Orthopedic Surgery

KNEE REPLACEMENT SURGERY

Knee replacement surgery can help relieve pain and restore function in severely affected knees. The knee joint replacement process removes the damaged bone and cartilage in the joint, and replaces the prosthesis with special metal alloys and other components. The aim of the prosthesis surgery applied to the knee joint is to provide a painless range of motion in the knee joint and to ensure the highest quality of daily life.

Who Should Have Knee Prosthesis?

For knees, exercises, drugs, physiotherapy methods are applied in patients with pain and deformity, but the pain in the knees does not disappear, activities such as walking, climbing stairs in daily life are strictly limited and it is understood that the articular cartilage is seriously damaged.

What Diseases Can Knee Prosthesis Cause?

For various reasons, degeneration (calcification) occurs in the knee joint. Calcification of the knee joint is called gonarthrosis (knee calcification). Most gonarthrosis occurs spontaneously with age. Excess weight increases degeneration. Degeneration of the knee joint can occur due to ruptures, injuries and operations of the meniscus, rheumatological diseases, infectious diseases, traumatic cartilage lesions. Knee replacement surgery is performed on all patients with serious knee joint disease. In the presence of an active infection in the knee joint, knee replacement is not performed.

What are the Stages of Knee Replacement Treatment?

First, knee replacement should be applied to patients who do not use non-prosthetic treatment options (medicine, physiotherapy, etc.) and should be at a beneficial stage for them. The presence of tooth decay, wound or any other infection in the body before the operation should be carefully examined and, if so, it is very important to treat it. Although the duration of the operation varies depending on the patient, it takes about 1 hour. The next day, the patient can meet his personal needs with a crutch.

There are risks of knee replacement surgery in the early and late period during surgical treatment. There are risks associated with the anesthesia available in every operation. In addition, temporary or permanent blood vessel and nerve injuries may occur in the area during use in the surgical field.

Infection is the most important early and late postoperative complication. This is the most important complication affecting the survival of the prosthesis. This can be easily avoided by paying attention to the foci of infection and careful care of the wound before the operation. Another late complication is loosening of the prosthesis. It is important for the patient to lose weight and do regular knee exercises to prevent relaxation.

During knee surgery, the damaged parts of the knee bones are removed and metal and plastic implants are attached to the knee surface in the appropriate direction and covered. We can list the operations performed during the knee surgery operation as follows:

  • A cannula is placed in your hand or arm. This cannula is used to administer antibiotics and other drugs during surgery.
  • After the painkiller starts to take effect, your knee is sterilized with a special solution.
  • The coating process of the knee joint surfaces usually takes 1 hour.
  • Implants are attached to the bones. The ligaments surrounding the knee need to be adjusted to ensure optimal knee function.
  • If the surgeon is satisfied with the fit and function of the implants, the incision is closed.
  • A special tube (drain) is placed in the wound to remove natural fluids from the body.
  • A sterile dressing is applied. An elastic bandage is wrapped from the foot to the groin.
  • The effect of the anesthesia starts to wear off while you are in the room where you are resting and you regain consciousness.

After Knee Replacement Surgery

Knee replacement surgery there are some important points that patients who have undergone knee replacement surgery should pay attention to. These can be listed as follows;

  • It is absolutely necessary to consult a doctor when exposed to any infection.
  • Dental controls and treatments should not be interrupted.
  • Living areas should be cleared of factors that may pose a risk of falling. Items such as coffee tables and carpets should be positioned so that they do not pose a risk of falling.
  • Heavy sports should be avoided.
  • Long walks, climbing and jumping that will strain the knee joints should be avoided.
  • Knee joints should be protected from traumas such as falls, impacts and accidents.
  • Bone and muscle health should be protected. The diet should be created in a way that strengthens bone health.
  • The exercise programs recommended by the doctor should not be interrupted.

After knee replacement surgery, the patient’s quality of life will increase. Problems such as pain sensation and limitation of movement will disappear. For this reason, the things to be considered after the surgery should not be ignored.

After the application of prosthesis to the knee joints by surgical intervention, the knee joints should be protected from traumas and strains. However, in order to protect joint and bone health, attention should be paid to the nutrition program and attention should be paid to consuming foods that strengthen bones. It is necessary to use the drugs recommended by the doctor, not to interrupt the exercise programs and not to interrupt the physical therapy and rehabilitation sessions in order to control the pain and prevent the formation of edema after the surgery. At the same time, it is of great importance to protect the whole body from inflammation and infections in order not to prevent the prosthesis used during the operation from fusing with the joint.

What are the ways to prevent infection after knee replacement surgery?

After knee replacement surgery, the doctor; There are many recommendations that should and should not be implemented. The implementation of these recommendations is of great importance for both shortening the healing process and prolonging the life of the prosthesis. The biggest risk factor after knee replacement surgery is infections. Exposure of any part of the body to infection causes serious damage to the knee prosthesis. The ways to prevent infection can be listed as follows;

Before the operation, dental check-ups should not be interrupted and in case of any infection, it must be treated.

