30.4C: Arthroplasty

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Arthroplasty is a surgical procedure in which an arthritic or dysfunctional joint surface is replaced or repaired.

Learning Objectives

Describe the purpose and process of arthroplasty

Key Points

Arthroplasty can include removing or remodeling damaged surfaces and replacing them with silicone.
Prosthetic replacements of hip and knee joints have become common arthroplastic surgeries.
Wear of the bearing surfaces of components is an issue of joint replacement that can lead to damage to surrounding bone and contribute to eventual failure of the implant.

Key Terms

arthroplasty: The surgical repair of a joint, or creation of an artificial joint, such as a hip replacement.

EXAMPLES

Hip fractures from falls are common among the elderly. Partial arthroplasty (replacing the hip socket and femur head and neck) may be done to relieve pain and improve mobility. However, as with all surgeries, complications can occur that for the elderly may prevent life-threatening challenges. Special care must be made when deciding to proceed with arthroplasty in the elderly patient.

Arthroplasty (literally “surgical repair of joint”) is an orthopedic surgical procedure in which the arthritic or dysfunctional joint surface is replaced and/or the joint is remodeled or realigned.

Planning Arthroplasty: CAD-assisted planning for a total hip arthroplasty.

Common types of arthroplasty include:

Interpositional arthroplasty with interposition of skin, muscle, or tendon to keep inflammatory surfaces apart.
Excisional arthroplasty in which the joint surface and bone are removed, leaving scar tissue to fill in the gap.

Other forms of arthroplasty include resectional arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, and silicone replacement arthroplasty, among others. Osteotomy to restore or modify joint congruity is also an arthroplasty.

For the last 45 years, the most successful and common form of arthroplasty has been the surgical replacement of degenerated joint surfaces with prostheses. For example, a hip joint that is affected by osteoarthritis may be replaced entirely (total hip arthroplasty) with a prosthetic hip. This would involve replacing both the acetabulum (hip socket) and the head and neck of the femur. The purpose of this procedure is to relieve pain, restore range of motion, and improve walking ability, thus leading to the improvement of muscle strength.

One of the main problems with joint replacements is wear of the bearing surfaces of components. This can lead to damage to surrounding bone and contribute to eventual failure of the implant. Use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). The plastic (actually ultra high-molecular-weight polyethylene) can also be altered in ways that may improve durability.

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