The lower limb could be affected by aches and pains of various muscles, joints, ligaments etc. The most common cause of pain is arthritis of the hip and knee joints.
Arthritis of hip joint and replacement
Arthritis of the hip joint is commonly due to osteoarthritis or rheumatoid arthritis. Sometimes arthritis follows trauma or other diseases like Perthes’ disease.
The pain in hip joint arthritis is usually felt in the groin. It could be quite incapacitating as far as day to day activities are concerned. Depending upon the magnitude of symptoms, patients are initially treated with painkillers, anti-inflammatory tablets, restriction of activities, walking aids etc. When the non-surgical treatment no longer proves effective, then a joint replacement could be of immense help to the patient.
A total hip replacement replaces the cup and the ball of the hip joint. Many different types of materials are now available. The cup and the ball with stem could be inserted with/without cement. The pros and cons of different materials are usually discussed with the patient.
Primary total hip replacement is nowadays, a sound procedure for the right patient. A thorough pre-operative check is necessary. Following admission the operation is performed with different types of anaesthesia which the consultant anaesthetist will discuss with the patient. Total hospital stay following surgery is 5 to 7 days. After the operation the pain is controlled with adequate painkillers. The patient is mobilised by a physiotherapist together with walking aids whilst in hospital. When the mobilisation is satisfactory the patient will be allowed home to continue their recovery. Often arrangements will be made to review the patient at home by a District Nurse. The wound will be checked within 10 to 12 days and the patient will be reviewed in the clinic approximately one month following surgery. After three months, the patient should be feeling much better due to relief of pain and increased mobility.
Although the success rate of the hip replacement is very high, it is important to remember that there can be complications like infection, DVT (deep vein thrombosis), dislocation etc. Much care is always taken in order to prevent any complication occurring.
The knee joint is one of the most common joints to be affected by wear and tear, arthritis and following trauma and often with meniscus (cartilage) ligament problems.
Pain in the knee due to arthritis can be quite incapacitating. It is very important to evaluate the knee by thorough clinical examination and in the first instance treated non-surgically with painkillers, anti-inflammatory tablets, reduction of activities, walking aids, physiotherapy etc.
Keyhole surgery (arthroscopy) is carried out to evaluate the extent of the joint’s disease and also at the same time can treat cartilage problems. Arthroscopy does have limited value for arthritic conditions. If the symptoms demand, then a total knee replacement would be required.
Before knee replacement surgery, thorough pre-operative assessments are carried out including blood tests, X-rays, ECG etc. If the patient is fit for surgery then he/she will be admitted accordingly and the operation will be performed. Following surgery the patient will be required to stay in hospital for 5 to 7 days. During this period, any pain the patient experiences will be controlled with painkillers and the patient will receive physiotherapy to mobilise.
Total knee replacement involves removing the lower part of the femur (thigh bone) with metal and replacing the upper part of the leg bone (tibia) with metal and plastic. The back of the kneecap may be replaced with a plastic button.
Total knee replacement (TKR) is a very good operation with good success rates. There may however be complications like infection and DVT (deep vein thrombosis) but steps are taken in order to prevent these occurring.