The mobile connection of the bones of the skeleton is a joint. Thanks to them, our limbs can move. We can move our hands and do a lot of things with them. We can move our legs and, thanks to this, move in space over considerable distances. Inside the joint, the ends of the bones are separated from each other by a lumen, they are covered with a synovial layer and an articular bag.
This is a very important part of the human skeleton. They are subjected to regular significant stress, wear, and are susceptible to various diseases.
Diseases, inflammations, damage to joints lead to stiffness and restriction in movements. In the case of severe or neglected diseases, complete loss of mobility or, conversely, looseness may occur. It is equally dangerous for human health and a full-fledged lifestyle.
If the joints are damaged and conservative treatment does not bring improvement, resort to surgical intervention.
Indications for operations
If you experience the following problems with the joints, surgery is simply necessary:
- Injuries of various origins.
- Osteoarticular tuberculosis.
- Ligament defect.
- Foreign bodies in the joint cavity.
- Arthrosis (a change in the tissues of the joints).
- Neoplasms (benign and malignant).
- Arthritis (inflammation of the synovial membrane).
- Joint dysplasia in children (for the purpose of reconstruction of TBS).
Features of the operation
During operations on the joints, physiological and anatomical features must be taken into account. As well as high sensitivity, vulnerability, vulnerability to infection, since the membranes of the bone joints are very susceptible to microbes. Features of operations are associated with the presence of periarticular formations, ligaments and with the speed of access to the problem place.
Currently, a number of operations are performed on the joints, depending on the nature of their injuries or diseases, namely: arthroplasty, replacement of removed joints (plastic), arthrodesis, puncture, arthrotomy, arthrosis, resection, arthrolysis.
Modern medicine allows operations without significant incisions in the soft tissues. Medical procedures are performed using an instrument (arthroscope) inserted into the cavity through a micro incision. Arthroscopy is a medical manipulation in which minimal penetration into the joint is performed to diagnose and correct internal injuries.
Dissection of the joint cavity
The internal cavity of the joint opens for certain manipulations. Arthrotomy of the joints is carried out to drain the cavity. The need for this arises when the connection becomes inflamed (this is accompanied by an accumulation of pus). An autopsy of the joint can be performed to remove a foreign body, remove the meniscus, and carry out any operations. The cross section should not damage the ligaments. It has a standard direction. In some cases, the healing process is not limited to surgery. Postoperative medical procedures are important. For example, with arthrosis after surgery, the obligatory wearing of a knee brace is prescribed. The design supports the leg in the correct position, preserves muscle tone.
Excision of adhesions (fibrous) inside the joint
Arthrolysis operation is performed when cicatricial contraction of the skin and tendons appear. This, in turn, leads to difficulty in flexion or extension of the limbs. During manipulation, the articular surfaces of damaged bones are preserved. First, an arthrotomy is performed, then adhesions are dissected, then the bones (their ends) are set in the correct position in relation to each other, laying between the joints of the adipose tissue, which prevents adhesion. Mobility is most often restored, but there may be a relapse.
Joint mobility recovery
Resection arthroplasty returns joint mobility or eliminates the condition in which immobility (ankylosis) is formed after resection. This complication often occurs. A problem with mobility can occur, for example, in the case of jointing of the surface of the joints. Surgery on the joints of the hands occurs with a more favorable outcome. On the joints of the bones of the upper limbs, the load is less than on the lower. With the advent of artificial joints, the demand for arthroplasty decreased, but for young people it is preferable. First, the joint is opened, then a gap is artificially formed, the configuration of the bone ends is brought in the correct form, close to natural. The next stage is to ensure joint mobility, then its development.
The creation of ankylosis (immobility) of the joint
Arthrodesis of the knee joint is carried out in case of looseness (pathological mobility) of the joint. Stillness is recreated in a position convenient for a limb in several ways.
Intra-articular arthrodesis is performed by opening the inside of the joint and resecting the surface, or creating roughnesses. The joints are connected (with screws or nails), then the limb for some time should be motionless in a position that is most beneficial for healing.
Extraarticular arthrodesis is performed without an incision. A bone graft is inserted periarticularly inside. That is, an injection is made into the joint to administer the appropriate medication. Fixation can be carried out extracapsularly using metal plates.
Combined arthrodesis is a combination of the above methods. This option is most often used at present. One of the modern ways to achieve ankylosis is compression arthrodesis. The compression apparatus secures the surfaces of the joints.
The compression-distraction arthrodesis method is used to lengthen the knee joint. Impose a special device. With the open method, an economical resection is done before that. About 15 days spend compression (compression). Then on the device include stretching (distraction) mode. Stretching is carried out very slowly, not more than 1 mm per day. Restoring bone tissue (bone regenerate) helps to lengthen the limb (legs).
Arthrosis
The purpose of the operation is to reduce the amplitude of movement of the joint. The best intervention is in childhood. Bone growth is not finished, they have not yet formed. This is necessary for paralysis of a certain category of muscles, due to which loosening of the joint has formed. During the operation, a “limiter” of flexion or extension of the limb is established. In practice, this operation is carried out mainly on the ankle. Limiter make special plates (metal or bone). They are installed between the calcaneal protrusion and the tibia. In some cases, tendons (tenodesis) or lavsan tape (lavsanodez) are used instead of plates. The tibia is the last to be connected with the calcaneus. Now used more often to exclude relapses. And after tenodesis relapses occur, so it is almost never used.
