Joint Replacement
Joint Replacement

Knee Replacement

Total Knee Replacement Surgery

Introduction

Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly increased its effectiveness. Total knee replacements are one of the most successful procedures in Orthopedics

Knee Joint

The knee is the largest joint in the body and having healthy knees is required to perform most everyday activities. The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The ends of these three bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily.

Details of Surgery -

Knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are actually replaced. There are four basic steps to a knee replacement procedure.

There are four basic steps to a knee replacement procedure.

  • Prepare the bone : The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Position the metal implants : The removed cartilage and bone is replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.
  • Resurface the patella : The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.
  • Insert a spacer : A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.
  • Deformity correction: During the operation any deformities must be corrected, and the ligaments balanced so that the knee has a good range of movement and is stable and aligned.

Total Knee Implant :-
A) Components

There are three components to a knee implant, replacing three bone surfaces - femoral, tibial and patellar implants. The components weigh between 10 to 15 ounces in total.

  • Femoral Component :In a knee implant, the femoral component, made of metal, curves up arounds the end of the femur (or thighbone). It has a central groove allowing the patella (or kneecap) to move up and down smoothly as the knee joint bends and straightens.
  • Tibial Component : The tibial component of a knee implant is a flat metal platform with a polyethylene insert or spacer. These have a double dish configuration for the femoral condyles and also either a notch to accommodate the cruciate ligaments (cruciate sparing) or a cam structure to take their place (cruciate sacrificing).
  • Patellar Component: The patellar 'button' is a dome-shaped piece of ultrahigh molecular weight polyethylene that replicates the surface of the kneecap.

B) Types of Implants

Unconstrained :- Cruciate substituting/ Cruciate retaining

  • Fixed Bearing : The polyethylene cushion of the tibial component is fixed to the metal platform base.
  • Mobile Bearing : The difference between a fixed-bearing implant and a mobile bearing implant is in the bearing surface. They allow patients a few degrees of greater rotation to the medial and lateral sides of their knee.
  • Medial Pivot (also known as Rotating Platform): In a rotating platform, the polyethylene insert can rotate slightly around a conical post, thereby copying the activity of the natural knee joint.
  • Posterior Cruciate Ligament (PCL)-Retaining: Another important aspect of a total knee replacement is the treatment of the Posterior Cruciate Ligament which prevents the femur from shunting back on the top of the tibia when it is flexed - sometimes referred to as 'roll back'. Depending upon its condition, this ligament can be kept (retained) or sacrified.

C) Constrained - Hinge Type

Commonly available / used implant brands :-

  • Stryker - Knee Systms - Scorpio NRG, Scorpio Single Axis
  • Depuy - PFC Sigma, RPF
  • Smith Nephew - Genesis II, Journey, Technology
  • VERILAST-OXINIUM- alloy and a highly cross-linked polyethylene(XLPE)
  • VISIONAIRE - Patient Matched Instrumentation-uses the patient's own MRI and full leg X-Ray to design cutting blocks specific to that patient.

Indus Knee

Variations in TKR
Minimal invasive TKR-have been developed in total knee replacement (TKR) that do not cut the Quadriceps-tendon. This technique has advantages of shorter incision length, retraction of the patella (kneecap) without eversion (rotating out), and specialized instruments.

UKR-Partial knee replacement

The knee is generally divided into three "compartments": medial (the inside part of the knee), lateral (the outside), and patellofemoral (the joint between the kneecap and the thighbone). patients having arthritis of all three compartments need total knee replacement .patients with wear confined primarily to one compartment, usually the medial, and may be candidates for unicompartmental knee replacement or High TIbial Osteotomy. Advantages of UKA compared to TKA include smaller incision, easier post-op rehabilitation, better post-operative range of motion, shorter hospital stay, less blood loss, lower risk of infection, stiffness, and blood clots.

Hip Replacement

Anatomy

Hip is one of the body's largest joints. It is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the large pelvis bone. The ball is the femoral head, which is the upper end of the femur (thighbone).The bone surfaces of the ball and socket are covered with articular cartilage, a smooth tissue that cushions the ends of the bones and enables them to move easily.

A thin tissue called synovial membrane surrounds the hip joint. In a healthy hip, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost all friction during hip movement. Bands of tissue called ligaments (the hip capsule) connect the ball to the socket and provide stability to the joint.

Total Hip Replacement

Total hip replacement surgery is a major orthopedic procedure which is designed to relieve pain by the removal of a damaged hip joint and the replacement of that joint with prosthesis and help the patient return to everyday activities. Traditional and minimally invasive hip surgeries are both options for those suffering from pain or immobility of the hip joints.

