Total HIP Replacement

The hip joint is a ball and socket joint and one of the bigger joints of our body. It plays a very important role in our day to day living like walking, running, sitting, squatting, sitting cross-legged etc. When the hip joint is damaged, these activities tend to become difficult.

COMMON CAUSES OF HIP DAMAGE:

1. Osteoarthritis:
This a condition where there is degeneration of the smooth cartilage covering the ball and cup of the hip joint due to wear and tear. Apart from excess weight and work, genetic and racial causes also are attributed to osteoarthritis.
2. Avascular necrosis:
The bone is a living organ and it requires blood to survive. The blood supply to the hip joint is reduced in this condition and the ball part of the hip bone dies and the bone collapses and becomes irregular. This causes pain and disability to a person.

3. Rheumatoid arthritis:
Rheumatoid arthritis is a disorder affecting many joints of the body, where there is cartilage damage and resulting in arthritis.
4. Post-traumatic arthritis:
Sometimes serious injuries to the hip joint like dislocations or fractures can lead to irregular joints and cause secondary arthritis and pain.
5. Childhood hip disorders:
Some childhood hip conditions like congenital hip dislocations, Perthes disease, etc can lead to secondary arthritis.
6. Infections:
Infections of the hip joint especially Tuberculosis in our country can lead to joint damage and arthritis.

Hip Arthroplasty
Hip-Arthroplasty

When all modalities of treatment such as physiotherapy, exercises, medicines do not give any pain refief, then a total hip replacement is given as an option to people suffering from hip arthritis. Total hip replacement is a surgery, where both the ball and socket of the hip joint are replaced with artificial materials. This surgery was pioneered by Sir John Charnley of England in the 60s and evolved over the years to long-lasting implants available today.

In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

1. The damaged femoral head can be removed and replaced with a metal stem. Then it can be placed into the hollow center of the femur. The femoral stem may be either “press fit” or cemented into the bone.
2. Ceramic ball or a metal can be placed on the upper part of the stem and the damaged femoral head can be replaced with ceramic ball.
3. The damaged cartilage surface of the socket called acetabulum can be removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
4. A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.
THR is usually done under general or epidural anesthesia, and the person is made to walk after 2 days from surgery and patient can go home after 5-7 days. Complications like infections, DVT and dislocations can be avoided by taking adequate precautions.

Like mentioned earlier, newer materials like titanium, ceramics, and materials allowing bone growth into the artificial implant lead to longer life of implants. Also larger diameter ceramic heads allow the person to sit on the floor and squat as well. A well done uncemented, a ceramic implant can last upwards of 30 years.

Total hip replacement is a successful surgery and can change the lives of people who are suffering from arthritis of the hip.

Post Traumatic Stiffness Of Elbow Joint

Normal elbow movements are essential for daily activities like eating, work, and other leisure pursuits. If their right is affected, it will be more difficult. Normal elbow movement is 0-150°.  When the elbow is straight, it is 0 position and it is called as an extension. When the elbow is up to full, it is called as flexion. Elbow joints, one of the commonest joints in the body which gets injured in children and adults after a fall or after a director injury. When you fall from a bike or in stairs or on the street, we automatically tend to protect our body from falling on the outstretched hand are land on the tip of the elbow injuring it.

Very often, after the injury in the rural setup and also in the urban area people take it likely and go for native treatment. The post-traumatic stiffness of the elbow joint is one of the most common problems, we see in our day to day practice. All the more it is common in our country as most of the villages including learner people go in for native treatment even after X-rays being taken, because of fear of surgery, on the insistence of old folks at home and economic constraints.

ANATOMY:

Elbow movement of flexion and extension occur through the ulna humeral and radio-capitellar articulation along with the proximal radioulnar joint. The radio-capitellar articulations further provide an important interface to forearm rotation. This movement of rotation is important for eating, to receive something from with the hand or for any games.

Joint Stiffness - Bone, Joint, and Muscle Disorders

CAUSES OF ELBOW STIFFNESS:

The important cause of the elbow stiffness is following an injury. The other cause is being myositis ossifications (New bone formation around the elbow joint). This may form commonly after a massage by native doctor head injury and burns. Other causes like tuberculous arthritis, rheumatoid arthritis, non-specific sub-acute infections and hemophilia must be ruled out.

AIM OF TREATMENT:

The main indication for elbow release surgery is stiffness that limits the activates of daily living. Especially on the right side for eating. Extension (bring the elbow into straight position) loss is better tolerated than flexion (taking the hand to mouth) loss. For release surgery (Arthrolysis), a normal articular surface is important.

HISTORY TAKING:

This is important to know about the initial injury, period of immobilization (prolonged immobilization with plaster or by bamboo sticks, native medicines are bad for elbow joint) and previous history of surgical intervention.

MOVEMENTS:

The usable range of movements for elbow joint is 30“ to 130″. If an individual has this range of movement, a course of physiotherapy will suffice. But it must be done very carefully, sometimes it may become worse also.

X-RAY:

To assess the joint anatomy regarding any old fracture and unreduced dislocation, articular congruity, presence and location of plates and screws, the presence of myositis mass and its location for the future plan for surgery. Sometimes CT scan and MRI may be necessary.

TREATMENT:

For the release of elbow stiffness surgery, it is important for the patient to know that they will get a usable range of movement and not a perfect joint movement. After the release of the contracted tissues around the joint (Arthrolysis) and removal myositic mass, it is mandatory the patient must co-operate for intensive physiotherapy. The pain during mobilization will be reduced by painkillers, ice back therapy, wax therapy and continuous passive motion machine CPM. Physiotherapist must be well experienced and patient’s cooperation is important.

CONCLUSION:

Elbow release surgery (Arthrolysis) is a reward and it is done by an experienced surgeon. The role of physiotherapist is very important who is competent to give relief of pain and increase the range of movement after surgery. All the more essential is patient’s compliance and cooperation to get back the usable range of movement of 30“-l30°.

We always give a lot of moral support to get back the usable range of movement and tell them ‘Life is mobility, mobility is life’. Life is miserable to live with a stiff and painful elbow. There is always a cure for stiff elbow by surgical methods in the form Arthrolysis and rarely elbow joint replacement.