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Joint Replacement & Arthroscopic

Joint Replacement and Arthroscopy

When it comes to chronic and severe joint pains, making the right decision is the most crucial part of the patient treatment. It is extremely important for the patient to be well aware of the difference in procedures, along with the  advantages and disadvantages of joint replacement and arthroscopy.

Depending upon the complexity and severity of the  joint pain it is highly essential to opt for the right choice of  surgery so as to attain maximum relief with minimum risk so that the patient can lead a healthy happy life.

Joint Replacement

Joint replacement is usually the last line of treatment for any  joint diseases when all other treatments that involve physical therapy and medications seem to have made no difference in patient’s quality of life. Without a doubt, replacement surgery is a highly effective way of  eliminating joint pain, correcting a deformity, and helping improve the patient’s mobility.

Primary and Revision Knee Replacement

If you have been asked to consider a knee surgery by your doctor the following total  knee replacement information might help you understand the procedure in a better manner.

Usually the human knees work hard during the daily routine. The arthritis of the knee or an injury in the knee can make it hard for the patient to perform his/her usual tasks. If the injury or arthritis is severe, there may be an experience of pain when the patient is sitting down or trying to sleep.

A total  knee replacement involves cutting away the damaged bone of the knee joint and replacing it with a prosthesis. The “new joint” prevents the rubbing of bones providing a smooth functioning of the knee joint.

After the  surgical procedure is done, the patient is discharged when he/she is able to walk with a walker or crutches and can bend the knee 90 degrees and straighten it.

A routine of home exercises is prescribed along with the physical therapy, where the patient will work on an advanced strengthening program and such programs as stationary cycling, walking, and aquatic therapy.

Revision Knee Replacement:

After a few years of  knee replacement surgery, it may fail for various reasons. In such circumstances, the knee can become painful and swollen. It may also feel stiff or unstable, making it difficult to perform everyday activities.

In such cases, the doctors recommend that to have a second surgery—revision total knee replacement. In this procedure, there is removal of some or all of the parts of the original prosthesis and it is replaced with new ones.

Partial Knee Replacement

This surgical procedure is less invasive than total  knee replacement. It is usually prescribed for people who are suffering from  arthritis of the knee or have faced an injury of the knee. Partial  knee replacement surgery replaces only the damaged area of the knee joint. It requires dramatically less recovery time when compared with total  knee replacement surgery.

The human knee has three compartments: the medial compartment, the lateral compartment, and the patello-femoral compartment. The uni-compartmental implant is designed to replace either the medial or lateral compartment.

The  surgical procedure begins with an incision of 3 to 4 inches. Further, there is a balancing of the knee joint. After this, the end of the femur and top of the tibia are shaped to accommodate the uni-compartmental  knee replacement components. Trial components are placed on the bones to ensure proper alignment and are removed once this alignment is achieved. Here, the femoral and tibial components are implanted. With this, the incision is closed and the procedure is completed.

It is a  minimally-invasive surgical procedure that provides several benefits to patients who have an active lifestyle, are within normal weight ranges, and have arthritis that is confined to a single compartment. The procedure causes less post-operative pain and requires reduced hospitalization as compared to a total knee replacement. Also, patients recover faster and experience an increased range of motion as compared to total knee replacement.

Primary and Revision Hip Replacement

In a total  hip replacement surgery, a part of the thigh bone (femur) including the ball (head of the femur) is removed and a new, smaller artificial ball is fixed into the thigh bone. The surface of the existing socket in the pelvis (the acetabulum) is made a bit rough to accept a new socket component that will then articulate with the new ball component.

A number of  artificial joint components are fixed into the bone with acrylic cement. However, these days, it is becoming more common for one part (usually the socket) or both parts to be inserted without cement. In such cases if the cement isn’t used, the surfaces of the implants turn rough. Bone is a living substance and, as long as it’s strong and healthy, it’ll continue to renew itself over time and provide a long-lasting bond. Where only one part is fixed with cement, it’s known as a hybrid  hip replacement.The replacement components can be of plastic (polyethylene), metal or ceramic and can be used in different combinations:

Metal-on-plastic i.e. a metal ball with a plastic socket is the most commonly used combination.

Ceramic-on-plastic i.e a ceramic ball with a plastic socket or ceramic-on-ceramic i.e. where both parts are ceramic. It is often used in younger, more active patients.

