Arthroplasty and Reconstructive Surgery of the Hip and Knee
Core principles
- Arthroplasty is indicated for end-stage pain and functional limitation after failed non-operative care, not for radiographic appearance alone.
- Fixation choice depends on bone quality and patient factors: cemented stems, cementless press-fit implants and hybrid constructs have different failure profiles.
- Bearing surfaces trade wear against fracture and instability risk; highly cross-linked polyethylene reduces wear, while ceramic and metal-on-metal have specific complications.
- Alignment and soft-tissue balance affect instability and polyethylene wear. Documentation, consent and infection prevention are part of the procedure.
- Aseptic loosening, periprosthetic fracture, instability, infection and thromboembolism are core complications.
Worked example
A 68-year-old with severe knee osteoarthritis and varus deformity asks for replacement. Reasoning: confirm pain limits walking and sleep, exclude referred hip pain, optimize diabetes and smoking, plan correction of deformity without overcorrection, and discuss infection, stiffness, instability and revision risk. Postoperative VTE prophylaxis follows local protocol and bleeding risk.
Traps
Do not operate for painless stiffness. Do not ignore a painful arthroplasty: aspiration and culture are needed before assuming loosening. Do not overlook component malposition when instability appears.
Key points are listed separately.