WhatsAppJoint Replacement Operations
In advanced joint damage, the Academic Hospital Hip and Knee Replacement Surgery Department replaces the damaged joint surfaces with biocompatible implants, eliminating pain and restoring mobility. A wide patient group is served, from osteoarthritis to rheumatoid arthritis and from avascular necrosis to joint damage following a fracture. Supported by robotic planning systems and enhanced recovery protocols, the surgical team creates an individualised treatment plan for every patient.
Contents
- What Is Hip and Knee Replacement Surgery?
- Which Diseases and Conditions Are Treated Surgically?
- When Should You Consult Us?
- Preoperative Assessment
- Operations and Surgical Procedures Performed
- The Postoperative Process
- Hip and Knee Replacement Surgery at Academic Hospital
- Frequently Asked Questions
- References
What Is Hip and Knee Replacement Surgery?
Joint replacement surgery (arthroplasty) is the surgical specialty in which damaged joint surfaces are replaced with implants made of metal, ceramic or polyethylene components, in joints where the cartilage and bone tissue have been severely destroyed. Total hip arthroplasty covers the acetabulum and the femoral head, while total knee arthroplasty covers the distal femur, the proximal tibia and, where necessary, the patellar surface. In partial (unicompartmental) knee arthroplasty only the damaged compartment of the joint is replaced; healthy tissue and ligaments are preserved. This surgical field is a subspecialty of orthopaedics and traumatology and also covers revision arthroplasty and robotic-assisted systems.
Which Diseases and Conditions Are Treated Surgically?
| Disease or condition | Description |
|---|---|
| Advanced cartilage loss and narrowing of the joint space in the hip joint | |
| Degenerative damage in the medial, lateral or patellofemoral compartment of the knee joint | |
| Inflammatory arthritis with joint involvement; a surgical indication arises in severe joint damage that does not respond to drug therapy | |
| Death of bone tissue in the femoral head due to impaired blood supply | |
| An indication for partial or total hip replacement, particularly in elderly patients | |
| Joint damage developing after a fracture or serious joint injury | |
| Early joint damage due to acetabular dysplasia | |
| Implant loosening, aseptic (non-infected) or septic (infected) failure, polyethylene wear |
When Should You Consult Us?
The following symptoms indicate that you should consult an orthopaedic specialist:
- Knee or hip pain lasting at least 6 months that does not improve sufficiently with medication and physiotherapy
- Joint pain that continues at rest during the night; episodes of pain that disturb sleep
- Pain that prevents walking even over distances shorter than 500 metres
- Marked difficulty going up and down stairs and sitting down or standing up
- Swelling, increased warmth or visible deformity in the joint area
- A sudden increase in pain, a feeling of instability, or catching and clicking sounds if a replacement has previously been fitted
Postponing joint pain for a long time can weaken the surrounding muscles and cause bone loss, which may increase the surgical risk.
Preoperative Assessment
A comprehensive assessment process is carried out before replacement surgery; this process both confirms the indication and increases the safety of the operation.
| Assessment | What it provides |
|---|---|
| Assessment of joint space narrowing, osteophyte formation and deformity; the basis of implant sizing | |
| Detection of the depth of cartilage loss, meniscal pathologies, bone oedema and early-stage avascular necrosis | |
| Creation of a three-dimensional anatomical model for robotic surgical planning; it provides additional information in complex deformities and revision cases | |
| Determination of the presence and severity of osteoporosis; it affects the implant fixation method | |
| Full blood count, coagulation tests, inflammatory markers (CRP, sedimentation rate), kidney and liver function tests | |
| Preoperative cardiac assessment in patients over 50 or with cardiac risk factors | |
| ASA classification, choice of anaesthesia method (general, spinal or epidural) and adjustment of medication | |
| Weight loss before surgery in patients with a BMI over 40; it has a direct effect on wound healing and implant life |
Operations and Surgical Procedures Performed
The surgical method is selected according to the location and degree of joint damage and the patient's age and activity level.
