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 a joint bag.
This is a very important part of the human skeleton. They are subjected to regular significant stress, wear and tear, and are prone to various diseases.
Diseases, inflammation, damage to the joints lead to stiffness and limitation in movement. In the case of severe or neglected diseases, a complete loss of mobility or, conversely, looseness may occur. This is equally dangerous for human he alth and a fulfilling lifestyle.
If the joints are damaged and conservative treatment does not improve, resort to surgery.
Indications for operations
When the following problems occurwith joints, surgery is a must:
- Injuries of various origins.
- Osteoarticular tuberculosis.
- Defective ligaments.
- Foreign bodies in the joint cavity.
- Arthrosis (change in joint tissues).
- Neoplasms (benign and malignant).
- Arthritis (inflammation of the synovium).
- Joint dysplasia in children (for hip reconstruction).
Features of the operation
In operations on the joints, it is imperative to take into account the physiological and anatomical features. 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 area.
Currently, a number of joint operations are performed depending on the nature of their damage or disease, namely: arthroplasty, replacement of removed joints (plasty), arthrodesis, puncture, arthrotomy, arthroresis, resection, arthrolysis.
Modern medicine allows operations to be performed without significant soft tissue incisions. Medical procedures are performed using an instrument (arthroscope) inserted into the cavity through a micro-incision. Arthroscopy is a medical procedure in which minimal penetration is made into the joint to diagnose and repair internal damage.
Opening the joint cavity
The internal cavity of the articulation is opened for certainmanipulations. Joint arthrotomy is performed to drain the cavity. The need for this arises when the connection becomes inflamed (this is accompanied by an accumulation of pus). An opening of the joint can be performed to extract a foreign body, remove the meniscus, or perform any operations. The section should not damage the ligaments. It has a standard direction. In some cases, the healing process is not limited to the operation. Medical procedures in the postoperative period are important. For example, in case of arthrosis after surgery, it is mandatory to wear a knee joint brace. The design supports the foot in the correct position, maintains muscle tone.
Excision of adhesions (fibrous) inside the joint
Arthrolysis operation is performed when cicatricial tightening of the skin and tendons appears. 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 the adhesions are excised, then the bones (their ends) are set in the correct position relative to each other, and adipose tissue is laid between the joints, which prevents fusion. Mobility is most often restored, but there may be a relapse.
Restoring joint mobility
Resection arthroplasty restores joint mobility or eliminates the condition in which immobility (ankylosis) is formed after resection. This complication occurs quite often. A problem withmobility can occur, for example, in the case of fusion of the surface of the joints. Surgery on the joints of the hands occurs with a more favorable outcome. The load on the joints of the bones of the upper limbs is less than on the lower ones. With the advent of artificial joints, the demand for arthroplasty has 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 to the correct shape, close to natural. The next step is to ensure the mobility of the joint, then its development.
Creating ankylosis (immobility) of the joint
Arthrodesis of the knee joint is performed in case of looseness (pathological mobility) of the joint. Immobility is recreated in a position convenient for the limb in several ways.
Intra-articular arthrodesis is carried out by opening the inside of the joint and resection of the surface, or creating roughness. The joints are connected (with screws or nails), then the limb must be immobile for some time in a position that is most beneficial for healing.
Extra-articular arthrodesis is performed without an incision. The bone graft is inserted inside periarticularly. That is, an injection is made into the joint to administer the appropriate medication. Fixation can be performed extracapsularly using metal plates.
Combined arthrodesis - a combination of the above methods. This option is most often usedcurrently. One of the modern ways to achieve ankylosis is compression arthrodesis. Compression apparatus secures joint surfaces.
The compression-distraction arthrodesis method is used to lengthen the knee joint. Apply a special device. With the open method, an economical resection is made before this. Compression (compression) is carried out for about 15 days. Then the device includes the mode of stretching (distraction). Stretching is carried out very slowly, no more than 1 mm per day. Regenerating bone tissue (bone regenerate) contributes to the lengthening of the limb (leg).
Arthrosis
The purpose of the operation is to reduce the range of motion of the joint. It is best to intervene in childhood. Bone growth is not complete, they have not yet formed. This is necessary for paralysis of a certain category of muscles, due to which a loose 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. The limiter is made by special plates (metal or bone). They are placed between the heel protrusion and the tibia. In some cases, tendons (tenodesis) or lavsan tape (lavsanodesis) are used instead of plates. The last connect the tibia to the calcaneus. Now they are used more often to exclude relapses. And after tenodesis, relapses occur, so it is almost never used.
