduce swelling, patient may be asked to
elevate the leg or apply ice to the knee.
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