Joint replacement surgery is one of the most effective orthopaedic interventions in providing painless functional range of motion to the joints - principally the hip and knee. With newer materials and designs these implants can typically last 15 to 20 years. After this time these implants do run their course and need to be changed out. The standards of joint replacement have by en large been dictated by Western research and literature that generally predict a specific body type and requirement for anatomical restoration. Modern day Asian surgeons who were trained in the West, however, realise that Asian patients are quite different. There is a tendency for increased femoral and tibial bowing and this results in unusual strains on implants designed for a Western individual. Furthermore, Asian patients tend to have a greater requirement for deep flexion for squatting.
Most times the implants put in are able to last the patients lifetime. Occasionally, however, the joints need to be changed especially if the patient had them put in early in a previous time. Unlike primary joint replacements which should be in the purview of most orthopaedic surgeons, the experience required for such revision arthroplasties are not common. The patients tend to be older and require specific consideration for more medical problems. The implants used may not be compatible with newer designs and need to be revamped if they cannot be retained and adapted. Bone loss as a result of revision can result in the need for bone transplants in addition to specialised joint replacement implants. Most orthopaedic surgeons who have skills in revision arthroplasty would have to be affiliated with a tertiary referral centre, gone on to do fellowships in top centers and then returned o practice in tertiary centers for a number of years. Consequently such a experience skill set is uncommon. Here at Limb Salvage and Revision Arthroplasty Surgery Pte Ltd our surgeons are well skilled in all aspects of revision arthroplasty and are actively involved in research and education on the subject. For more information on other services we provide you can proceed to our central website at www.limbsalvagesurgery.com .
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Figure 1. In the Asian community the more common causes of hip arthritis is that due to avascular necrosis (a) where cavities form in the head due to bone death (arrowed) and (b) developmental dysplasia where the head becomes uncovered (arrowed) due to a shallow acetabulum.
Figure 2. In younger patients like this, large heads allow the patient extreme stability and range of motion (a) with implants made with hard materials articulating on hard sockets as in the ceramic on ceramic hip replacement inserted through the anterior minimally invasive surgery approach here (b). Whenever the head becomes bigger the socket becomes thinner (arrowed) and more prone to early failure (c).