Anterior arthritis limits excessive back flexion of the foot in the ankle (with moderate calcaneal deformity).
Posterior arthritis limits excessive plantar flexion (in the case of a horse's foot, with no heel deformation).
Lateral arthrosis corrects the valgus and varus position of the horse's foot. There is no bone deformation.
Resection
An operation to stress a joint or part of it is called a resection. Indications for its implementation: suppuration, tuberculosis (joints or bones), tumors (malignant). If only the cartilaginous surfaces of the pineal glands are removed, then this is an economical resection. If the ends of the bones (articular) and the synovial membrane and cartilage are removed, then this is a complete resection. The operation may be extra-articular (extracapsular). The inside of the joint is not opened, the epimetaphysis of the bone is removed simultaneously with the capsule. Resection can be intraarticular (intracapsular). Manipulation is carried out after opening the joint cavity. This operation may be the first step before prosthetics.
Endoscopy technique
Endoscopy is a technique of surgical manipulations that are performed on internal organs through a small puncture (without large incisions). Using this method, internal diagnostics and surgery are performed.
Arthroscopy is a few types of operations. All of them are carried out on the joints. Two punctures are made on the skin. Through one, a tiny video camera is inserted inside. With its help, a view of the joint is projected onto the screen, which allows the doctor to observe his actions and the condition of the joint. Diagnostics is carried out in the same way. Medical instruments are inserted through the second puncture, and they are used to perform an operation, such as grinding cartilage, removing inflamed tissues, suturing ligaments, removing fragments of cartilage, excising adhesions. After the operation is completed, the tools and the camera are pulled out, the puncture is sutured.
The above actions can be done in the usual way for surgeons, arthrotomy. But with arthrotomy, the inside of the joint is opened, and the doctor sees and eliminates the defects with his own eyes. The actions are the same as with arthroscopy, but in different ways. The main difference is the way to access the problem area. Arthroscopy is certainly less traumatic and easier. In addition, the sensitive surface of the joints is not at risk of infection. With arthroscopy, complications are much smaller, the rehabilitation period is much shorter.
A similar operation is performed on the temporomandibular, brachial, elbow, carpal, femoral, knee, ankle joints, on the foot. For the rest it is impossible to carry out this procedure, since they are very small. The camcorder will not fit in the cavity.
Diagnostic arthroscopy is performed in cases where other types of studies (x-ray, tomography, ultrasound) are not allowed to make an accurate diagnosis. This is due to the fact that the video camera must penetrate into the joint, this can injure it.
Puncture
Puncture cannot be called a full operation. This is a puncture or injection into the joint. It is carried out for the purpose of diagnosis or for the introduction of drugs into the joint cavity.
Prosthetics and endoprosthetics
Replacing a part of a joint with an artificial implant is called prosthetics. Endoprosthetics is a complete replacement for a broken joint. This operation is carried out if its recovery is impossible. Replacing the joint with artificial significantly improves the quality of life of the patient. He gains the ability to move unlimitedly (as before the disease), passes the pain that constantly accompanies a person. Prosthetics become an outlet for those who are not helped by other methods of treatment (conservative and surgical).
Similar operations are carried out on all joints, both small and large. But most often, joint replacement operations are performed in patients with osteoporosis on the knee and hip joints. Prosthetics are also performed in case of:
- Abnormally fused joints after fractures.
- Dysplasia
- Arthritis, arthrosis (degenerative-dystrophic forms).
- Rheumatism
- Ankylosing spondylitis.
- Fractures, injuries (as well as complications after them).
But for the positive effect of prosthetics, surgery should be carefully prepared, taking into account the recommendations of the doctor. It is necessary to conduct tests, consult with other doctors. You may have to abandon bad habits (for example, smoking), lose weight, follow a diet. Keep a constant weight, so as not to overload the joints when walking.
It is extremely important to remember the period of rehabilitation after joint replacement. How long it will take, how it will proceed, depends on the complexity of the operation and the condition of the patient. Rehabilitation of the hip and knee joints takes longer. In the future, their full recovery, normal walking in many respects depends on how correctly the patient underwent recovery measures. The main thing is to carry out the doctor’s prescriptions: wear a bandage for the knee joint (or another, if necessary), regularly do therapeutic exercises, without increasing or decreasing the prescribed load, take medication.
Hip Joints in Babies
Some newborns are born with an abnormality of the hip joints. Such a child does not have the correct contact between the hollow of the pelvic bone and the convex part of the femur. The joint should go into the cavity and rotate there. Sometimes a child has a dislocation (the joint rotates freely outside the pelvic cavity). There may also be instability of TBS (this is a milder anomaly than a dislocation). In newborns, this is considered a fairly common disease, so treatment and surgery on the hip joint are simply necessary. Kids are immediately tested by an orthopedist. Timely detection painlessly and effectively correct the anomaly. Belated identification will entail more serious consequences. Joint dysplasia in children is treated conservatively or surgically. In the early stages of detecting joint abnormalities, a conservative one will help. In this case, various orthopedic devices are used that direct the joint into the cavity (that is, in the correct position). Further development of the joint occurs without deviations.
Surgical treatment is performed if reconstruction of TBS is necessary. This happens when a joint abnormality is revealed late or conservative methods are not effective. The type of intervention depends on the specific defect. In the best case, after surgery, the joint will snap into place. In case of complications, several operations will be required.