Today’s living conditions, our habits and human life, which is longer than in ancient times, have caused some medical results as well as good results. The joints in our body (especially the knee and hip joints) begin to wear out with advancing age. Although this process varies from person to person, it usually starts after the age of 40. The most remarkable feature here is that it does not cause any complaints in the first years of wear.
Wear and deterioration in the joints progresses rapidly, especially with weight. In addition, life habits and heavy work conditions initiate and accelerate the process. Not using the joints adequately, that is, a sedentary lifestyle can have a negative effect on wear and tear on the joints.
Joint wear is a natural process. Here, the desired and expected aging is the progression of the person’s own age. Orthopedic surgery interferes with the deterioration in this process. Causes of premature wear by age:
2. Joint traumas and joint fractures
Rheumatic and metabolic bone diseases that cause rapid wear on the third joint
heavy work and living conditions
5.traditional living habits (sitting styles etc.)
Various treatment procedures are applied according to the degree of deterioration in joint deterioration. In this article, I will talk about prosthetic surgery applications, which are part of the treatment. The most important point to be considered in prosthetic surgery is that this method is the last option. In other words, prosthesis treatment comes to the fore in patients whose problems cannot be solved with other treatments. Another aspect of the issue is whether a prosthesis should be applied to a patient who is in the normal aging process and has complaints. The approach to the subject is not clear today. In general, it is evaluated with criteria such as patient demand and how much it limits daily activation, and the patient and physician decide together. (comfort surgery-elective surgery)
Another group that will undergo prosthetic surgery is the group of young patients with congenital joint anomaly. (such as congenital hip dislocation)
Finally, prosthetic surgery can be considered in joint fractures that are too deformed to be restored due to trauma.
Regardless of the reason, if the joint is deformed and the patient’s quality of life has started to suffer serious losses, if the decision for prosthetic surgery is taken, the process is started.
Planning and Preparation
The patient’s age and co-morbidities determine the process. Evaluates other branch physicians under the coordination of the anesthesiologist. (Internal medicine, cardiology, chest diseases …) blood sugar regulation is very important, especially in systemic diseases such as diabetes. If urinary tract infection or gum infection is present, it should be treated before surgery.
It is one of the most important conditions for success in surgery. Today, there are various types of prostheses designed according to the patient’s age, bone quality, joint structure and the patient’s expectations. The main thing here is to determine and use the right type of prosthesis for the right patient. For example, in hip prostheses, there are prosthesis types such as total or partial, cemented or uncemented. The concept of good or bad prosthesis is wrong here. The best prosthesis is the one that suits the patient.
The patient, whose preparations are completed, is taken into surgery. The form of anesthesia is taken jointly by the patient, the anesthesiologist and the surgeon. The decisive factor here is the patient’s preference and the decision of the anesthesiologist. In general, spinal or spinal epidural anesthesia forms are preferred in hip, knee and ankle prostheses. (waist numbing)
It is important that the operating room has the infrastructure and standards applicable to prosthetic surgery. In particular, material sterilization is very important. It is necessary to have a sufficient number of hand tools.
The duration of surgery varies according to the prosthesis and the type of prosthesis. 1-1.5 hours for knee prostheses
30-45 minutes in hip prostheses (partial)
(total) 1-1.5 hours
1.5-2 hours for ankle prostheses
1 hour for shoulder prostheses (partial)
(total) 1.5-2 hours
1.5-2 hours for elbow prostheses
Except for hip and shoulder prostheses, there is no bleeding since a tourniquet is used during the surgery in other prosthesis applications. If necessary, blood transfusion can be done during surgery in hip and shoulder prostheses.
The average hospital stay after surgery is 3-5 days. The first two weeks are wound care and dressing process. Rehabilitation should be started quickly the next day after surgery. The form and process of physical therapy are very different. But the main idea of the subject is the rapid operation of the prosthetic joint of the patient. There are great differences, especially in hip replacements. While starting to walk with full weight in partial dentures, partial load should be given in total dentures. Gaining the full range of motion of the joint is important in prostheses such as the knee, elbow and shoulder area. Although this process varies, it requires an average of 2-3 months of rehabilitation.
As a result, prosthesis surgery provides serious comfort when it is performed on the right patient at the right time and using the right techniques. As with all surgical procedures, there are risks of complications. However, these risks are minimal considering the benefit ratio. Each prosthesis applied to the body has a certain lifespan and these times vary. The most decisive factor in this is the bone quality and the material used. Especially in the last 10 years, the surfaces of the prostheses have been improved, ensuring a better integration with the bone, and the length of stay in the body has been extended. This factor should be taken into consideration in every patient undergoing prosthesis surgery and the patient should be informed. Since the expected life expectancy is long especially in the young age group, it is almost certain that the prosthesis will be renewed.