Arthroplasty (literally " e-orming of

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...

") is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by

osteotomy An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is ...

or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

Types

For the last 45 years, the most successful and common form of arthroplasty is the surgical replacement of arthritic or destructive or

necrotic Necrosis () is a form of cell injury which results in the premature death of cells in living tissue by autolysis. Necrosis is caused by factors external to the cell or tissue, such as infection, or trauma which result in the unregulated dige ...

joint or joint surface with a

prosthesis In medicine, a prosthesis (plural: prostheses; from grc, πρόσθεσις, prósthesis, addition, application, attachment), or a prosthetic implant, is an artificial device that replaces a missing body part, which may be lost through trau ...

. For example, a hip joint that is affected by osteoarthritis may be replaced entirely (

total hip arthroplasty Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement ...

) with a prosthetic hip. This would involve replacing both the acetabulum (hip socket) and the head and neck of the

femur The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates with ...

. The purpose of this procedure is to relieve pain, to restore range of motion and to improve walking ability, thus leading to the improvement of muscle strength.

Other types of arthroplasty

* Interpositional arthroplasty, previously a popular form of arthroplasty, with interposition of some other tissue like

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

to keep inflammatory surfaces apart * Excisional or resection(al) arthroplasty in which joint surface and bone is removed. The remaining ends are attached, or left to give time for

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

tissue to fill in the gap. One variant of is the ''Stainsby procedure'' which consists of excision of part of a

proximal phalanx The phalanges (singular: ''phalanx'' ) are digital bones in the hands and feet of most vertebrates. In primates, the thumbs and big toes have two phalanges while the other digits have three phalanges. The phalanges are classed as long bones. ...

in a

metatarsophalangeal joint The metatarsophalangeal joints (MTP joints), also informally known as toe knuckles, are the joints between the metatarsal bones of the foot and the proximal bones (proximal phalanges) of the toes. They are condyloid joints, meaning that an ellipt ...

, reduction of the

plantar plate In the human foot, the Anatomical terms of location#Relative directions in the limbs, plantar or Anatomical terms of location#Relative directions in the limbs, volar plates (also called plantar or volar ligaments) are Fibrocartilage, fibrocartilagi ...

and

kirschner wire Kirschner wires or K-wires or pins are sterilized, sharpened, smooth stainless steel pins. Introduced in 1909 by Martin Kirschner, the wires are now widely used in orthopedics and other types of medical and veterinary surgery. They come in differ ...

fixation of the

metacarpal bone In human anatomy, the metacarpal bones or metacarpus form the intermediate part of the skeletal hand located between the phalanges of the fingers and the carpal bones of the wrist, which forms the connection to the forearm. The metacarpal bones ar ...

to the remaining phalanx. * Resurfacing arthroplasty, where one or both bone surfaces are trimmed and replaced with a smooth metal covering. * Mold arthroplasty, * Silicone replacement arthroplasty *

Osteotomy An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is ...

to restore or modify joint congruity

Complications and improvements

Arthroplasty presents various and continuous challenges to the engineer and surgeon. The prosthesis selected must be nontoxic yet resistant, compatible and durable. Meeting all these criteria usually means that the prosthesis will not last 10–20 years. 75% of artificial knees will last 20 years and 90% will last 10 years. In recent years the technology has been improved with a porous-coated prosthesis which allows for stronger bonding to the body, but even more notable improvements have derived from the recent explosion in computer-assisted design and manufacturing (CAD/CAM). Using X-rays and other scans of the patient as well as modern 3D printing, personally tailored prostheses are a reality for more and more individuals.NIH 3D Print Exchange , A Collection of Biomedical 3D Printable Files and 3D Printing Resources Supported by the National Institutes of Health (NIH). U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 22 Nov. 2016.

Indications

osteoarthritis Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...

(OA) *

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...

(RA) *

avascular necrosis Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop which may limit the ability to move. C ...

(AVN) or osteonecrosis (ON) * congenital dislocation of the hip joint (CDH)

Hip dysplasia (human) Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. Hip dysplasia may occur at birth or develop in early life. Regardless, it doe ...

* acetabular dysplasia (shallow hip socket) * frozen shoulder, loose shoulder * traumatized and malaligned joint * joint stiffness

Complications

* Blot clots or

deep vein thrombosis Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enla ...

Infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

Bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

Periprosthetic Periprosthetic in medicine refers to a structure in close relation to an implant. Clinically it can refer to: *Bone fracture or 'periprosthetic fracture' around an artificial joint, e.g. after a knee replacement *infection around an artificial joi ...

fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...

* Loosening * Mechanical wear * Failure

References