Description

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

  • The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow center of the femur. The femoral stem may be either cemented or "press fit" into the bone.
  • A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
  • The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.
  • A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

Anesthesia

After admission, patient will be evaluated by a member of the anesthesia team. The most common types of anesthesia are general anesthesia (you are put to sleep) or spinal, epidural, or regional nerve block anesthesia (you are awake but your body is numb from the waist down). The anesthesia team, with your input, will determine which type of anesthesia will be best for you.

Implant Components

Many different types of designs and materials are currently used in artificial hip joints. All of them consist of two basic components: the ball component (made of highly polished strong metal or ceramic material) and the socket component (a durable cup of plastic, ceramic or metal, which may have an outer metal shell).

The prosthetic components may be "press fit" into the bone to allow your bone to grow onto the components or they may be cemented into place. The decision to press fit or to cement the components is based on a number of factors, such as the quality and strength of your bone. A combination of a cemented stem and a non-cemented socket may also be used.

Your orthopaedic surgeon will choose the type of prosthesis that best meets your needs.

Dr Punit take a comprehensive approach to the treatment of hip pain including non-surgical therapies and total hip replacements.: Whether you are simply in need of physical therapy or total hip replacement surgery; Dr Punit is always with you to help you through every step of the diagnosis, treatment and rehabilitation process. If you are in need of treatment for hip pain and/or hip replacement surgery, schedule a consultation with Dr Punit today.

Shoulder Replacement

Anatomy

Shoulder is made up of three bones, upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid.

The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint.The muscles and tendons that surround the shoulder provide stability and support.

Conditions for shoulder replacement

  • Osteoarthritis (Degenerative Joint Disease)This is an age-related "wear and tear" type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.
  • Rheumatoid Arthritis : This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."
  • Post-traumatic Arthritis: This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments may damage the articular cartilage over time. This causes shoulder pain and limits shoulder function.
  • Rotator Cuff Tear Arthropathy A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.
  • Avascular Necrosis (Osteonecrosis): Avascular necrosis is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis.
  • Severe Fractures : A severe fracture of the shoulder is another common reason people have shoulder replacements. When the head of the upper arm bone is shattered, it may be very difficult to put the pieces of bone back in place.
  • Failed Previous Shoulder Replacement Surgery:-Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.

Indications for Shoulder Joint Replacement :
People who benefit from surgery often have :

  • Severe shoulder pain that interferes with everyday activities, such as, dressing, toileting, and washing.
  • Moderate to severe pain while resting. This pain may be severe enough to prevent a good night's sleep.
  • Loss of motion and/or weakness in the shoulder.
  • Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.
  • X-rays or MRI shows arthritis or other problems.

Total shoulder replacement implant :

The humeral implant consists of a metal ball that replaces the head of the humerus, and a stem that is secured into the main arm bone (humerus).The humeral stem is made of titanium for maximum strength. The head is made of cobalt chrome to provide a smooth surface for movement with the glenoid component, which is made of polyethylene.

The metal ball and stem are selected by the surgeon from multiple sizes to fit the contour and shape of each patient's humerus. This two-piece construction is known as a modular implant. This modularity allows surgeons to closely replicate the natural shoulder.

If the surgeon uses only the metal humeral components (humeral head and stem), the procedure is called a partial shoulder replacement. If the surgeon uses both the humeral components and the glenoid implant, the procedure is called a total shoulder replacement. Surgeons will decide which procedure to use based on the extent of damage to their patients' shoulders.

Shoulder Replacement Options

Shoulder replacement surgery is highly technical. It should be performed by a surgical team with experience in this procedure.

Total Shoulder Replacement

The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and plastic socket.t They may be either cemented or "press fit" into the bone. If the bone is of good quality, surgeon may choose to use a non-cemented (press-fit) humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid (socket) component is implanted with bone cement.

Implantation of a glenoid component is not advised if :

  • The glenoid has good cartilage
  • The glenoid bone is severely deficient
  • The rotator cuff tendons are irreparably torn

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Shoulder Hemiarthroplasty

Depending on the condition of your shoulder, surgeon may replace only the ball. This procedure is called a hemiarthroplasty. Indications for a hemiarthroplasty include:

  • Arthritis that only involves the head of the humerus with a glenoid that has a healthy and intact cartilage surface
  • Shoulders with severely weakened bone in the glenoid
  • Some shoulders with severely torn rotator cuff tendons and arthritis the humeral head is severely fractured but the socket is normal.

Resurfacing Hemiarthroplasty

Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a stem. With its bone preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard shoulder replacement.

