Arthroplasty

Arthroplasty literally means 'formation of joint'. It refers to the surgical replacement of arthritic or destructive joint with prosthesis. During arthroplasty, the dysfunctional joint is replaced with a better remodeled joint. Osteotomy procedure used to restore or modify joint congruity is also arthroplasty. Although arthroplasty is used for construction of a new movable joint, it cannot be applied to every body joint. Its use, in practice, is confined to the shoulder, elbow, hip, knee, certain joints of the hand, metatarso-phalangeal joints in the foot.

The two main reasons for undergoing arthroplasty are pain in the joints and decreased quality of life. Some common indications for arthroplasty would include advanced osteoarthritis, rheumatoid arthritis with avascular necrosis, congenital dislocation of the hip joint, shallow hip socket, frozen shoulder, loose shoulder, traumatized joint and joint stiffness, un united fractures of the neck of the femur, and for correction of certain types of deformity.

There are three methods in general which are adopted in Arthroplasty: excision arthroplasty, half-joint replacement arthroplasty and total replacement arthroplasty. Each of these methods have their own distinct merits as well as disadvantages and special applications.

In excision arthroplasty both the articular ends of the bones are simply excised. A gap is created between them and this is filled with fibrous tissue, a pad of muscle or other soft tissue which may be sewn in between the bones. This method is applicable to all the joints other than the knee and ankle.

In half-joint replacement arthroplasty, one of the articulating surfaces is removed and this is replaced by a prosthesis of similar shape. The prosthesis is made of metal and rarely silicone rubber. This technique has its application at the hip. It has rather limited use elsewhere in the body.

As for total replacement arthroplasty, both the opposed articulating surfaces are excised and replaced by prosthetic components. Sometimes, in larger joints, one of the components is of metal and the other, a high density polyethylene. Both components are held in place by acrylic 'cement.'

The joint is fully exposed and the damaged bone and cartilage are cut away or reshaped. Prosthesis are inserted after measurements are taken to ensure proper fit. The joints are usually tested before the incision is closed. Arthroplasty is typically followed by several days of hospitalization. Medications are given to relieve the pain and prevent further infections and blood clots. Physical therapy is extensively employed to bring back the joints to near normal functioning. Occupational therapy is also prescribed to enable patient independently cope up with routine activities. Patients resume normal activities after two to three months duration.

Otosclerosis

When there is abnormal growth of the bone of the middle ear, otosclerosis is said to occur. This disease of ear bone degeneration is usually noticed during early adult years. The bones of the ear turn into spongy bone tissue and lead to excessive buildup of bone tissue. This impairs the hearing process since there is a barrier to sound being conducted to the inner ear. The bones are then unable to vibrate and pass the sound into the inner ear. Usually the outer and middle ear are affected, leading to conductive hearing loss. Nerves of the ears may also get affected, leading to senso-neural hearing loss. Otosclerosis is noticed to occur in persons with family history of hearing loss. Hearing may be impaired in one or both ears. This condition affects nearly 10% of the American population. Pregnancy is known to trigger this condition in some women.

One of the most common symptoms of otosclerosis is tinnitus (noise originating inside the ear). Hearing loss may be gradual, which is why this condition is not often diagnosed at the early stage. Other accompanying symptoms are dizziness and balance problems. In many cases, persons suffering from otosclerosis are not even aware of their condition and do not seek medical help. An otologist (ear physician) will need to conduct a physical examination and study the history of hearing loss This condition can be diagnosed with the help of audiometric examination and special x-rays. A CT scan of the temporal bone can help in ruling out other causes of hearing loss. The hearing and balance functions will be assessed with various tests and procedures. Audiometry, tympanometry and tuning fork tests are conducted to test the extent of hearing loss.

A hearing aid is used to treat this condition when the hearing loss is mild. You can take the help of an audiologist to choose the one that fits your specific needs best. Doses of oral sodium fluoride are known to improve otosclerosis. Sodium fluoride aids calcification of new bone and checks further otoscelerotic damage. Fluoride medication along with calcium and Vitamin D are prescribed. A surgical procedure known as stapedectomy is performed to replace the fixed stapes bone in the ear with a prosthesis. This device allows sounds waves to pass to the inner ear. The stapes bone is either completely or partially removed. The laser stapedectomy surgery is usually performed under local anaesthesia and is an outpatient procedure. Only one year is operated at a time. In most of the cases, stapedectomy benefits the patient suffering from otosclerosis. After surgery, a patient must avoid loud noises and sudden changes in pressure for a few weeks. Rarely are there complications with this surgery leading to total deafness or formation of blood clots in the ear.