Type of Surgery
Information
Last updated: 11/24/2009
The goal of arthroplasty is to restore the function of a stiffened synovial joint and relieve pain. As a surgical procedure, it is usually performed when medical treatment has not improved function in the affected joint. There are two types of arthroplastic...
surgery: joint resection and interpositional reconstruction. Joint resection involves removing a portion of the bone from a stiffened joint, increasing the space between the bone and the socket to improve the range of motion. Scar tissue eventually fills the gap, narrowing joint space again. Pain is relieved and motion is restored, but the joint is less stable.
Interpositional reconstruction is surgery to reshape the joint and add a prosthetic disk between the two bones forming the joint. The prosthesis can be made of plastic, metal, ceramic material, or formed from such body tissue as skin, muscle, or fascia. When interpositional reconstruction fails, total joint replacement may be necessary. Joint replacement is also called total joint arthroplasty.
In recent years, joint replacement has become the operation of choice for most chronic knee and hip problems, particularly because of advances in the type and quality of prostheses (articifical joints). Elbow, shoulder, ankle, and finger joints are more likely to be treated with joint resection or interpositional reconstruction.
Arthroplasty is performed on people suffering from severe pain and disabling joint stiffness. Osteoarthritis (OA), a degenerative joint disease, is the most common condition causing joint destruction with pain and impaired movement. Other causes include rheumatoid arthritis (RA), hemophilia, synovitis, and rare bone diseases, which are all known to destroy cartilage. Joint resection, rather than joint replacement, is more likely to be performed on people with rheumatoid arthritis, especially when the elbow joint is involved. Joint replacement is usually reserved for older patients, because of the limited longevity of benefits. The younger the patient, the greater the reliance on medical treatment.
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This video contains an artist's representation of what bone looks like at the microscopic level. While many think that bone is simply a solid piece of calcium, it is actually a living, changing tissue with blood vessels and various small areas of open space.
In this shoulder arthroplasty procedure, an incision is made into the shoulder (A). The head of the humerus (upper arm bone) is removed from the shoulder joint, and bone growths, or osteophytes, are removed (B). Small holes are drilled into the head to accept the prosthesis (C). Similar holes are drilled in the glenoid cavity (shoulder joint) (D). The final prosthesis improves shoulder function (E). (Illustration by GGS Inc.)
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Arthroplasty (literally "formation of joint") is an operative procedure of orthopaedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure. Previously, a popular form of arthroplasty was interpositional arthroplasty with interposition of some other tissue like skin, muscle or tendon to keep inflammatory surfaces apart or excisional arthroplasty in which the joint surface and bone was removed leaving scar tissue to fill in the gap. Other forms of arthroplasty include resection(al) arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, silicone replacement arthroplasty, etc. Osteotomy to restore or modify joint congruity is also an arthroplasty.
For the last 45 years the most successful and common form of arthroplasty is the surgical replacement of arthritic or destructive or necrotic joint or joint surface with prosthesis. For example a hip joint that is affected by osteoarthritis may be replaced entirely (total hip arthroplasty) with a prosthetic hip. This would involve replacing both the acetabulum (hip socket) and the head and neck of the femur. 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.
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New procedures like minimally invasive procedures are often subject to scrutiny, but I think that one of the biggest problems facing these innovative procedures is for people to understand exactly what we do.
-Dr. Michael Perry, Laser Spine institute
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