detail description of the

1. TOTAL JOINT
TRANSPLANT AND
REPLACEMENT
SURGERIES.
MS. SAHELI C
1ST YEAR MSC NURSING.
RINER.

2. INTRODUCTION:-
 Total joint replacement is one of
the most commonly performed
and successful operations in
orthopedics as defined by clinical
outcomes and implant
survivorship.
 Most joint replacement consist of
metal (cobalt-chromium),
titanium and high density
polyethylene components.
 Total Joint replacement also
called as ‘ARTHROPLASTY’.

3.  Total joint replacement (TJR) is one of the most
cost-effective procedures in all of medicine.

4. DEFINITION:-
 Total joint replacement is a surgical procedure in which
parts of an arthritic or damaged joint are removed and
replaced with a metal, plastic or ceramic device called a
prosthesis. The prosthesis is designed to replicate the
movement of a normal, healthy joint.

5. PREVALENCE OF TJA:-
 Indian Society of Hip and Knee Surgeons has
established a ‘joints registry’ and has been
collecting data for last 6 years.
 Joint registry estimated that till date 34,478 Total
Knee Arthroplasty (TKA) and 3604 Total Hip
Arthroplasty (THP) has been done , contributed by
42 surgeons across INDIA.

6. TJA: INDICATIONS
 Debilitating joint pain.
 Slow loss of cartilage in affected
joints which related to loss of
motion and movement.
 Rheumatoid Arthritis.
 Osteoarthritis.
 Synovitis.
 Connective tissue disease.
 Paget’s disease.
 Congenital deformity.
 Trauma-RTA, Sports injury, Crush
injury.
 Tumors.
 Sepsis.
 Failed prior procedure.

7. Arthritis is the second most common
chronic condition in the US.
 Most common among elderly
20-30% of people over age 70 suffer from
osteoarthritis (OA) of the hip
Arthritis affects over 32 million people in
the US

8. GOALS OF JOINT REPLACEMENT
SURGERY
 Relieve pain.
 Improving joint
motion.
 Restore function,
mobility.
 Correcting deformity
and mal-alignment.
 Removing intra-
articular causes of
erosion.

9. COMMON REPLACEMENT SURGERIES
OF JOINTS:-
 Total Hip Replacement.
 Total Knee Replacement.
 Finger Joint Arthroplasty.
 Elbow and Shoulder Arthroplasty.
 Ankle Arthroplasty.

10. IMPLANT MATERIAL
1. Metal: Metal used in implants are screws, plates,
prosthesis. Those commonly used are stainless steel,
cobalt chromium alloys and titanium alloys.
2. Silicon compound: there is a wide variety of silicon
polymers of which silicon rubber is particularly used.
3. Ceramic compound: these are being used either alone or
bonded to metal for joint replacement prosthesis.
4. Carbon compound: is used to replace ligaments. This are
the substitute for natural ligament.
5. Acrylic cement: in joint replacements the prostheses are
often fixed to the bone with acrylic cement ( polymethyl
methacrylate ).
6. Hydroxyapatite:- this material has been used to reproduce
the osteoinductive and osteoconductive properties of bone
grafts.

11. TOTAL HIP REPLACEMENT :-
 Total 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 replacement.
 If Person’s hip has been damaged by arthritis, a fracture, or other
conditions, common activities such as walking or getting in and
out of a chair may be painful and difficult. Person’s hip may be
stiff, and it may be hard to put on shoes and socks. Person even
feel uncomfortable while resting.
 Hip replacement surgery is a safe and effective procedure that
can relieve pain, increase motion, and helps to get back to
enjoying normal, everyday activities.
 First performed in 1960, hip replacement surgery is one of the
most successful operations in all of medicine. Since 1960,
improvements in joint replacement surgical techniques and
technology have greatly increased the effectiveness of total hip
replacement.

