Orthopaedic Surgery

When should hip and knee replacement be recommended?

A variety of conditions can result in a reduced range of motion in your hip and knee, such as osteoarthritis and rheumatoid arthritis. Joint pain is often caused by damage to the cartilage that lines the ends of the bones (articular cartilage) caused by an arthritis, a fracture or another disease. It is this sharp pain that prompts patients to seek medical treatment.

If nonsurgical treatments such as medications, physical therapy and lifestyle changes do not alleviate your pain and discomfort, your doctor may suggest total joint replacement.

What happens during hip and knee replacement surgery?

In cases requiring hip replacement, the damaged ball and socket joint is removed and replaced with either a metal or ceramic ball. This ball is connected to a stem that fits into the femur (thigh bone). The prosthesis is normally covered with a specific material into which the bone can develop over time.

However, in some cases, the prosthesis is cemented into the bone. The socket part of the ball and socket joint is also replaced by a metal cup that is inserted into the pelvis. After that, a plastic liner is snapped into the metal cup and rotates with the new ball at the end of the femoral stem. Prostheses and implants are available in a variety of shapes and sizes that can be customised according to the patient.

In knee replacement surgery, a thin layer of bone is removed from the end of the femur or thigh bone, the top of the tibia or leg bone, and the underside of the kneecap. The bone surfaces are then moulded and sized with tools to allow for an optimal implant fit for each individual knee.

The major ligaments and tendons of the knee are usually held in place to provide support and regular motion of the knee joint. Knee replacements, like hip replacements, may be cemented in place or covered in a special material into which bone can develop.

Complications

Your orthopaedic specialist will discuss the possible risks and complications of hip and knee replacement surgery, including those linked to the surgery itself and those that may arise over time following the surgery.

Complications that may arise during or post-surgery include infection, blood clots, nerve damage, and prosthesis issues such as loosening or dislocation. However, such complications are not common.

Recovery

Each patient’s recovery and rehabilitation is unique. In most cases, your doctor will advise you to start using your "new" joint as soon as possible after surgery.

Most patients will experience some temporary pain in the replaced joint as the surrounding muscles are weak from inactivity. The body is also adjusting to the new joint and the tissues are healing. This pain should resolve in a few months.

Exercise is a key element of the healing process. The doctor or physical therapist may recommend specific exercises to help restore mobility and stabilise the joint.

If you have any questions about movement limits after hip or knee replacement surgery, please consult your doctor.

Long-Term Outcomes

After joint replacement surgery, the majority of patients are able to enjoy everyday tasks with greater ease. Most people can expect their joint replacement to last for several years, providing them with a higher quality of life, including reduced pain and increased motion and strength that would not have been possible otherwise.

At Parkcity Medical Centre (PMC), our team of exceptional orthopaedic specialists provide high-quality care for a large range of orthopaedic conditions. Our highly experienced orthopaedic surgeons provide first-rate surgical intervention covering a large number of procedures such as hip and knee replacements, shoulder injuries and spinal surgery, as well as offering exceptional clinical care for the treatment of sporting injuries.

Diagnostic and Therapeutic Spinal Injections

Selective spinal injections are being performed with increasing frequency in the management of acute and chronic pain syndromes. A few of the most common indications for these diagnostic and therapeutic spinal procedures are noted as follows:

• Spinal nerve radiculopathy;
• Spinal stenosis;
• Discogenic pain (i.e., symptomatic, internal disc disruption);
• Contained, disc bulge, or protrusion vs. extruded or sequestered herniated disc;
• Multilevel degenerative disc disease;
• Facet joint arthropathy or associated facet joint nerve pain;
• Sacroiliac joint pain dysfunction;
• Failed back surgery syndrome (FBSS);
• Epidural and/or perineural fibrosis/granulation with associated symptomatic pain;
• Complex regional pain syndrome (CRPS) (formerly known as reflex sympathetic dystrophy, RSD).

