Joint Replacements

Joint Replacements

  •  Total Knee Replacement
  •  Partial Knee Replacement
  •  Ligament Reconstruction
  •  Total Hip Joint Replacement
  •  Hip Resurfacing
  •  Shoulder Joint Replacement
  •  Rotator cuff surgery
  •  Elbow replacement
  •  Spin surgery

What is arthroplasty

Structure of Knee:

The knee is one of the largest and most complex joints in the body.

The knee is made up of the lower end of the thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella).

The ends of these three bones are covered with articular cartilage,

Knee surface are covered by a thin lining called the synovial membrane. This membrane releases a fluid that lubricates the cartilage, reducing friction.

The menisci are located between the femur and tibia. These C-shaped wedges act as "shock absorbers" that cushion the joint.

Tendons connect the knee bones to the leg muscles that move the knee joint.

Ligaments join the knee bones and provide stability to the knee four ligament;

The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).

The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).

The medial and lateral collateral ligaments prevent the femur from sliding side to side.

Numerous bursae, or fluid-filled sacs, help the knee move smoothly

There are different types of knee replacements. Options include:

  •  Total knee replacement: the whole knee is replaced
  •  Partial knee replacement: only the affected part of the knee is replaced
  •  Bilateral knee replacement: both knees are replaced at the same time

Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.

Total knee arthroplasty, is a highly successful surgical procedure which involves replacement of all three compartments of the knee (the medial compartment (inside aspect of the knee), the lateral compartment (outside of the knee) and the patellofemoral compartment (in front of the knee)).

Knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability.

It is most commonly performed for osteoarthritis, and also for other knee diseases such as rheumatoid arthritis and psoriatic arthritis.

When Surgery Is Recommended?

There are several reasons when recommend knee replacement surgery. People who benefit from total knee replacement often have:

Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs. It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker

Moderate or severe knee pain while resting, either day or night

Chronic knee inflammation and swelling that does not improve with rest or medications

Knee deformity - a bowing in or out of the knee

Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Conditions that can be treated with knee replacement
  •  Severe osteoarthritis
  •  Ligament damage or infection that leads to severe osteoarthritis
  •  Rheumatoid arthritis
  •  Haemophilia
  •  Crystal deposition diseases such as gout and ‘pseudogout’
  •  Avascular necrosis – death of bone following loss of blood supply
  •  Bone dysplasia’s – disorders of the growth of bone.
Surgery description

A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones is replaced.

There are four basic steps to a knee replacement procedure:

Prepare the bone - The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.

Position the metal implants - The removed cartilage and bones are replaced with metal components that recreate the surface of the joint. These metal parts may be cemented or "press-fit" into the bone.

Resurface the patella - The under surface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons do not resurface the patella, depending upon the case.

Insert a spacer - A medical-grade plastic spacer is inserted between the metal components to create a smooth gliding surface.

Surgical Procedure

Total joint replacement surgery takes a few hours. The procedure is performed in a hospital or outpatient surgery Centre.

During the surgery, the damaged cartilage and bone is removed from your joint and replaced with prosthetic components made of metal, plastic, or ceramic. The prosthesis mimics the shape and movement of a natural joint. For example, in an arthritic hip, the damaged ball (the upper end of the femur) is replaced with a metal ball attached to a metal stem that is fitted into the femur, and a plastic socket is implanted into the pelvis, replacing the damaged socket.

Types of knee implants

Four types of knee implants are the most common. They are

Metal on plastic. It is the most common type of knee implant. It has a femoral metal component and a polyethylene spacer attached to the tibial component. The commonly used metals are cobalt-chromium, titanium, zirconium, and nickel.

Ceramic on plastic. The femoral component is made of ceramic instead of metal and has a plastic spacer attached to the tibial end.

Ceramic on ceramic. In this, both the femoral and tibial ends will have ceramic implants

Metal on metal. The femoral and tibial ends are metallic

In some, the plastic used in the implants can cause an allergic reaction. In such cases, the surgeon will avoid using plastic implants. Ceramic implants can create some sounds while walking, and cannot bear a lot of stress. Your surgeon will decide the type of implant according to your needs and budget.

