WINTER is when old bones feel older, aches and pains get acute and movement becomes a bigger bother. But there’s a solution: joint replacement. It’s a fairly common surgery in India, and not just for the aged. When is surgery recommended?‘‘Treatment always aims to eliminate pain and discomfort; replacement is recommended when other methods have failed, and the pain affects normal functioning,’’ says Dr Yash Gulati, senior consultant, department of spine surgery and joint replacement, Indraprastha Apollo Hospital, New Delhi. And he says ‘replacement’ is a misnomer, since the surgery is for joint resurfacing, and not replacement. ‘‘A troublesome knee may be repaired or the damaged parts replaced. A joint surface is prepared using stainless steel on one side and high-density polythelene on the other, and fitted over the joint for support and action.’’ What is the process of joint replacement?The diseased or damaged parts are removed, and artificial parts, called prostheses or implants, inserted. Prostheses are medical devices regulated by the Food and Drug Administration. Can all joints be operated upon?All major joint extremities can be operated on, though the hip and knee are most common. Replacements can also be performed on the shoulder, elbow, finger and ankle. What conditions necessitate a joint replacement?• Osteoarthritis: The most common reason for hip and knee replacement. ‘‘It’s a degenerative joint disease, marked by the breakdown of the joint’s cartilage. Although it commonly affects people over 45, younger men and women are not exempt,’’ says Dr Gulati. Some people are born with a deformed joint or defective cartilage, which leads to osteoarthritis. Excess weight, joint fracture, ligament tears and other injury can also damage cartilage and trigger osteoarthritis.• Rheumatoid arthritis: A chronic inflammation of the joint lining, and a trigger for pain, stiffness, and swelling. The inflamed lining can invade and damage bone and cartilage. It generally strikes during middle age, though it can affect children and young adults.• Avascular necrosis: This is the loss of bone caused by poor blood supply.• Bone tumours. What are the risks?Infection, blood clots and complications from anaesthesia. Other complications include nerve damage, dislocation or breakage after surgery, and wear out over time. Also, after a hip replacement, one leg may be shorter than the other. The benefits?Long-term pain relief. The effects of the surgery last for 15-20 years under ideal conditions. Patients have to be hospitalised for a week, and can walk independently in 6-12 weeks. The surgery costs about Rs 1.5 lakh.
