American Medical Association Family Medical Guide - American Medical Association [702]
Hip replacement surgery
In a hip replacement, the surgeon removes the end of the thighbone affected by arthritis (left) and creates a hollow channel in the bone. A metal shaft (with a ball at the head) is inserted into the channel in the thighbone (center). The surgeon creates a cavity in the hipbone and implants a plastic socket in the cavity. The metal ball is fitted into the plastic socket (right), forming an artificial hip joint that works like a natural ball-and-socket hip joint.
Arthrodesis
A surgical procedure called arthrodesis, or joint fusion, sometimes is used to correct severe joint problems caused by osteoarthritis. In this procedure, the surgeon makes the affected joint permanently immobile by using a bone graft and inserting metal screws, plates, and rods to hold the joint in place. Arthrodesis is performed only when the pain from osteoarthritis is so severe that immobilizing the joint is an improvement. This procedure is usually performed on smaller joints such as those in the fingers, toes, ankles, or feet.
Osteotomy
Osteotomy is a surgical procedure most often performed on younger people who have a joint (usually a hip or knee) that has been unevenly damaged by osteoarthritis. The procedure is done to relieve stress on the cartilage and prevent further damage to the joint. During an osteotomy, the surgeon removes a small wedge of bone near the affected joint. Removing the piece of bone realigns the bone and improves the contact between the remaining, healthy areas of cartilage in the joint. In younger people, this procedure can delay joint replacement surgery for years.
Arthroscopy
Arthroscopy, or “scoping” a joint, is an outpatient procedure that is used to examine and sometimes repair joints. The procedure is performed most often on knees and shoulders but can be done on other joints, including the hip. For arthroscopy, the doctor inserts a viewing tube (arthroscope) through a small incision into the fluid-filled space in the affected joint. Through the arthroscope the doctor can see any tissue damage and make necessary repairs. Although the repair may provide temporary relief of symptoms, it does not stop the progression of arthritis.
Cartilage transplantation
Unlike bone, cartilage that is injured does not rejuvenate. Cartilage injuries commonly occur with ligament injuries. Damaged cartilage can increase friction in joints, sometimes leading to osteoarthritis. Cartilage transplantation uses live cells from donated cartilage. The donated cartilage must be transplanted within 72 hours. The graft is made of cartilage and bone (the person’s bone heals into the donated bone supporting the cartilage).
Dislocated Joint
A joint is dislocated if the bones that normally connect in the joint are pulled apart, usually by a severe injury. Dislocations that are not caused by injury may be present from birth (such as congenital dislocation of the hip; see page 401) or may occur as a complication of rheumatoid arthritis (see page 918).
A dislocation can occur repeatedly in a joint that has been weakened by an earlier injury. The jaw and shoulder joints are especially susceptible to recurring dislocation. Dislocation of vertebrae can damage the entire spinal cord, sometimes causing paralysis of areas of the body below the level of the injury. Dislocation of a shoulder or hip can cause paralysis of an adjacent arm or leg by damaging the main nerves to the arm or leg. Some joints that have been dislocated can eventually become susceptible to osteoarthritis (see page 996).
Symptoms and Diagnosis
A dislocated joint is usually painful, swollen, and discolored, and cannot be moved. See your doctor or go to the nearest hospital emergency department immediately if you think you have dislocated a