Anterior arthrosis limits excessive dorsiflexion of the foot at the ankle (withaverage heel deformity).
Posterior arthrosis limits excessive plantar flexion (in the case of a "horse" foot, there is no heel deformity).
Lateral arthrosis corrects the valgus and varus position of the "horse" foot. In this case, there is no bone deformation.
Resection
The operation to stress the joint or part of it is called resection. Indications for its implementation: suppuration, tuberculosis (of the joints or bones), tumors (malignant). If only the cartilaginous surfaces of the epiphyses are removed, then this is an economical resection. If the ends of the bones (articular) and the synovium and cartilage are removed, then this is a complete resection. The operation can be extra-articular (extracapsular). The interior of the articulation is not opened, the epimetaphyses of the bone are removed simultaneously with the capsule. Resection can be intraarticular (intracapsular). Manipulation is carried out after opening the articular cavity. This operation may be the first step before prosthetics.
Endoscopy technique
Endoscopy is a technique of surgical manipulations that are performed on the internal organs through a small puncture (without large incisions). With this method, internal diagnostics and surgical operations are carried out.
Arthroscopy is several 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, the view of the joint is projected onto the screen, which allows the doctor to observe his actions and condition.joints. In the same way, diagnostics are carried out. Through the second puncture, medical instruments are inserted inside, with the help of which an operation is performed, for example, grinding of cartilage, removal of inflamed tissues, stitching of ligaments, removal of fragments of cartilage, excision of adhesions. After the operation is completed, the instruments 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 for arthroscopy, but in different ways. The main difference is the way to access the problem area. Arthroscopy is certainly less traumatic and easier operation. In addition, the sensitive surface of the joints is not at risk of infection. With arthroscopy, complications are much less, the rehabilitation period is much shorter.
Similar operation is carried out on the temporomandibular, shoulder, elbow, carpal, femoral, knee, ankle joints, on the foot. On the rest it is impossible to carry out this procedure, since they are very small. The video camera will not fit in the cavity.
Diagnostic arthroscopy is performed in cases where other types of studies (X-ray, tomography, ultrasound) did not allow an accurate diagnosis. This is due to the fact that the video camera must penetrate the joint, this can injure it.
Puncture
Puncture cannot be fully called an operation. This is a puncture or injection into the joint. It is carried out for the purpose of diagnosis or for the administration of drugs.drugs into the joint cavity.
Prosthetics and endoprosthetics
Replacing part of a joint with an artificial implant is called prosthetics. Endoprosthesis is a complete replacement of a destroyed joint. This operation is carried out if its restoration is impossible. Replacement of the joint with an artificial one significantly improves the quality of life of the patient. He acquires the ability to move indefinitely (as before the disease), the pain that constantly accompanies a person disappears. Prosthetics are becoming an option for those who are not helped by other methods of treatment (conservative and surgical).
Such operations are carried out at all articulations, both small and large. But most often, joint replacement surgery is performed in patients with osteoporosis on the knee and hip joints. Prosthetics is 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 a positive effect from prosthetics, you should carefully prepare for the operation, taking into account the doctor's recommendations. It is necessary to carry out analyzes, consultations with other doctors. You may have to give up 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 rehabilitation period after joint replacement. How long will it take,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 complete recovery, normal walking largely depend on how the patient went through the rehabilitation measures correctly. The main thing is to follow the doctor's prescriptions: wear a bandage for the knee joint (or another, if necessary), do therapeutic exercises regularly, without increasing or decreasing the prescribed load, take medication.
Hip joints in babies
Some newborns are born with abnormal hip joints. In such a child, there is no proper contact between the socket of the pelvic bone and the convex part of the femur. The joint must enter the cavity and rotate there. Sometimes the child has a dislocation (the joint is free to rotate outside the pelvic cavity). There may also be hip instability (this is a milder anomaly than dislocation). In newborns, this is considered a fairly common disease, so treatment and surgery on the hip joint are simply necessary. Babies are immediately checked by an orthopedist. Timely detection painlessly and effectively correct the anomaly. Late detection will lead to more serious consequences. Joint dysplasia in children is treated conservatively or surgically. At an early stage of detection of an anomaly of the joint, a conservative one will help. In this case, various orthopedic devices are used that guide the joint into the cavity (that is, into the correct position). Further development of the joint occurs without deviations.
Surgical treatmentcarried out if it is necessary to reconstruct the TBS. This happens when the anomaly of the joint was detected late or conservative methods were not effective. The type of intervention depends on the specific defect. In the best case, after the operation, the joint will fall into place. In case of complications, several surgeries will be required.
