SERVICES
JOINT REPLACEMENT SURGERY



OVERVIEW
Joint replacement surgery consists of several procedures to replace damaged or arthritic joints with prosthetic devices made from ceramic, plastic or metal. Replacement surgery helps the patient return to full mobility after experiencing debilitating pain from joint arthritis. An implanted prosthesis will function as a normal joint would after surgery and in order to aid in the patient's recovery, this is coupled with physiotherapy.

 

PROCEDURES: JOINT REPLACEMENT SURGERIES
The hip and knee joints are the most common joints that need to be replaced as a result of general wear and tear. How we replace these joints depends on the patient’s diagnostic evaluation.

These surgical procedures include:

 
1HIP REPLACEMENT (ANTERIOR AND POSTERIOR APPROACHES)

Depending on the patient, total hip replacement (hip arthroplasty) can be performed anteriorly or posteriorly. An incision can be made on the front or back part of the hip. Moving aside tissue and muscle is necessary in order to gain access to the joint. Dr du Toit removes injured tissue and bone and inserts a prosthetic socket within the pelvic bone. A new prosthetic ball replaces the ball at the tip of the femur that connects to a long stem in the thighbone. Surgical techniques for hip replacement are always changing, and new, less invasive ways of removing tissue and replacing the joint are now possible.

2KNEE REPLACEMENT

Knee replacement surgery (Knee arthroplasty) treats debilitative knee pain and restores mobility of the knee. Surgery involves removing diseased cartilage and bone from areas such as the shinbone, thighbone and kneecap and then replacing it with a synthetic joint (prosthesis) made of polymers, metal and plastic.

Patients require knee replacement surgery when they develop constant pain due to osteoarthritis and, in turn, have trouble climbing stairs, running errands, performing general daily activities and getting up from sitting or squatting positions. They also experience knee pain when not engaging in physical activity, especially at night. If the pain does not respond to normal pain tablets anymore, knee replacement surgery is inevitable.

Surgery often begins by preparing the operative site and creating an incision along the front part of the knee. Afterwards, Dr du Toit pushes aside the kneecap and removes damaged joint tissue. When he is done preparing the joint surface, he aligns and inserts the prosthetic pieces and then closes the incision. Bending and the stability of the knee is assessed in order to evaluate the function of the new knee replacement.

3HIP REVISION

Hip revision surgery is a procedure to fix a damaged prosthetic hip and to treat pain associated with that. The prosthetic can become damaged due to either infection, general wear and tear of the implant or as a result of an injury. As a result, hip revision may take longer than the original total hip replacement surgery as it is a more complex type of surgery rebuilding the damaged joint. The expected outcomes are long-lasting and provides immediate relief from pain, and restores the patient's mobility, helping them return to a state of normalcy. Usually, revision surgery patients must be followed up more closely as the potential risk for complications are higher. How the body responds to the new joint replacement is different in each case but depends on the patient's health and various other factors.

4KNEE REVISION

Knee revision is a procedure that involves redoing and replacing previously implanted knee prostheses in the knee. The old prosthetic is replaced with a new implant to restore the pain-free mobility of the joint. Usually, revision surgery is more complicated than a total knee replacement, but the aim of the surgery is the same, to ensure a return to mobility and treat pain. The total knee replacement prostheses would have already been fixated to the bone with bone cement, so separating this attachment is critical. Removal of the old prosthetic results in some bone loss, so special revision implants are sometimes necessary. However, the new revision implants will remain in a stable and fixed position allowing full pain-free mobility after the surgery.

5ROBOTIC/NAVIGATED HIP & KNEE REPLACEMENTS

Joint arthroplasty is a highly effective surgical procedure to replace a worn-out joint with a prosthetic joint. Robot-assisted technology makes surgery even more precise, thus reducing the risks of complications and improving outcomes. Computer-driven operative technology not only increases the longevity of the prosthesis but ultimately ensures that the surgery is a success.

Planning occurs prior to surgery, whereby doctors use a navigation system and receive feedback on their strategy and have a chance to improve upon it. A surgeon's technical skills, and ability to position and align the prosthesis, will determine the life expectancy of the implant. Navigation systems provide immediate feedback on the procedure, ensuring the orthopaedic surgeon can correct issues with the manual insertion of the prosthesis.

6PATIENT-SPECIFIC AND CUSTOM IMPLANTS

The technology exists to provide customised prosthetic implants to suit the needs of each individual patient. These implants are designed according to the patient’s specifications. Furthermore, an MRI scan of the patient’s hip or knee will determine how the implant is made. Details of the scan are used to create a three dimensional model of the bone and specific surgical cutting blocks used during the final joint replacement surgery. Surgical time is decreased, and efficiency is increased, leading to better patient outcomes and lower risks of complications.

An implant works just as well as the native hip or knee as it functions in conjunction with the remaining ligaments and tendons. However, anything off the shelf means compromises must be made during surgery to ensure that soft tissues agree to an implant that is not necessarily the same shape and size as the natural bone. By using patient-specific implants, the accuracy for matching the implants to the ligaments and soft tissues is increased.

 

RECOVERY
Recovery depends on the procedure and technique undergone. Patients are encouraged to begin walking or moving again as soon as the implant is in. Following the doctor's orders will help hasten the patient's recovery and ensure a safe and healthy return to their lifestyle.

 


 

FAQ

  1. WHEN DO YOU NEED HIP ARTHROPLASTY?
    You require hip replacement surgery when you develop:
    • Osteoarthritis is degenerative arthritis that occurs when smooth cartilage covering the bones’ ends wears thin.
    • Rheumatoid arthritis arises from an overactive immune system. As a result, excessive inflammation can destroy cartilage and bone.
    • Osteonecrosis arises from insufficient blood supply to the hip’s ball socket. When this occurs, the risk of dislocation and fracture is high.
    • Hip Dysplasia is a condition that affects the normal shape of the hip socket leading to destruction of the joint and pain.
  2. ARE THERE TESTS TO DETERMINE THE NEED FOR KNEE REPLACEMENT SURGERY?
    To determine the need for knee replacement surgery, Dr du Toit will assess your knee’s range of motion and strength. In addition, he carries out x-ray imaging to find out if there is severe damage to the knee. Finally, Dr du Toit can decide on the type of knee prosthesis to use and the technique to implant it based on your condition and imaging results.
  3. WHY DO YOU NEED REVISION SURGERY?
    Artificial joint failure and a worn-out prosthesis necessitate the need for revision surgery. The mechanical components of a replaced joint can only last so long before becoming worn out. The risk of this happening is likely to occur in younger patients having undergone joint replacement surgery. In addition, placing excess stress or weight on the joint itself can also increase the risk of the prosthesis wearing out. Recurrent joint dislocations, painful replaced joints, fractures around the replacements and joint infections will require revision surgery.

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