Joint Replacement

Joint replacement is a radical treatment for many joint pathologies. These operations are mostly performed for arthrosis. They are less often performed for inflammatory diseases, injuries, tumors, congenital underdevelopment of the joints. Modern types of endoprostheses can last for decades. If necessary, they can be replaced during the revision surgery.

You can travel abroad to get the replacement surgery done safely, with better functional outcomes. Booking Health will organize your trip. Feel free to visit our website where you can find the cost of treatment in different hospitals in order to book a medical care program at an affordable price.

Content

1. Hip replacement surgery
2. Knee replacement surgery
3. Shoulder replacement surgery
4. Ankle replacement surgery
5. Elbow replacement surgery
6. Treatment in European hospitals with Booking Health

Hip replacement surgery 

Hip replacement surgery is the most common operation not only in endoprosthetics, but also in orthopedics in general. The doctor removes the patient's own joint and replaces it with the components of the endoprosthesis.

Types of joint replacement:

• Subtotal (partial) joint replacement  is the replacement of only the femoral component. Surgeons implant a part of the artificial joint that recreates the proximal portion and the femoral head, but it rotates in the patient's own acetabulum. Such surgical procedures are usually performed by surgeons for a femoral neck fracture.
• Total joint replacement is the main treatment option for coxarthrosis. This surgery is also performed for hip dysplasia, bone tumors, severe inflammatory diseases and other pathologies. Surgeons perform total hip replacement more often than partial one.

A total hip prosthesis consists of a femoral and pelvic component. An artificial hip is a leg that mimics the proximal part of the femur, the neck and head – it fits into the acetabulum of the pelvic bone. The second component is the pelvic component. It is a cup with a polyethylene liner inside. It softens the friction of the endoprosthesis components and prolongs its service life.

The hip endoprosthesis can be implanted using either cement or cementless fixation techniques. As a rule, the cementless method is used. The endoprosthesis component is pressed into the bone and fixed with screws. The cement method involves "gluing" the artificial joint using a special solution. The method allows a person to recover faster. Cement is more often used in patients over 85 years of age with concomitant diseases and osteoporosis.

By the number of operations performed, hip replacement surgery can be: 

• Primary – a surgical procedure that is performed for the first time.
• Revision – a repeated surgical intervention that is performed due to complications or wear and tear of the endoprosthesis. 

The two main reasons for revision surgery are infectious complications and aseptic loosening of the endoprosthesis. In the first year, infectious causes dominate. They are more difficult to treat. In 85% of cases, the infected endoprosthesis must be removed. Some patients require multiple surgeries, as a new prosthesis usually cannot be implanted immediately after the old one is removed.

But the main reason for the revision surgery is the loosening of the endoprosthesis. The repeated operations are usually performed many years after the first joint replacement surgery. In 60% of cases, the doctor replaces only one of the two components of the artificial joint, in 40% of cases, both have to be replaced at once.

Hip replacement surgery is the most successful surgery in arthroplasty. It is effective in over 90% of cases. In the best hospitals in the world, the efficiency of such surgical procedures exceeds 98%. Few patients will require revision joint replacement surgery in the future.

The doctors abroad successfully perform hip replacement surgery even in the most difficult cases, including post-traumatic coxarthrosis with significant acetabular deformation. Even if the patient is unable to find a suitable endoprosthesis, it is made individually using a 3D printer.

Knee replacement surgery 

Knee replacement surgery is a technically more complicated operation. The artificial knee must be positioned very precisely. Otherwise, the endoprosthesis will quickly wear out, and it will have to be replaced with another one.

Knee replacement surgery can be either unicompartmental or total. The unicompartmental one is used less often, but if possible, doctors opt for it. With partial replacement surgery, the doctor replaces only half of the knee. Such operations are more sparing and the cost of treatment is lower. The patients recover faster, the prosthesis lasts longer, and knee movements are more natural.

Nonetheless, most patients with gonarthrosis have to resort to total knee replacement. Three types of prostheses can be used for this operation: 

• Constrained. 
• Unconstrained. 
• Partially constrained. 