Attention should be paid to hand and foot hygiene.

Nail care should be taken care of.

Rehabilitation After Knee Replacement Surgery

Knee joints lose their strength to a certain extent after knee replacement surgery. At the same time, a certain time is needed for the implanted prosthesis to fuse with the bone tissue. For this reason, especially in the postoperative period; Physiotherapy and rehabilitation applications are carried out for the patient to regain their mobility and get rid of the feeling of pain. In this process, the patient should eat healthy, maintain his ideal weight, avoid heavy sports and adverse movements, and protect the operation area from traumatic events such as hitting, falling or being hit.

HIP REPLACEMENT

Hip replacement is a surgical treatment method for hip joint diseases. The hip joint is the strongest and largest joint in the human body. In addition to this feature, it is of great importance because it carries a large part of the body weight and because it gives people the ability to move (sitting, walking, standing, bending). The hip joint may experience some problems for various reasons, and hip replacement can be applied in the treatment of these problems recently.

What is Hip Replacement?

Hip prosthesis; It is a surgical application applied in the treatment of problems in the hip joint. It is based on the discipline of placing the personalized prosthesis in the appropriate area within the hip joint. There are some points that the patient should pay attention to before and after this application.

Why is it needed?

Situations that require hip replacement surgery can be listed as follows:

If hip pain interferes with the patient’s entire life

  • If hip pain is felt even at rest
  • If the drugs used do not relieve hip pain
  • If the stiffness felt in the hip prevents sitting up and walking.

Hip Replacement Types

Hip prostheses are applied in 2 basic types: uncemented hip bone prostheses and cementless hip bone prostheses.

Cementless Hip Prosthesis

In line with the developing treatment conditions in today’s conditions, cementless hip prostheses are applied in the majority of hip prosthesis applications. Cementless hip prostheses have a rough surface and bone can grow within this surface. The cementless hip prosthesis, which is screwed into the pelvis and the femur, allows the prosthesis and the bone to fuse together more easily and allows it to function like a part of the body. In this respect, it is important which materials are used to make the moving head-nest parts of the applied prostheses.

We can list the cement less hip prosthesis combinations applied today as follows;

  • Metal head-plastic socket prostheses
  • Ceramic head-ceramic socket prostheses
  • Metal head-metal socket

Cemented Hip Prostheses

It is the process in which an adhesive substance called ‘bone cement’ is applied in order to attach the hip prosthesis to the bone. Cemented hip prostheses, which are made by applying chemically polymethyl methacrylate bone cement, appear as simple and inexpensive applications. Cemented hip prostheses are highly adaptable and durable for up to 25 years.

Surface Coating Hip Prostheses

In line with the developing and changing living conditions, surface coating hip prostheses emerge as a new type of hip prosthesis developed in recent years. Surface coating hip prostheses have achieved significant success in young and active patients. Unlike conventional hip prostheses, surface-covered hip prostheses are applied without cutting the head of the thigh bone, and the lower part of the prosthesis and the head region are bonded with bone cement. The risk of dislocation of surface-covered hip prostheses is very low.

Hip Replacement Surgery

Hip replacement surgery performed under general anesthesia takes approximately 1 to 2 hours. The surgery is performed with open surgery method. The patient may need to stay in the hospital until he recovers after the surgery.

However, after the surgery, the patient can stand up and walk as soon as possible. The reason for this is that the placed prosthesis fuses with the surrounding tissues much more quickly and the formation of clots in the vessels is prevented due to immobility.

In Which Situations?

There are 2 situations that are considered as the basis for the application of hip prosthesis.

  1. The distance that the patient can walk without pain is less than 300 meters. It has become compulsory to use painkillers every day due to pain and limitation of movement.

However, hip replacement applications should be applied urgently and necessarily in cases of hip fracture. In cases of hip fracture, hip replacement emerges as the most important way to save the patient’s life.

Before Hip Replacement Surgery

Before hip replacement surgery, a definitive diagnosis of the problem in the hip joint should be made. In this process, physical examination and various radiological imaging such as magnetic resonance, tomography, ultrasound, x-ray are used. After the definitive diagnosis process, the decision to plan the surgery is made. In this process, it is not necessary to evaluate the general health status of the patient and the drugs he uses in a qualified way.

Before hip replacement surgery, it is evaluated whether the patient has diabetes or an inflammatory disease. However, if there is any inflammatory condition in the body, this problem should be treated first. For this reason, oral and dental controls must be applied before the surgery.

Patients who are above the ideal weight before hip replacement surgery are expected to lose weight. However, if blood thinners are used, this should be reported to the doctor.