Resurfacing hemiarthroplasty may be an option for you if :

  • The glenoid still has an intact cartilage surface
  • There has been no fresh fracture of the humeral neck or head
  • There is a desire to preserve humeral bone

For patients who are young or very active, resurfacing hemiarthroplasty avoids the risks of component wear and loosening. Due to its more conservative nature, resurfacing hemiarthroplasty may be easier to convert to total shoulder replacement, if necessary at a later time.

Reverse Total Shoulder Replacement

Reverse total shoulder replacement is used for people who have :

  • Completely torn rotator cuffs with severe arm weakness
  • The effects of severe arthritis and rotator cuff tearing (cuff tear arthropathy) mainly used for older patients.
  • Had a previous shoulder replacement that failed.

In reverse total shoulder replacement, the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

Minimally invasive shoulder replacement surgery

Minimally invasive shoulder replacement surgery enables the surgeons to perform the surgery through a smaller incision and reduced muscle disruption. This signifies a shorter recovery time for the patient.

Risks

Risks of any anesthesia are:Allergic reactions to medicines,Breathing problems.

Risk of any surgery are : Bleeding, Blood clot, Infection

Risks of shoulder replacement surgery are :

  • Allergic reaction to the artificial joint
  • Blood vessel damage during surgery
  • Bone break during surgery
  • Nerve damage during surgery
  • Dislocation of the artificial joint
  • Loosening of the implant over time

Ankle Replacement

Anatomy

The ankle joint is made up of three bones: the lower end of the tibia (shinbone), the fibula (the small bone of the lower leg), and the talus, the bone that fits into the socket formed by the tibia and fibula. The talus sits on top of the calcaneus (the heel bone). The talus moves mainly in one direction. It works like a hinge to allow your foot to move up and down.

Ligaments on both sides of the ankle joint help hold the bones together. Many tendons cross the ankle to move the ankle and the toes. (Ligaments connect bone to bone, while tendons connect muscle to bone.) The large Achilles tendon at the back of the ankle is the most powerful tendon in the foot. It connects the calf muscles to the heel bone and gives the foot the power for walking, running, and jumping.

Inside the joint, the bones are covered with a slick material called articular cartilage. Articular cartilage is the material that allows the bones to move smoothly against one another in the joints of the body. The cartilage lining is about one-quarter of an inch thick in most joints that carry body weight, such as the ankle, hip, or knee. It is soft enough to allow for shock absorption but tough enough to last a lifetime, as long as it is not injured.

Introduction

Surgery to replace the ankle joint with an artificial joint (called ankle arthroplasty) is becoming more common. Recent advances in the design of the artificial ankle and changes in the way the operation is performed have made artificial ankle replacement a growing alternative to ankle fusion for the treatment of ankle arthritis. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. There is another very important aspect to ankle replacement in that it avoids the stresses that occur following ankle fusion or arthrodesis. When an ankle joint is fused, there is of course no up and down movement in the ankle. There does however remain for some patients a limited amount of up and down movement which occur in the adjacent joints.

Indications : The ideal patient, is someone who is over the age of 50, is not too heavy, and is not extremely active

  • Patients with primary or posttraumatic osteoarthritis with relatively low functional demand.
  • Patients with severe ankle rheumatoid arthritis but not severe osteoporosis of the ankle.
  • Patients suitable for arthrodesis but rejecting it.

Contraindications are :

  • Varus or valgus deformity greater than 15 degrees, severe bony erosion, severe talus subluxation.
  • Substantial osteoporosis or osteonecrosis particularly affecting the talus.
  • Previous or current infections of the foot.
  • Vascular disease or severe neurologic disorders.
  • Previous arthrodesis of the ipsilateral hip or knee or severe deformities of these joints.
  • Capsuloligamentous instability and hindfoot or forefoot deformities affecting correct posture.

Objectives of the prosthetic design for ankle joint replacements are:

  • To replicate original joint function, by restoring an appropriate kinematics at the replaced joint
  • To permit a good fixation of the components, which would involve an appropriate load transfer to the bone and minimum risk of loosening
  • To guarantee longevity of the implant, which is mainly related to wear resistance
  • Feasibility of implantation, because of the small dimensions of the joint

Risks

Risks for any anesthesia are: Allergic reactions to medicines, Breathing problems Risks for ankle replacement surgery are:

  • Allergic reaction to the artificial joint
  • Ankle weakness, stiffness, Pain or instability
  • Blood vessel damage
  • Bone break during surgery ,Malleolar fracture
  • Dislocation of the artificial joint
  • Loosening of the artificial joint over time
  • Nerve damage
  • Deep infection of the joint, Wound infection
  • Delayed wound healing or breakdown
  • DVT or pulmonary embolism
  • Impingement
  • Failure of implant ,Further surgery needed ,Fusion needed following replacement surgery

Elbow Replacement

Anatomy of Elbow Joint

Anterior Cruciate Ligament Repair Introduction
The elbow is a hinge joint which is made up of three bones, humerus (upper arm bone), ulna (forearm bone on the little finger side) & radius (forearm bone on the thumb side).The surfaces of the bones where they meet to form the elbow joint are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the elbow joint. In a healthy elbow, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction as you bend and rotate your arm.Muscles, ligaments, and tendons hold the elbow joint together.