Ceramic-on-ceramic i.e.a ceramic ball with a ceramic socket is a combination that is used very rarely.

Revision Hip Replacement

Years after the  hip replacement surgery, complications may occur. That is when the expert recommends the patient to have a second surgery to remove some or all of the parts of the original prosthesis and replace them with new ones. This procedure is called revision total  hip replacement surgery.

Although both procedures have the same goals i.e. to reduce or eliminate pain and improve function and quality of life, the revision surgery is different than primary total hip replacement. Revision  hip replacement is a longer, more complex procedure.

Shoulder Replacement

The  shoulder replacement surgery is an option for treating severe arthritis of the shoulder joint. In the condition of arthritis, the smooth cartilage lining of the joint is seen to be eroded. As the cartilage wears, the protective layer between the bones is lost. In such a condition, painful bone-on-bone arthritis is seen to develop. Severe  shoulder arthritis cause restriction of shoulder motion and severe pain. Initially it is treated with simple treatments like medications and lifestyle adjustments. But sometimes, if the severity is too high, there is a need for  surgical procedures.

The common symptoms of the shoulder arthritis include, pain with activities, limited range of motion, stiffness of the shoulder, swelling of the joint, tenderness around the joint, or a feeling of grinding or catching within the joint.

The total  shoulder replacement surgery alleviates pain by replacing the damaged bone and cartilage with a metal and plastic implant. The shoulder joint is a ball-and-socket joint. The ball is the top of the arm bone (the humerus), and the socket is within the shoulder blade (scapula).

During the surgery, the ball is removed from the top of the humerus and replaced with a metal implant. It is attached to a stem inserted down the center of the arm bone. The socket portion of the joint is given a smooth texture and is replaced with a plastic socket that is cemented into the shoulder blade.


Arthroscopy is a  surgical procedure that is used by orthopedic surgeons to visualize, diagnose, and treat problems inside any particular joint. While a patient might undergo an  arthroscopy, the doctor would need to insert a small-narrow tube attached to a fiber-optic video camera through a small incision. The incision would be about the size of a ball-pen refill diameter. The view inside the patient’s joint is transmitted to a high-definition video monitor. The complexity inside the patient’s joint can be traced with a minimally invasive technique. Adding another incision or two can also offer the surgeons an opportunity to repair some type of joint damages.

Knee Arthroscopy

Knee  arthroscopy is a surgical technique that can diagnose and treat problems in the knee joint. They type of knee arthroscopy that is to be performed depends upon the injury or the complication that needs to be resolved.


The anterior cruciate ligament (ACL) or the posterior cruciate ligament (PCL), are the tissues that hold the human knee together and help it move in different directions. Research says that, it gets damaged very  easily. If the ligament or two are torn in the knee, there is likely a need for  surgery to repair the caused damage. To repair and rebuild the ligaments one of the following procedures may be needed:

  • Autograft: Tissues are taken from other healthy muscle/parts of the body and are used to repair or reconstruct the torn ligament.
  • Allograft: Healthy tissues from a muscle tissue bank is transplanted in the torn ligament.
  • Revision: It is a procedure in which repairing is carried out for failed ACL/PCL if any.

ii. MCL

Medial Collateral Ligament (MCL) tears/ sprains are a common injury caused to almost anyone. It can be easily cured by medicines and some primary treatments in case the injury is not too severe. However, sometimes there happen to be devastating injuries involving more than one ligament. These are often high-energy injuries that require a combination of surgery, bracing, and rehabilitation.

The medial collateral ligament (MCL) connects the femur to the tibia and helps to stabilize the knee joint. The MCL injury can occur independently or along with ACL rupture or tears. The MCL tears occur with a twisting injury which is painful and involves a tearing sensation. Swelling and pain are only felt on the inner part of the knee. If the whole knee swells up rapidly, it is probably more than just an MCL injury.

iii. LCL/PCL

The LCL (lateral collateral ligament) is a ligament that runs along the outer side of the knee. It helps to hold the bones together so that the knee joint remains stable when the patient moves. Due to some unusual activities, there might be an LCL tear. The symptoms of the injury can be, The knee feeling stiff, sore, or tender along the outer edge of the knee may feel like it could give out while walking or standing or the knee may lock in place or catch when you walk, instead of moving smoothly.