| Operation or procedure | How it is performed |
|---|---|
| The standard total knee replacement in which all the joint surfaces of the femur, the tibia and, where necessary, the patella are replaced; the implant design is chosen according to the distribution of compartment damage and the state of ligament balance | |
| Replacement of only the damaged medial, lateral or patellofemoral compartment; healthy tissue is preserved and the recovery period is shorter | |
| The standard hip replacement in which the acetabulum and the femoral head are replaced; the anterior, posterior or lateral approach is chosen according to the patient's anatomy and the surgeon's experience | |
| A partial replacement in which only the femoral head is replaced; it is preferred particularly in elderly patients who have sustained a femoral neck fracture | |
| Removal and renewal of an implant that has loosened, become infected or worn out; it is a more complex operation than a primary replacement and requires special revision implants | |
| Preoperative planning with millimetric precision on a 3D model obtained from CT images; placement of the implant in the anatomical position with real-time intraoperative alignment verification. It offers a marked advantage particularly in patients with deformity and in those undergoing revision | |
| Cementless (press-fit) fixation in young patients with good bone quality; the cemented technique is preferred where osteoporosis is present |
The Postoperative Process
Thanks to enhanced recovery protocols, rehabilitation after replacement surgery begins on the day of the operation.
| Stage | What to expect |
|---|---|
| Under enhanced protocols, walking is started with a physiotherapist on the day of surgery or on the first day; this both reduces the risk of clots and allows muscle strength to be regained more quickly | |
| Anticoagulant medication and pneumatic compression stockings to prevent deep vein thrombosis (clots) begin on the day of surgery; this usually lasts 4 to 6 weeks | |
| 1 to 3 days under enhanced protocols; it may be longer in revision and complex cases | |
| A comprehensive exercise programme lasting 3 to 6 months after discharge; it covers strengthening, range of motion and gait training | |
| Return to daily activities takes 6 to 8 weeks and full recovery is completed within 6 to 12 months | |
| Joint-friendly sports such as swimming and cycling can be started at 3 to 4 months; running, jumping and contact sports are not recommended because they accelerate implant wear | |
| Between 90 and 95 percent of modern implants function without problems for 15 to 20 years; annual orthopaedic checks allow early complications to be detected |
Book an appointment with the Hip and Knee Replacement Surgery Department.
Book an AppointmentHip and Knee Replacement Surgery at Academic Hospital
The Academic Hospital Hip and Knee Replacement Surgery Department manages the whole pathway under one roof, from preoperative planning to rehabilitation after discharge. The following departments are involved throughout the process:
- Orthopaedics and Traumatology: assessment of joint damage and determination of the surgical indication
- Physical Medicine and Rehabilitation: postoperative strengthening, range of motion and gait training programme
- Rheumatology: drug therapy and follow-up of inflammatory joint diseases such as rheumatoid arthritis
- Radiology: surgical planning with joint radiographs, magnetic resonance imaging and computed tomography
- Anaesthesia and Reanimation: choice of anaesthesia method and postoperative pain management
- Cardiology: preoperative cardiac risk assessment and consultation
- Sports and Knee Injuries: assessment of knee injuries before replacement and joint-preserving treatments
Frequently Asked Questions
References
The general information given on this page about the indications for joint replacement surgery, the operations performed and the postoperative process is supported by the reliable health sources listed below.
- American Academy of Orthopaedic Surgeons, "Total Knee Replacement", orthoinfo.aaos.org
- American Academy of Orthopaedic Surgeons, "Total Hip Replacement", orthoinfo.aaos.org
- National Institute for Health and Care Excellence (NICE), "Knee replacement: management. NG157", nice.org.uk
- Learmonth ID, Young C, Rorabeck C, "The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-1519", pubmed.ncbi.nlm.nih.gov
The information on this page is for informational purposes only; it does not replace medical examination, diagnosis or treatment. Please consult a healthcare institution regarding your complaints.