The elbow joint
consists of two types of joints called the ulnohumeral joint and the radioulnar joint. The ends of the humerus and ulna form a hinge that allows flexion and extension and the radius and ulna allow rotation or pivoting of the forearm. The elbow provides the arm with flexion and rotation. Flexion allows us to bend our elbows (such as scratching our nose and feeding ourselves) and rotation allows us place our palm up to receive objects, or down to perform tasks like writing.

Indications for Surgery
The indications for total elbow arthroplasty include severe pain, loss of motion, deformity, instability or destruction of the elbow joint. Indicated in following conditions:-

  • Chronic inflammatory arthropathies.
  • Posttraumatic osteoarthritis.
  • Acute distal humerus fractures.
  • Distal humerus Nonunions.
  • Extreme intrinsic stiffness/ankylosis.
  • Large posttraumatic bone defects.
  • Primary osteoarthritis (rare).
  • Haemophilic arthropathy.
  • Haemophilic arthropathy.
  • Reconstruction after tumor resection.

Details of the surgery
Total elbow replacement surgery, the damaged parts of the humerus and ulna are replaced with artificial components. The artificial elbow joint is made up of a metal and plastic hinge with two metal stems. The stems fit inside the hollow part of the bone called the canal.

Possible benefits of elbow replacement surgery
Elbow joint replacement arthroplasty offers the opportunity for people to regain much of the lost comfort and function in an arthritic elbow. It also can restore smooth, stabilizing joint surfaces when these surfaces have been damaged by arthritis. The effectiveness of the procedure depends on the health and motivation of the patient, the condition of the elbow, and the expertise of the surgeon. When performed by an experienced surgeon, total elbow replacement arthroplasty usually leads to improved elbow comfort and In function. The greatest improvements are in the ability of the patient to sleep and to perform activities of daily living.

Small Joint Replacement

Introduction

If nonsurgical treatments are not successful in easing problems of finger arthritis, you may be need replacing the surfaces of the joint

Anatomy of small joints of hand

The finger joints work like hinges when the fingers bend and straighten. The main knuckle joint is the MCP joint. It is formed by the connection of the metacarpal bone in the palm of the hand to the finger bone, or phalanx. Each finger has three phalanges, separated by two interphalangeal joints (IP joints). The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). The joint near the end of the finger is called the distal IP joint (DIP joint).

Ligaments are tough bands of tissue that connect bones together. Several ligaments hold each finger joint together. These ligaments join to form the joint capsule of the finger joint. The joint capsule is a watertight sac around the joint. The joint surfaces are covered with a material called articular cartilage. This material is the slick, spongy material that allows one side of a joint to slide against the other joint surface easily. When this material wears out, the joint develops a type of arthritis called osteoarthritis and becomes painful.

Joint Replacement Surgery of the Hand At A Glance

  • Joint replacement surgery involves replacing a destroyed joint with an artificial joint.
  • This procedure is typically employed in treating severe arthritis involving certain joints.
  • Surgical options for treatment of arthritis of the hand include cleaning of the abnormal cartilage and bone, fusion, and replacement surgery.

Surgical options with the different joints of the hands and wrists.

Hand joint replacement surgery options differ according to the specific joint(s) involved.

