Arthroplasty is a reconstructive surgery to restore joint motion and function or relieve pain by replacing damaged bone and joint surfaces with prosthetic implants. The document discusses various types of arthroplasty including hip, knee, and shoulder arthroplasty. It describes the principles of arthroplasty, techniques, approaches, and potential complications for each type of joint replacement surgery.

1. ARTHROPLASTY
SANA MASROOR
MPT 2ND SEM.
ORTHOPAEDICS SURGERY AND MEDICINE
2018

2. Introduction
◦ Arthroplasty is a reconstructive surgery to restore the joint motion and function
and to relieve pain. It generally involves the replacement of bony joint structure
by a prosthesis.
◦ Main varieties:-

3. ◦ John Charnely (1979) revolutionized the management of the arthritic hip with the
development of low-friction arthroplasty.
◦ His three major contribution to the evolution of hip replacement were:-
1. The concept of low-friction torque arthroplasty.
2. The use of acryclic cement to fix the components.
3. The introduction of high-density polyethylene as a bearing materials.

4. Principles
◦ Durable.
◦ They must permit extraordinary low-friction movement at the articulation.
◦ They must be firmly fixed to the skeleton.
◦ They must be inert and not provoke any unwanted reaction in the tissue.
◦ The prostheses are of various designs and may be fixed to the remaining bone by cement, press
fit, or bone ingrowth.
◦ Selection of the prosthesis and fixation technique depends on patient’s bone structure, joint
stability, and other individual characteristics, including age, weight, and activity level.

5. Hip Arthroplasty
◦ Indication: sever OA and RA, fracture, failure
of previous surgery, congenital hip disease
◦ Implant
◦ Type of fixation
- Cemented
- Uncemented

7. Techniques
◦ Posterior (Moore) :- The posterior (Moore or Southern) approach accesses the
joint and capsule through the back, taking piriformis muscle and the short
external rotators off the femur.
◦ Lateral (Hardinge or Liverpool) :- The lateral approach is also commonly used
for hip replacement. The approach requires elevation of the hip abductors
(gluteus medius and gluteus minimus) to access the joint.
◦ Antero-lateral (Watson-Jones) :- The anterolateral approach develops the
interval between the tensor fasciae latae and the gluteus medius.
◦ Anterior (Smith-Petersen) :- The anterior approach uses an interval between
the sartorius muscle and tensor fascia latae.
◦ Greater trochanter osteotomy.
◦ Minimally invasive approach.

8. Complication
◦ Intraoperative complication
◦ Sciatic nerve injury
◦ Postoperative dislocation
◦ Heterotropic bone formation
◦ Aseptic loosening
◦ Osteolysis
◦ Infection

9. Knee Arthroplasty
◦ Principles:
-Restore limb alignment
-Achieve soft tissue balance
-Use correct implant
-Restore joint line
-Obtain good range of motion
◦ Indication: pain combined with deformity and instability
◦ Types of operation
-partial replacement
-minimally constrained total replacement
-constrained joint
-minimally invasive total knee replacement

10. ◦ Approaches;
◦ "simple" primary knee arthroplasty approaches
◦ medial parapatellar
◦ midvastus
◦ subvastus
◦ minimally invasive
◦ "complex" primary or revision total knee
arthroplasty
◦ quadriceps snip
◦ V-Y turndown
◦ tibial tubercle osteotomy

11. Complication
◦ Infection
◦ Loosening
◦ Patellar problem

12. Shoulder Arthroplasty
◦ Shoulder replacement was initially introduced by Neer in the 1950s
◦ The indications for arthroplasty are:
1. Osteoarthritis causing pain and loss of movement
2. Rheumatoid arthritis
3. Complex fractures of the proximal humerus
4. Avascular necrosis of the humeral head
5. Tumours of the proximal humerus
6. Severe arthritis with cuff arthropathy.
◦ Approach:
-Deltopectoral

14. Complication
◦ Loosening of the components
◦ gleno-humeral instability
◦ Rotator cuff failure
◦ peri-prosthetic fracture
◦ infection
◦ implant failure