Depending upon the intensity and severity of the tear, the type of treatment differs. In case the issue is not resolved by medicines and physical therapy surgery is required. The surgeon may stitch up the torn LCL or attach it to the bone where it is tore. LCL surgery is an “open-knee procedure.”

iv. Meniscus Tear – Lateral / Medial

It’s a piece of cartilage in the knee that cushions which stabilizes the joint. It protects the bones from wear and tear. If the knee is twisted really badly, there is a severe tear to the meniscus. In some cases, a piece of the shredded cartilage breaks loose and catches in the knee joint, causing it to lock up.

Meniscus tears are common in contact sports like football as well as non-contact sports requiring jumping and cutting such as volleyball and soccer. They can happen when a person changes direction suddenly while running, and often occur at the same time as other knee injuries. Meniscus tears are a special risk for older athletes since the meniscus weakens with age. More than 40% of people 65 or older have them.

v. Root Repair

The root attachments of the posterior horns of medial and lateral meniscus are very important for joint health. The meniscus root repair involves isolating the root, placing a minimum of two sutures in the remaining meniscal attachment. There is an attempt done to re-position it back to a more anatomic position. In some instances, the meniscus posterior horn may need to be released from scar tissue to allow it to be repositioned. This is important because these repairs are still quite tenuous with current technology, so it is important to try to put the meniscus back into a position where there would not be a lot of tension on the repair with knee range of motion.

Shoulder Arthroscopy

Since the shoulder is the most mobile joint of the human body, the complications associated with it are also many

i. Shoulder Dislocation

The  shoulder Dislocation may be partial or complete. The dislocation may occur in any possible degree and may also tear the ligaments. Both types of dislocations (partial and complete) cause pain and unsteadiness in the shoulder.

As a treatment to resolve this issue, the ball of the upper arm bone (humerus) is placed back into the joint socket. This process is called a closed reduction. Severe pain stops immediately once the shoulder joint is back in place.

ii. Impingement

It is the irritation of the tendons which compose the rotator cuff as they pass through the subacromial space. Injuries to rotator cuff tendons may be caused due to vascular factors, mechanical factors, presence of unfused acromion, thickening of the subacromial bursa, or degenerative factors.

iii. Rotator Cuff Tear

The rotator cuff is the group of four tendons and muscles that surround the shoulder joint. When the rotator cuff is injured, it’s actually the tendons that are injured. When there is an injury caused to these tendons, they cannot function properly.

The rotator cuff is important with lifting movements of the shoulder. Without a properly functioning rotator cuff, there are some limits in normal shoulder function.

Apart from medications and physical therapy, if the issue is seen to be unresolved, surgery has to be carried out. An arthroscopic surgery, has been used to identify and repair areas of damage to the rotator cuff without having to make large incisions around the shoulder.

Iv. AC Joint Injuries

The acromioclavicular (AC) joint along with ligaments connects the collarbone and shoulder blade. An injury to the AC joint is like a shoulder separation. The type of shoulder separation depends on how much the tear of AC joint or coracoclavicular (CC) ligaments is that hold the joint in place.

Type I = the AC ligament is slightly torn, but there is no damage to the CC ligament.

Type II = the AC ligament is completely torn, and there’s little or no tear to the CC ligament.

Type III = both the AC and CC ligaments are completely torn. In this case, the collarbone separates from the end of the shoulder blade.

v. Frozen Shoulder

In this condition, the shoulder stiffens reducing the mobility of the shoulder. It is also termed as adhesive capsulitis. The shoulder is comprised of three bones: The scapula – shoulder blade, the collarbone, and the upper arm bone or humerus. Basically is a ball-and-socket joint, where the round head of the upper arm bone fits into this socket. Connective tissue, known as the shoulder capsule, surrounds this joint. Synovial fluid enables the joint to move without friction. The condition of a frozen shoulder happens when scar tissue forms in the shoulder. This causes the shoulder joint’s capsule to thicken and tighten, with less movement or a movement that may be stiff and painful.

We at  Bhatwal Surgical and Maternity Hospital implement and utilize the most Advanced & Minimally Invasive Techniques to Restore Life Mobility. To get your appointment fixed with our  Joint replacement and Arthroscopy expert, Dr. Divyanshu S. N. Goyal, who is India’s one of the  most renowned Joint replacement and Arthroscopy surgeon, get in touch with us today. Dr. Goyal visits us on the last Sunday of the month for check-up and treatment of the patients. He will further help and guide you in your understanding of  Bone and Joints Problem and the safest way to treat them.