Period After Hip Replacement Surgery

There are some points to be considered after hip replacement surgery;

A companion is needed in the early stage healing process.

Medications recommended by the doctor should be used to provide pain control.

It may be necessary to make a rearrangement in order to avoid any accidents at home.

The patient must sit in high and hard seats.

The immune system should be kept strong.

Hip prosthesis can be used for about 20 years. For this reason, it is generally a preferred treatment method in patients over 60 years of age. However, hip replacement surgery can also be applied as a result of the fracture of the bones forming the hip joint due to congenital hip dislocation or traumatic events

What are the Benefits?

Hip replacement is the creation of a new and artificial joint structure for the patient at the end of a painful and immobile process. We can list the benefits of hip replacement application as follows;

Continuous and severe pain is relieved or greatly reduced.

The limitation of movement caused by severe pain disappears and the person regains a range of motion in their daily life.

As long as heavy activities are not performed, daily life can be continued.

By eliminating the loss of movement, a significant ease of movement is provided compared to the preoperative period.

By replacing the damaged joint tissue, a solid joint structure is created.

LENGTH EXTENSION SURGERY

Lengthening surgeries are performed to correct conditions such as shortness/curvature due to childhood diseases, traumas in which growth plates are damaged, or malunion fractures

What is Length Extension Surgery?

Lengthening surgeries;

Dwarfism, which is called congenital achondroplasia in children, and shortness due to metabolic and hormonal disorders that affect growth/nutrition,

Traumas in which growth plates called epiphysis are damaged due to various reasons,

Conditions that develop due to improperly fused fractures,

It is done to correct the acquired shortness and curvature conditions.

When Should Lengthening Be Applied?

The most important point is the timing of the surgery. Early surgery carries risks such as recurrence of shortness, growth plate inhibition and infection. Delayed surgery can cause permanent disorders in the joint and spine. For this reason, lengthening surgeries are not recommended for children before the age of 5 years.

How many cm lengthening is possible with surgery?

 In children with achondroplasia, it is possible to lengthen up to 25 cm in two sessions.

Classic Lengthening Method:

In the 1950s, Russian Orthopedist Dr. Ilizarov was the first to introduce limb lengthening and dwarf lengthening to the world.

In this method, which Dr. Ilizarov introduced to the world, the patient’s bones can be extended by 8-10 cm at once, while 35-40 cm elongation can be achieved in dwarfs by applying more than one procedure. In this process, which is known as the classical lengthening method, it is possible to lengthen up to 1 mm per day by using a ring-shaped device connected to the screws and passing a wire through the bone.

Modern Surgical Techniques:

Today, in lengthening surgery; Modern surgical techniques such as lengthening over nail-LON and automatic nail extension methods are also applied. If lengthening up to 7-8 cm is planned with these methods, a single bone (tibia or femur) is planned, and if more lengthening is planned, both bones are lengthened. The bone is cut surgically and the gap created using internal (motorized nail/LON), external (external fixators/Ilizarov) or combined type implants is 1 mm per day is planned to open. Bone fragments are not used externally in this surgery. Tissues such as vessels, nerves and muscles other than bone tissue are not interfered with. They adapt to elongation in the process.

What kind of process awaits the patient after the operation?

Postoperative hospital stay is between 2-3 days. Patients are walked with crutches in the early period and exercise programs are started.

Implants are removed when full healing is achieved in the extended bone. This period is an average of 6-8 months.

What are the possible problems that may be encountered during the treatment process?

Although lengthening surgeries are a successful method, it is possible to encounter problems  in the process:

Treatment lasts for months. It is important that both the patient and the patient’s family are prepared for this process. In addition, there is a risk of encountering some problems during treatment. Inflammation may occur in the soft tissue and in the entrance and exit areas of the bone where wires and screws pass. Sufficient bone tissue may not be obtained in the bone area where the lengthening procedure is applied, or problems such as skin injury may occur. All situations that may pose a risk are followed in detail by our expert team and necessary interventions are made quickly.

Depending on the technique applied, some complications may develop. Average 1 cm in the classical Ilizarov method. For lengthening, the patient must carry the fixator for 1.5 months. 5 cm. when an extension is planned, the duration is approximately 7.5 months. This process is seen as an annoying situation for patients. LON technique can be applied to shorten the fixation time. In this technique, when the lengthening is completed, the external fixator is removed.

The lengthening application, which is fully extended through the bone with the help of automatic nails and does not require a fixator, is known as the most modern method in lengthening surgery. However, this method also has disadvantages such as the expensiveness of the nail, the limitation of the amount of extension and the inability to load during extension.

Can Lengthening Surgery Be Performed for Aesthetic Purposes?

It is necessary to be very selective in patients who want to increase their height for aesthetic purposes. Giving detailed information to both the patient and his family before the surgery, psychological support before the extension and during the treatment are among the factors that increase the success in this process.