  • DIP joint (joint closest to the fingertip) : This joint is not a good candidate for joint replacement. The bones are very small and do not hold the implant very well. The best treatment option for advanced arthritis at this joint is fusion. Hand function is only minimally compromised by lack of motion at this joint after a fusion procedure, while pain is relieved.
  • PIP joint (second joint from the fingertip) : Joint replacement is commonly performed in the PIP joint. Hand function, especially power grasp, can be hindered by fusion of this joint. The small and ring fingers are the best candidates for joint replacement as they are the most important for power grasp. The index finger is not a good candidate for a PIP joint replacement, as it must withstand sideways forces which accompany movements such as key turning and fine manipulation of objects. These forces cause excess stress on the joint implant and can lead to early implant breakage. The best results with PIP joint replacement are in patients with rheumatoid arthritis and in older, lower-activity patients.
  • MCP joint (third joint from the fingertip) : Osteoarthritis rarely affects the MCP joints. The most common need for joint replacement in this joint is destruction from rheumatoid arthritis.
  • Thumb basal joint (where the thumb meets the wrist): This joint is exposed to very high stresses with normal activities. Forces felt at the tip of the thumb are multiplied 12 times in their effect to the thumb base, thus predisposing this joint to wear. Arthritis of this joint is very common, especially in women, and frequently requires joint replacement. Attempts at silicone replacement of this joint have not been as successful as hoped due to implant failure and bone destruction. Thus, the most common joint replacement procedure for the thumb base is done with natural material. The procedure is termed the ligament reconstruction-tendon interposition procedure (LRTI). This procedure uses the patient's own tendon to stabilize the thumb and resurface the joint. LRTI provides stability and pain relief. Long-term results have been excellent. This has also been called the tendon roll or "anchovy" procedure because the tendon used is curled to form the new joint cushion.
  • Wrist joint : Most patients with wrist arthritis are best treated with surgical joint cleaning or fusion and not joint replacement. Most wrist-joint prostheses on the market are currently investigational and for use in extremely low activity patients with osteoarthritis or rheumatoid arthritis.

The risks are low, but include :

  • Infection - risk is low around 1%, but it occurs is a serious problem as control of infection can be difficult, due to the implant
  • Pain - This usually settles over the first week and is usually moderate.
  • Stiffness - Often the joint that is being replaced is very stiff. If this is the case the resultant movement after the operation will be limited. This is the most common complication in small joint replacements.
  • Swelling - The finger will remain swollen for 3 to 6 months
  • Nerve injury - Localised numbness around the wound may occur. It usually resolves with time.
  • Dislocation - This is a risk in the short term, before the tissues tighten. The risk is low, but if it does occur, a short anaesthetic is required to relocate the joint.
  • Loosening - This is the long term complication of the joint replacement and is almost inevitable. Once the joint is loose, it may become painful and swollen again. At that stage the majority of patients would have their replacement converted to a fusion. Hopefully though there have been many years of benefit!

The Operation

The procedure takes about two hours to complete. Surgery may be done using a general anesthetic, which puts you completely to sleep, or a local anesthetic, which numbs only the hand. With a local anesthetic you may be awake during the surgery, but you won't be able to see the surgery. Once you have anesthesia, your surgeon will make sure the skin of your hand is free of infection by cleaning the skin with a germ-killing solution. An incision is made across the back of the finger joints that are to be replaced. The soft tissues are spread apart with a retractor. Special care is taken not to damage the nearby nerve that passes by the joint. The joint is exposed. The ends of the bones that form the finger joint surfaces are taken off, forming flat surfaces. A burr (a small cutting tool) is used to make a canal into the bones that form the finger joint. The surgeon then sizes the stem of the prosthesis to ensure a snug fit into the hollow bone marrow space of the bone. The prosthesis is inserted into the ends of both finger bones. When the new joint is in place, the surgeon wraps the joint with a strip of nearby ligament to form a tight sac. This gives the new implant some added protection and stability. The soft tissues are sewn together, and the finger is splinted and bandaged.

After Surgery

After surgery, your finger will be bandaged with a well-padded dressing and a splint for support. The splint will keep the finger in a straightened position during healing. Some patients are placed in an arm-length cast with the finger in a straightened position for about three weeks after the prosthesis is implanted. surgeon will want to check your hand in five to seven days. Stitches will be removed after 10 to 14 days, You may have some discomfort after surgery. You will be given pain medicine to control the discomfort you have.

You should keep your hand elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

Rehabilitation

A physical or occupational therapist will direct your recovery program. Recovery takes up to three months after prosthesis is implanted.

The first few therapy treatments will focus on controlling the pain and swelling from surgery. Heat treatments may be used. Your therapist may also use gentle massage and other hands-on treatments to ease muscle spasm and pain.

Then you'll begin gentle range-of-motion exercise. Strengthening exercises are used to give added stability around the finger joint. You'll learn ways to grip and support items in order to do your tasks safely and with the least amount of stress on your new finger joint. As with any surgery, you need to avoid doing too much, too quickly.

Some of the exercises you'll do are designed to get your hand and fingers working in ways that are similar to your work tasks and daily activities. Your therapist will help you find ways to do your tasks that don't put too much stress on your finger joint. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.

The therapist's goal is to help you keep your pain under control, improve your strength and range of motion, and regain your fine motor abilities with your hand and fingers.

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