Most commonly done are:

• Epidural steroid injections (translaminar, transforaminal, caudal);
• Facet joint nerve blocks and facet joint intra-articular injections;
• Neurolytic and radiofrequency (RF) nerve ablation procedures;
• Sacroiliac joint and other intra-articular joint injections;
• Sympathetic ganglion nerve blocks;
• Diagnostic discographic injections;

Ultrasound-guided procedures

In recent years, there has been a movement to perform more and more procedures under ultrasound guidance. Retroperitoneal masses, pleural-based masses, deep masses in the liver, and musculoskeletal masses that were once typically biopsied under CT guidance or in open surgical biopsies are now being successfully performed using ultrasound guidance

The main advantage of using ultrasound for guidance is to have continuous real-time visualisation of the biopsy needle, which allows adjustment of the needle as needed during the procedure. As the biopsy specimen is being obtained, the needle tip can be watched in real-time to ensure that it does not slip outside the mass

The Benefits of Ultrasound-Guided Injections

Ultrasound, also known as sonography, is an imaging method that uses high-frequency sound waves to produce real-time and dynamic images of the body. Ultrasound is increasingly being used to assist Sports Medicine Physicians, Rheumatologists, Orthopaedists, and Primary Care Physicians in performing evaluations and injections of different muscles, tendons, ligaments and joints.

With the advancement of this technology, ultrasound machines have become smaller and more portable. This has allowed treating clinicians to be able to use real time, point of care ultrasound, to assist in the diagnosis and treatment of their patients. Although ultrasound is frequently used to identify injuries or abnormalities; it is also used when performing injections into the knee, shoulder and hip.

Injections can be beneficial for both the diagnostic and therapeutic treatment of a variety of problems involving the hip, shoulder, and knee. Typical problems include osteoarthritis, rheumatoid arthritis, labral tears, muscle tears, ligament tears and tendinopathies.

Injections have been used in the management of inflammatory and degenerative conditions when rest, ice and anti-inflammatory medications fail to provide adequate relief. The use of ultrasound improves the accuracy of the injection of corticosteroids, hyaluronic acid or other therapies such as Platelet Rich Plasma, Prolotherapy or Stem Cells.

Ultrasound can also be used for joint aspirations to rule out joint infection or gout. Lastly, guided injections can be used diagnostically to help determine which structures are generating the patient’s pain.

Ultrasound-guided injections allow the practitioner to visualise the needle in real time as it enters the body and traverses to the desired location. This assures that the medication is accurately injected at the intended site. Despite good intentions, even in the most experienced hands, blind (injections performed without imaging) injections are not 100% accurate and in some joints accuracy is as low as 30%-40%.

With ultrasound guidance, the accuracy of nearly every joint injection exceeds 90% and approaches 100% in many. Additionally, ultrasound guided injections have been shown to be less painful than blind injections.

Ultrasound injections also have the advantage of giving “real time” and “dynamic” feedback that the patient and the doctor can see and use immediately. The doctor is able to watch the desired treatment being delivered to the intended target and even visualise surrounding structures both before during and even after the procedure.

Although there are many different types of imaging that can be used to assist with injections, ultrasound has a few distinct advantages.

1. Ultrasound has no radiation. Fluoroscopy (a type of real time X-ray) allows the provider to easily visualise the joint making injections easier, however, fluoroscopy is associated with repeated doses of radiation. Additionally, with fluoroscopy, the providers are unable to visualise surrounding soft tissue structures including tendon, blood vessels or nerves that may be in the path of the needle. This could lead to increased pain or other complications from the injection.

2. Ultrasound allows us to visualise the bony joint as well as all of the surrounding structures. Moving the ultrasound probe, the practitioner can visualise what may be in the path of the needle and avoid any unwanted complications before they happen.

3. Ultrasound is able to identify fluid better than conventional radiographs and can see fluid that may have accumulated in and around joints, tendons, muscles, nerves and other soft-tissue structures. CT-guided (or CAT Scan) injections are also frequently used to assist in delivering treatments. With the CT, we are able to get a 3D view of the joint to be injected and can accurately deliver the intended medication, however, these tests come with an increasingly large dose of radiation, they are expensive and time-consuming. Ultrasound injections have been shown to be as accurate as these other imaging-modalities with less cost, improved soft tissue visualisation and without the associated radiation.

Ultrasound-guided injections have been extensively studied and have been found to have very few complications.

The risks associated with these procedures are the same as any type of injection: incomplete reduction of pain, bleeding, damage to surrounding structures and infection. The overall risks for injections are very low and the use of ultrasound guidance may further reduce some of these risks

Ultrasound is beneficial when performing injections in the knee, shoulder and hip; as well as many other structures throughout the body.

At ParkCity Medical Centre, our exceptional team of orthopaedic specialists offers high-quality care for a wide range of orthopaedic conditions, eve when it comes to niche areas such as minimally invasive interventional spine treatment. Our highly skilled orthopaedic surgeons are sure to provide you first-rate surgical intervention with a lot of care.