Protocol ensures precision while performing a medical procedure and reduces the risk of complications. Thus, for replacements as well, there are certain rules and regulations that an orthopedic surgeon, specialised in arthroplasty, has to follow.
These tend to be highly technical documents meant for surgeons. Yet, this article talks about the same in general and simple language so that one who is interested in educating themselves can do so.
Besides, this post is informative as well to enrich the experience of the reader so that while reading they don’t need to go anywhere else on the internet for extra research to understand anything written here.
Knee and Hip Replacement Surgeries
A replacement is a medical procedure where a worn-out and damaged joint is removed and a new surface is recreated in the same place with the help of artificial parts.
Often, in two cases, this surgery is recommended when either your joint has been severely injured because of some external trauma or your joint cartilage has worn down over time leading to the severe condition of Osteoarthritis.
Such debilitating and devastating injuries along with the medical condition of OA can happen to both of your joints like knees and hips.
When joint pain becomes unbearable and excruciating, a replacement is suggested. If you are looking for the best doctor for knee pain in Delhi, ensure the best specialist.
Protocol
Medical practitioners have to follow a set of rules to carry out medical interventions. These are collectively called protocols.
Mainly, there is a predefined set of rules, i.e., protocol instructing a surgeon how to do a particular thing within their specialisation merely to minimise the risk of mistakes and complications while performing surgery or giving drugs, medicines, anaesthesia etc.
For knee and hip replacement surgeries as well, there are well-defined instructions. All these procedural rules are discussed below in short.
However, these are all general guidelines and they don’t demand strict adherence from the end of your surgeon. The orthopedist who operates on your joints might follow the protocol that can deviate a little from the one discussed below.
Preoperative evaluation
This is the first thing your surgeon is supposed to do if you have been recommended for a joint replacement either for a knee or a hip.
Patient’s Medical History Assessment: A person whose joint is chronically and severely painful will benefit from the replacement surgery. However it might worsen the situation if proper evaluation of the medical history isn’t performed thoroughly in advance.
Physical Examination: A surgeon will perform tests ranging from imaging exams, blood tests and other diagnostic interventions to rule out any potential complications during and post surgery.
Comorbidity: Sometimes, a patient might have two or more underlying diseases. If it is not detected before surgery, the post-surgery time might be complicated to handle or at times, the patient’s life can also be at risk.
So, the analysis of medical history along with physical exams is extremely important and this is the first step in the protocol for arthroplasty.
Preparation for surgery
Before the replacement, you will first need to change into the hospital gown. Your surgeon will not perform surgery on the personal clothes you are wearing.
Afterwards, you will be taken to the surgery room for the next step.
Anesthesia
A surgeon or a doctor has more than one option to put you under anesthesia. These are as follows.
Local Anesthesia
If the doctor uses LA (local anesthesia), you won’t be totally unconscious.
Local anesthesia might not be an option during a replacement surgery, but for knowledge, it is used when the surgeon only needs to operate on a very small section of the body. Here, the anesthetic is directly injected into the concerned portion of the body.
It can be used for minor procedures like stitching a wound.
Regional Anesthesia
In case RA (regional anesthesia) is used, your brain and respiratory activities won’t be affected at all.
You will be awake but nerves to a specific region of your body will be blocked for example your pelvis section if it is a hip replacement or your entire leg if it is a knee replacement.
There are three types of RA, commonly known as,
- Spinal Anesthesia,
- Epidural Anesthesia, and
- Regional Nerve Block.
Spinal anesthesia is the one that is administered through the spine with the help of an injection full of anesthetic.
Epidural anesthesia is one that is given with a thin flexible tube made of plastic (like the one used to transfer glucose into the body). In this case as well, the anaesthetic is administered via your backbone.
RNB (Regional Nerve Block) is given through other parts of the body. For example, if a part like your arm is to be treated, then it will be numbed by the anaesthetist with an injection given into the side of the neck or armpit.
In short, if the anaesthetic is not administered through your backbone, it is RNB.
General Anesthesia
GA (general anesthesia) is used during major surgical operations like heart operation or brain surgery. You become totally unconscious in this form of anesthesia and don’t feel anything during the procedure.
Here, anesthetic can be given to you either via an injection into the vein or by allowing you to breathe in anesthetic in the form of gas so it can be carried to the brain through the veins leading from the lung cavities.
