Shoulder For
shoulder replacement, there are a few major approaches to access the shoulder joint. The first is the deltopectoral approach, which saves the deltoid, but requires the supraspinatus to be cut. The second is the transdeltoid approach, which provides a straight on approach at the glenoid. However, during this approach the deltoid is put at risk for potential damage.
Hip Hip replacement can be performed as a total replacement or a hemi (half) replacement. A total hip replacement consists of replacing both the
acetabulum and the femoral head while
hemiarthroplasty generally only replaces the femoral head. Hip replacement is currently the most common orthopaedic operation, though patient satisfaction short- and long-term varies widely. It is unclear whether the use of assistive equipment would help in post-operative care. Hip replacement surgery can be performed from three main directions, each with advantages and disadvantages The classical approach is the posterior, and requires dissection of the gluteus maximus and other large muscles of the back of the thigh to access the acetabulum. The anterior approach accesses the hip joint from the front, with less large muscle dissection but due to the proximity of the femoral artery, corresponding vein, and main nerve bundle for the leg lying just medial to the acetabulum the surgeon must exercise caution and maintain suitable landmarks. The lateral approach dissects smaller muscles than the posterior approach, but has similar navigation concerns as the anterior approach. Surgeon experience tends to determine the surgeon's preference, meaning that the surgeon will only rarely deviate from what method they were initially trained to use.
Knee Knee replacement involves exposure of the front of the knee, with detachment of part of the
quadriceps muscle (
vastus medialis) from the
patella. The
patella is displaced to one side of the joint, allowing exposure of the
distal end of the
femur and the
proximal end of the
tibia. The ends of these bones are then accurately cut to shape using cutting guides oriented to the long axis of the bones. The
cartilages and the
anterior cruciate ligament are removed; the
posterior cruciate ligament may also be removed but the
tibial and
fibular collateral ligaments are preserved. Metal components are then impacted onto the bone or fixed using
polymethylmethacrylate (PMMA) cement. Alternative techniques exist that affix the implant without cement. These cement-less techniques may involve
osseointegration, including
porous metal prostheses. The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation. The recovery period may be six weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the person's return to preoperative mobility.
Ankle Ankle replacement has become a treatment of choice for people requiring arthroplasty, replacing the conventional use of
arthrodesis, i.e. fusion of the bones. The restoration of range of motion is the key feature in favor of ankle replacement with respect to arthrodesis. However, clinical evidence of the superiority of the former has only been demonstrated for particular isolated implant designs.
Finger Finger joint replacement is a relatively quick procedure of about 30 minutes, but requires several months of subsequent therapy. Post-operative therapy may consist of wearing a hand splint or performing exercises to improve function and pain. ==Risks and complications==