Arthroplasty is a surgical procedure that involves restructuring, reshaping and refunctioning a pained and dysfunctional joint in order to remove the pain and recover its range of motion. It can be defined as a reformation of the joint or its renewal by an artificial one. In other words, it is a surgical intervention which provides a recovery of joints that prevent daily activities, hurt the patient and decrease his/her quality of life. Joints affected from arthritis are replaced by artificial parts produced from alloys containing steel, titanium, vanadium, aluminum, cobalt and chromium in order to achieve a pain-free range of motion.
Hip Arthroplasty (Hip Prosthesis)
Hip arthroplasty is a common surgical procedure that has pleasing results in cases of hip pain and limited range of motion based on arthritis.
Arthroplasty is applied as a last resort for these patients if all other treatment methods fail to satisfy their needs. The procedure is mainly composed of removing the bones and cartilages affected from arthritis, replacing them with new joint surfaces made of metal parts and durable polyethylene. Hip arthroplasty is a surgical operation aimed to improve the quality of life.
The time of the operation depends on the patient. Hip arthroplasty is an operation applied not only for hip arthritis, but also for traumatic fractures in the circumference of hips.
Some parts of the hip joint are unable to knit together. Therefore the fractured bones need to be removed and replaced with prosthesis in order to recover the functionality of the hip joint. Hip arthroplasty is also applied in what we call avascular necrosis in medicine, which means the death of bone tissue due to a lack of blood supply. The advanced stages in avascular necrosis are treated with total knee replacement.
Total Hip Replacement
In knee arthroplasty, there are two methods in stabilizing the implanted parts to the hip joint: cemented and cementless. In cemented knee replacement, the prosthesis is stabilized to the bones by a medical cement called polymethyl methacrylate. The first knee prostheses used in 1950’s are prepared with cement. Cemented knee prostheses can be used without a problem for up to 25 years after adaptation. The life of cemented knee prostheses are prolonged after the introduction of third-generation cementation techniques. Third-generation cementation techniques involve washing the cemented area with pressure water, creating a totally dry cementation area and using high-pressure liquid cement. It is suitable to use totally cemented prostheses in patients with severe bone loss over the age of 70.
Cementless acetabular (hip) prostheses are consisted of special parts that knit together with the bones in the course of bone development. Cementless prostheses are pressed between the socket of pelvis (acetabulum) and thighbone. Prostheses that are affixed by pressing have holes that allow the bones to grow inside and knit together with them. There is also the biomedical coating material called hydroxylapatite which speeds up the fusion process even further. Cementless prostheses are more widely chosen today except elderly patients with severe bone loss.
There are three types of prostheses according to the material:
Metal-on-polyethylene connection:
The first prosthesis designed and used for a long time. It reached the durability of ceramic prostheses by the recent developments in plastic (polyethylene) inserts technology. By the help of special coated heads called “oxinium” in plastic inserts, the durability is now close to that of ceramic prostheses.
Ceramic-on-ceramic connection:
It is a recent system with highly improved wear resistance, mostly preferred for young, active, lightweight female patients.
Metal-on-metal connection:
It is the most resistant prosthesis against impacts and corrosions, mostly preferred for young, overactive and overweight male patients.
Surface Arthroplasty
Hip resurfacing is an alternative form of hip arthroplasty that conserves proximal femoral bone. The prosthesis is affixed with cement. It is more suitable for males under 50 and females before menopause. It is an intervention aimed to preserve the patient’s bones.
Higher functional capacity can be achieved via this system compared to total hip replacement. It offers less need for rehabilitation, faster recovery and return to work. The prosthesis is high on anatomical compatibility and preserves the joint’s range of motion.
Platelet-Rich Plasma to the Hip Joint
Platelet-Rich Plasma (PRP) means: plasma rich with thrombocytes, which are known to release proteins that heal and recover tissues when activated. The thrombocytes in this treatment method are acquired from the patient’s own blood samples and injected to the regions of hip joint that are damaged by arthritis. They speed up the healing process dramatically by activating stem cells with concentrated thrombocytes (platelets).