Doctors always prefer unconstrained endoprostheses. They are more reliable, functional, and have a long service life. However, the implantation of such prostheses is possible with the preservation of the patient's own ligamentous apparatus.

In most cases, surgeons abroad implant mobile-bearing platform endoprostheses. They provide the best knee functionality. In addition, such artificial joints are more resistant to physical stress. They wear out more slowly in young, physically active patients.

Less commonly, fixed-bearing platform artificial joints are used. They provide better knee stability. However, they also have some disadvantages: less range of motion and low resistance to stress. Therefore, these types of endoprostheses are usually implanted in elderly patients with low physical activity.

If unconstrained prostheses cannot be used, partially constrained prostheses become an option of choice. They can come both with replacement and preservation of the posterior cruciate ligament. Both types of prostheses have a long service life, but the preservation of the posterior cruciate ligament is preferred. Studies have shown that it increases the ten-year survival rate of the endoprosthesis from 77% to 90%.

Constrained prostheses are used only as a last resort. The doctors implant them with a completely destroyed joint and bone deficiency. They can be used for revision knee replacement surgery. There are two main types of constrained endoprostheses: rotating hinge and pure hinge. The first ones are more functional, since the pure hinge ones provide only flexion and extension of the leg, without the possibility of lower leg rotation. Any constrained endoprostheses wear out faster than unconstrained ones.

When performing surgery to implant artificial knee joints, surgeons abroad use computer-assisted navigation. It provides very precise implantation of components: with an error of up to 0.1 mm and 0.1 degrees. As a result, doctors manage to achieve a minimum deviation of the biomechanical axis of the lower limb, which prolongs the life of the endoprosthesis. With computer-assisted navigation, the risk of aseptic loosening within 8 years can be reduced by 8 times.

Shoulder replacement surgery 

Primary arthrosis of the shoulder joint is rare. In most cases, it is the result of injury or long-term repetitive microtrauma. Whenever possible, doctors conduct conservative therapy for the disease. There are also organ-preserving surgeries that can improve shoulder function and relieve pain. Arthroscopic interventions can be used to remove inflamed areas of the synovium, bone and cartilaginous growths, chondromic bodies, and to perform cartilage resurfacing.

If the possibilities of drug therapy and organ-preserving surgery have been exhausted, but the desired result has not been achieved, doctors resort to joint replacement surgery. This can be:

• Partial – the replacement of only the proximal part of the humerus.
• Total – the replacement of not only the head of the humerus, but also the glenoid cavity of the scapula.

Partial shoulder replacement is used in 40% of cases. This operation is less traumatic, and the patient recovers quickly after it. The wear and tear of the artificial joint is very slow. But there are also disadvantages: shoulder function is not always fully restored, and joint pain may persist. In the future, arthrosis may progress, which will damage the scapula and require revision surgery.

Total shoulder replacement is performed in 60% of cases. The advantages of the operation are better function of the joint and complete absence of pain. This type of surgery allows doctors to cope with even the most severe cases of arthrosis.

Options of total joint replacement:

• Anatomical – performed in 90% of cases.
• Reverse – 10% of cases.

Anatomical joint replacement involves the implantation of an endoprosthesis that resembles the patient's own joint: a flat artificial cavity of the scapula and a spherical head of the humerus. 

Reverse joint replacement is used in patients with damaged tendons of the rotator cuff muscles. This type of prosthesis has a spherical shoulder blade and a flat shoulder. After the implantation of such an artificial joint, the deltoid muscle takes over the main function of its rotation.

Ankle replacement surgery 

The ankle joint has complex biomechanics. Its replacement is used relatively infrequently.

Ankle arthrosis is usually caused by injuries. Whenever possible, it is treated with conservative therapy: drugs, orthoses, physiotherapy, therapeutic exercises. When the possibilities of treatment have been exhausted, doctors resort to radical surgery. However, joint replacement is not considered first-line surgery. Doctors often perform arthrodesis – the leg is simply fixed in one position, and the ankle joint is forever bent at an angle of 90 degrees.

