Advancement in Joint Replacement Surgery : Dr. Raju Vaishya

Until a few decades ago, a diagnosis of arthritis was deeply discouraging to patient and doctor alike. While most kinds of arthritis are chronic and can’t be cured, one doesn’t have to face a life of pain. One can live a normal life, with arthritis. Today, though researches haven’t found a cure for most arthritis, there is an array of prescription drugs to help with more serious kinds of arthritis, including several new drugs for rheumatoid arthritis. In severe cases of joint damage, surgery can help restore joint function and mobility. There are now new, conventional and alternative treatments, the benefits of self-help programmes, plus treatment specific to the different types of arthritis.
In recent years there has been some revolutionary advances in joint replacement surgery. Till recently the joints, which were commonly replaced were that of knee joints and hip joints. Now the other parts of body can also be replaced as that of shoulder, elbow, wrist, finger and ankle joints.
Joints for Asian Knee
It has been observed that Asian bones are not only small but also more fragile as compared to European and American bones. This discovery has led to better joints, which are better replicates of original joints and their life span has also increased to 20 to 25 years. The improvement in the designs & materials used in artificial joints have contributed to increase the life span of these joints. Some new bearing surfaces, like metal on metal, ceramic on ceramic & development of cross linked poly ethylene has shown to increase the life of these joints by reducing the wear rate & providing an efficient low friction artificial joint surfaces. Hence, it is now possible to implant these joints even in younger patients with crippling arthritis.
Contemporary Total Knee Replacement (TKR) which is currently one of the most frequently performed orthopaedic surgical procedures, has developed over the past 30 years. Although the goal of TKR is simple, the means of accomplishment are complex as surgeons & engineers strive to design a prosthetic joint that will function like a human knee. Success of the procedure not only is dependent on the skills of the surgeon & his team, but is also coupled with the design of the implant & instrumentation. A scientific sound design must be complemented by easily used instruments & a technique that assumes accuracy & reproducibility.
Total Joint Replacement (TJR) represents a major advance in the management of severe, crippling arthritis. More than 5,00,000 patients undergo Total Joint Replacement each year, in USA alone. Joint replacement surgery not only relieves the pain & suffering of a crippling arthritic, but give a new lease of life to the joint & improves the quality of life tremendously.
Recent Advancements
Although the procedure is among one of the most successful in Orthopaedic Surgery, the debate continues as to the best treatment option regarding TKR. Newer types of joints like Unicompartmental, Mobile bearing, High flex knees, Hybrid Hips, Hip Resurfacing, Metal onMetal & Ceramic onCeramic implants have been introduced for use recently.
Not only there have improvements in the mate rials, designs & instrumentation of joint replacement surgery, but new techniques of replacing joints using small cuts (Minimally Invasive Surgery or MIS), computer assisted navigation surgery, & robot assisted surgery are becoming popular, as they are likely to provide more accurate placement of artificial joints with minimum of discomfort to the patient.
Future of joint replacement surgery in India
The future of joint replacement surgery is bright in India. The number of total joint repalcements being done in India is increasing at a rapid rate in the recent past. Total Joint Replacement surgery has come here to stay forever, as it has proved worldwide over in the last 3 decades, through its excellent results. A great amount of research is being carried out to further improve both the materials used in the replacement parts and in their design to make them function smoothly and as ‘normally’ as possible. With more trained personnel available in time to come & lower cost of prosthesis would certainly help in making the TJR to become extremely popular treatment option.n

Dr. (Prof.) Raju Vaishya , a surgeon of international repute, is best known for his swift surgical skills in the field of Orthopedic & Joint Replacement. He has been working at Indraprastha Apollo Hospitals, New Delhi as a Professor and Senior consultant. He is the founder president of Arthritis Care Foundation. Apart from his distinguished clinical work in the field of arthroscopic and joint replace¬ment surgery, he is well known for his academic contributions.

Common types of surgery for osteoarthritis
Debridement : The surgeon smoothes out irregular joint surfaces, and removes loose bits of bone or cartilage that could be contributing to inflammation.
Osteotomy : Doctors cut and re-set bones to re-align the joint. This procedure is most often performed on the knee joint
Arthrodesis : Also called “joint fusion”, your doctor may suggest this surgery when joints are seriously damaged. It’s usually done on sections of the spine but may involve ankles and other joints.
Arthroplasty : This is another term for total joint replacement; your damaged joint is removed and replaced with a plastic or metal joint. Most often done or knee and hip joints, arthroplasty can be done on any joint except those of the spine.


Vinod Kumar

Health Journalist & writer. Editor of monthly health magazine "Health Spectrum."

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