12. THA IMPLANTS :-

13. IMPLANT CHOICE
Cemented:
•Elderly (>65)
•Low demand
•Better early
fixation
•late loosening

14. IMPLANT CHOICE :-
Cementless:
•Younger
•More active
•Protected weight-bearing
first 6 weeks
•Better long-term fixation

15. TECHNIQUE: TOTAL HIP REPLACEMENT
 Femoral neck resection

16. TECHNIQUE: TOTAL HIP REPLACEMENT
 Acetabular reaming
 Insertion of
acetabular
component

17. TECHNIQUE: TOTAL HIP REPLACEMENT
 Reaming/broaching of
femoral component
 Insertion of
femoral component

18. TECHNIQUE: TOTAL HIP REPLACEMENT
 Femoral head
impaction
 Final implant

19. TOTAL KNEE
REPLACEMENT

20.  Total knee replacement surgery is considered for
patients who have severe pain and functional disabilities
related to destruction of joint surfaces by osteoarthritis
and rheumatoid arthritis.
 Metal and acrylic prostheses designed to provide the
patient with a functional, painless , stable joint may be
used.

21. COMMON CONDITIONS THAT LEAD TO TKR
 Osteoarthritis
 Primary (idiopathic)
 Secondary
 Post traumatic arthritis
 Rheumatoid arthritis
RISK FACTORS OF OSTEOARTHRITIS
 Increasing age
 Obesity
 Female
 Trauma
 Infection
 Repetitive occupational trauma

22. KNEE REPLACEMENT:-
There are two types of knee replacement surgery:-
 Partial knee replacement
 Total knee replacement

23. EVALUATION OF PATIENT BEFORE
SURGERY
 A Complete Medical History.
 Thorough Physical Examination.
 Laboratory Work-up.
 Anaesthesia Assessment.

24. ANATOMY—KNEE

25. KNEE REPLACEMENT—IMPLANTS
Patellar
component

26. PROCEDURE :-

33. FINGER JOINT ARTHOPLASTY
 A silicon rubber arthroplastic device is used to help restore
function in the fingers of the patient with rheumatoid
arthritis.
 Before surgery the patient is instructed to do hand
exercises including flexion, extension, abduction,
adduction.
 Post-operatively the hand is kept elevated with a bulky
dressing in place and neuro-vascular assessment is
conducted to assess for signs of infection.
 Once the dressing is removed a guided splinting is initiated
and patient will be instructed to use splint while sleeping
and hand exercises to be performed.

34. ELBOW AND SHOULDER
ARTHROPLASTY
 This procedure is not as common as other forms of
arthroplasty.
 Shoulder replacement is usually performed in patient
with severe pain because of rheumatoid arthritis,
osteoarthritis, trauma, avascular necrosis.
 If joint replacement is necessary for both elbow and
shoulder than elbow is usually done first because a
severely painful elbow may interfere with shoulder
rehabilitation programme.
 Functional improvement have resulted in better hygiene
and increased ability to perform activities of daily living
in most patients.

35. ANKLE ARTHROPLASTY
 Indications of ankle arthroplasty include rheumatoid
arthritis, osteoarthritis, trauma and avascular necrosis.
 Ankle fusion is selected over arthroplasty.
 Post-operatively the patient may not bear weight for 6
weeks and must elevate the extremity to reduce and
prevent edema, and be cautious to prevent infection and
patient should maintain immobilization.

36. CAUSES OF TOTAL JOINT
REPLACEMENT FAILURE.

37. DISLOCATION/ INSTABILITY

38. INFECTION

39. TEAR OF ARTICULAR BEARING SURFACE

40. OSTEOLYSIS

41. ASEPTIC/MECHANICAL LOOSENING

42. PERI-PROSTHETIC FRACTURE
 Sri: PP fracture

43. IMPLANT FAILURE

44. MAJOR OSSEOUS DEFECTS

45. THANK
YOU!!!

46. QUESTIONS?
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