But arthrodesis has several disadvantages: 

• Limb immobilization period up to 3 months.
• Insufficient functional effect, which especially interferes with fast walking or running.
• Rapid wear and tear of other joints of the lower limb: primarily the joints of the foot, sometimes the knee and hip joints also suffer. 

Ankle replacement surgery is technically challenging and it is performed relatively rarely. However, surgeons in Europe perform about 3,000 such operations every year, while 1,500 of them are carried out in Germany. There is a tendency to an increase in the number of interventions, as new types of endoprostheses appear – they are more reliable, with a service life of 10-20 years.

Ankle replacement surgery results in complete pain relief and restoration of the normal biomechanics of the lower limb. But prostheses wear out faster than artificial hip or knee joints. The wear and tear occurs especially quickly in young, physically active patients. Therefore, ankle joint replacement is preferable in elderly people who have a normal body weight, do not play sports and do hard physical labor.

Elbow replacement surgery  

Primary elbow arthrosis is an extremely rare disease. In most cases, arthrosis is of secondary origin. The joint is destroyed as a result of the trauma suffered.

Here are the most common indications for elbow replacement: 

• Improperly fused or non-fused intra-articular fractures.
• Severe injuries, in which the use of osteosynthesis is futile.
• Pseudoarthrosis. 
• Development of post-traumatic arthrosis in separate periods after elbow injury – the joint can collapse even after a minor injury.
• Rheumatoid arthritis.

Since the reason for replacing the elbow joint is usually injuries, their complications, immediate and long-term consequences, such operations often have to be performed in young patients. In about 25% of cases, elbow replacement is performed before the age of 40.

When deciding to replace an elbow, the doctor must repeatedly weigh the pros and cons. This is an extreme method that is used only if other treatment options are ineffective or unpromising. The problem is that elbow replacement surgery is not as successful as hip, knee, or shoulder replacement. In the best case, an artificial prosthesis lasts 15-20 years, and then it needs to be replaced again.

When performing elbow replacement surgery, the doctor removes the patient's own bone tissue. Most patients need two components to be replaced: the elbow and the shoulder. Less often, the head of the radius has to be replaced.

Elbow replacement surgery is technically difficult. This is due to the fact that in 2 out of 3 patients, the intervention is performed for traumatic joint damage. At the same time, the doctor has to perform many other manipulations: plastic repair of tendons and soft tissues, removal of bone fragments. The accurate and secure placement of the endoprosthesis components is very important in order to avoid early loosening.

In foreign countries, even such a complex operation as elbow replacement provides good or excellent results in 90% of patients. Their pain completely disappears, the elbow joint is stabilized, and the full range of motion is restored.

Treatment in European hospitals with Booking Health

To undergo treatment in European hospital, please use the services of Booking Health. On our website, you can see the cost of treatment in different hospitals, compare prices and book a medical care program at an affordable price.

Please contact the Booking Health specialists to undergo treatment in European hospital. Here are our benefits for you: 

• We will choose the best European hospital whose doctors specialize in joint replacement surgery.
• We will help you overcome the language barrier, establish communication with your attending physician. 
• We will reduce the waiting time for the start of the medical care program and book a doctor's appointment on the most suitable dates.
• We will reduce the price. The cost of treatment in European hospitals will be decreased due to the lack of additional coefficients for foreign patients.
• We will take care of all organizational issues: documents for entering the country, transfer from the airport, hotel, interpreter, etc. 
• We will prepare a program and translate medical documents. You do not have to repeat previously performed diagnostic procedures.
• We will provide communication with the European hospital after the completion of the medical program.
• We will organize additional medical examinations and treatment in European hospitals, if necessary.
• We will buy medicines abroad and forward them to your native country. 
• We will help you keep in touch with the European hospital after the completion of the program. 

Booking Health makes treatment in European hospitals easier, faster and cheaper. We will fully organize your trip, and you will only have to focus on restoring your health.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Journal of Orthopaedic Surgery and Research

Articles for Orthopaedic Practice - Orthogate

Johns Hopkins Medicine