Mr Dean Schluter - Orthopaedic Surgeon
Private Service, Orthopaedics
Joint Replacement - Hip, Knee And Ankle
Total hip joint replacement is a very successful operation for hip arthritis secondary to degeneration of the cartilage due to osteoarthritis, rheumatoid arthritis or rarer conditions such as avascular necrosis and trauma. It is increasingly performed through smaller incisions, where appropriate, which can speed recovery. In order to prolong the lifespan of the commonly used prostheses, different bearing surfaces can be used for younger patients rather than the traditional metal head & polyethylene liner. These are metal on metal bearings (as used in hip resurfacing) or ceramic on ceramic. These produce less wear particles, thereby reducing the risk of loosening of the prosthesis in the long term.
Total knee joint replacement is a very successful operation for treatment of knee arthritis secondary to cartilage degeneration from trauma, osteoarthritis and rheumatoid arthritis. In addition to resurfacing the degenerate compartments, it corrects the varus or valgus alignment of the limb so that the weight bearing axis passes from the centre of the hip to the centre of the ankle through the centre of the knee replacement at the end of the procedure, prolonging the life of the implant. The alignment is corrected by the use of the bone cuts and the accuracy of the bone cuts is increased with Computer Navigation. This also enables the surgeon to check the accuracy of the cuts after they are made which isn't possible with the traditional jigs.
Unicompartment knee replacement is used to replace the degenerate compartment only (usually medial) in patients with less deformity and less severe changes, which has the advantage of a smaller incision, quicker recovery and usually better postoperative flexion. It also enables easier revision if this is required in the future.
Total ankle joint replacement is indicated in selected patients with ankle arthritis who do not have significant deformity and if there is evidence of arthritis elsewhere in the foot such as the subtalar joint. This therefore avoids stressing these arthritic joints more which would occur with stiffening of the ankle with a fusion.