Anesthesia Involved in Arthroplasty
Spinal anesthesia is the most effective and utilised numbing option to perform arthroplasty. This comes under regional anesthesia. This makes the part below your waist all numb and ready for either a total hip or knee replacement.
However, for effective results, the surgeon handling your case can combine any of the discussed forms of anesthesia.
Surgical Procedure
Now, let’s talk about how a total replacement is done.
Hip Replacement
Your hip joint is made out of the lower part of the pelvis where your thigh bone top meets. Technically, the pelvis part is called the acetabulum and the thigh bone is called the femoral head.
During the hip replacement, the acetabulum, which is just a concave-like space, is removed along with the femoral head and neck. After the removal of the damaged parts, the surgeon will resurface the femoral head with implants and also replace the acetabulum with the artificial component, the acetabular cup.
The procedure requires the following:
Incision: The surgeon will make an incision around your hip section as per the requirements.
Exposure: The incision made will facilitate the exposure of the damaged hip joint that is to be removed for the insertion of artificial parts.
Artificial (or Prosthetic) Setup: Once the acetabulum (hip joint socket in the lower pelvis region) and femoral sections (top thigh bone) have been removed, artificial parts like the acetabular cup, liner, head and femoral stem will be used for the recreation of the joint.
The artificial parts used in hip replacements are as follows:
- The acetabular cup: This is used to replace your natural concave-like cavity or hip joint socket.
- Polyethylene liner: Inside the cup, there goes a plastic liner. It covers the inside of the acetabular cup. This works the same as a natural articular cartilage. In other words, this part provides for a smooth hip joint movement after the replacement.
- Femoral head: This part takes the role and function of the top of your thigh bone (the femoral head) that resembles the look of a ball.
- Femoral stem: This implant or artificial part replaces the removed neck of the thigh bone just below the femoral head.
Knee Replacement
A knee is the most complicated joint in the body along with the fact that it is the biggest musculoskeletal component as well. A knee joint is usually made up of the meeting of two bones, i.e., leg and thigh bones along with connective and protective tissues like ligaments and cartilage covered by muscles, nerves and veins.
When your cartilage part gets worn down because of daily activities, your knee joint finds it hard to produce a natural lubricant for smooth mobility involving the knee range. Because of these changes of a degenerative sort (that worsens with time or irreversible procedure), your knees feel inflamed rendering you physically inactive as walking becomes all painful.
During a knee replacement, the damaged cartilage or bones are removed. Afterwards, artificial parts are used for the recreation of the joint. These artificial parts are also called prosthesis in medical parlance.
Post-operative care (Rehabilitation Protocol)
After the surgery, you are given rehabilitation care. The rules and guidelines for that are as follows.
Recovery room
Once a joint has been replaced, you will be taken to the rehabilitation or recovery room. You will receive the utmost medical care and attention there.
The patient is monitored very closely to make sure heart rate, blood pressure, and oxygen levels are normal. It helps find out in advance if anything might go wrong in the near future.
Pain management
This is one of the most crucial—after-surgery rehabilitation—elements. Without it, the recovery will be unbearable.
Your surgeon can use a variety of medicines to relieve knee pain immediately after surgery when you wake up from your anaesthesia.
Physical therapy
After some time, when you have recovered sufficiently from the surgery, you will receive physical therapy. In this, you will have to work with a physiotherapist to expand your range of knee joint mobility.
You will do certain exercises, receive massages or learn to give the replaced joint several hand massages with the right techniques.
Besides, physical therapy also includes heat and ice treatment for pain management. In short, your replaced joints will be taken care of in every way except with the use of medicine or drugs to relieve pain, increase your range of motion and go back to normal life faster after the surgery.
Hospital stay
Physiotherapy along with occupational therapy help a patient post-replacement to get back to normal life. You become able to walk, stand or exercise lightly without any trouble.
How soon one completes the recovery period totally varies from person to person. Thus, a person might stay at the rehabilitation facility longer than other human beings.
If you tend to exhibit complication symptoms, the surgeon will not discharge you from the hospital and your hospital stay might get extended.
Conclusion
A total hip or knee replacement is a complicated procedure. It requires a lot of precision and dexterity (skilled hands) for the most desired results. Thus, before you make a decision to go for a replacement, see that you can first ensure the top hip replacement surgeon in Delhi or whatever location you find comfortable.