Attain greater flexibility and to reduce the build-up of scar tissue. Strengthening the muscles around your knee is essential to avoid pressure on the new joint.

Your surgeon will also tell you about what to do and what not to do after surgery. You will have to follow it for faster recovery and to avoid complications.

During knee replacement surgery, damaged bone and cartilage is resurfaced with metal and plastic components. In unicompartmental knee replacement (also called "partial" knee replacement)

Only a portion of the knee is resurfaced. This procedure is an alternative to total knee replacement for patients whose disease is limited to just one area of the knee.


In knee osteoarthritis, the cartilage protecting the bones of the knee slowly wears away. This can occur throughout the knee joint or just in a single area of the knee.

Your knee is divided into three major compartments:

  •  Medial compartment (the inside part of the knee)
  •  Lateral compartment (the outside part)
  •  Patellofemoral compartment (the front of the knee between the kneecap and thighbone)

ACL ligament surgery - The ACL is one of the four ligaments that keep the knee joint in a stable position. It connects the femur or the thigh bone with the tibia or the shin bone and runs diagonally across the middle of the knee joint.

An ACL injury is common among those who take part in sports and games. Abrupt stops, sudden turns, pivots, mistimed jumps, etc. can injure the ACL.

Other reasons include direct trauma to the knee, falls, sudden twisting of the knees, etc.

Symptoms of an ACL tear or injury

An ACL injury is usually of sudden onset, and the symptoms also appear at the same time. The most common signs that you will have are:

  •  A popping sound in the knee at the time of injury
  •  Sudden swelling of the knees
  •  Sharp pain in the knees
  •  Weakness and instability of the knees

If the tear is complete, you will find it difficult to walk or even stand up. You should not walk without support then, or else there can be more complications.

Why it's done

ACL injury open pop-up dialog box

Ligaments are strong bands of tissue that connect one bone to another. The ACL one of two ligaments that crosses the middle of the knee connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.

Most ACL injuries happen during sports and fitness activities that can put stress on the knee:

  •  Suddenly slowing down and changing direction (cutting)
  •  Pivoting with your foot firmly planted
  •  jump incorrectly
  •  Stopping suddenly
  •  direct blow to the knee
  •  Reconstructive ACL surgery

A torn ACL cannot be repaired by stitching it back together, but it can be reconstructed by attaching (grafting) new tissue on to it. The ACL can be reconstructed by removing what remains of the torn ligament and replacing it with a tendon from another area of the leg, such as the hamstring or patellar tendon. The patellar tendon attaches the bottom of the kneecap (patella) to the top of the shinbone (tibia).

All ligament reconstructive treatment available

The hip joint is a ball and socket type joint and is formed where the thigh bone (femur) meets the pelvis. The femur has a ball-shaped head on its end that fits into a socket formed in the pelvis, called the acetabulum.

Large ligaments, tendons, and muscles around the hip joint hold the bones (ball and socket) in place and keep it from dislocating.

Hip joint is designed for stability and weightbearing rather than a large range of movement.

When to do a hip replacement surgery?

Osteoarthritis is the main reason for the degeneration of the hip joint. Some of the other main factors are

  •  Rheumatoid arthritis
  •  Septic arthritis
  •  Ankylosing spondylitis
  •  Bone dysplasia, a condition characterized by an abnormal growth of bones

All these diseases cause a degeneration of the hip joint. You will need a hip replacement if it is severe.

You may consider a hip replacement surgery if you have any of the following

  •  Severe pain during activity as well as rest
  •  Stiffness in the hip joint that reduces your movements
  •  You are not able to lift your leg
  •  You have problems doing routine stuff like walking, bending, etc
  •  The pain in the hip is so severe that it prevents you from sleeping
  •  You have a fracture in the hip bone

Hip replacement surgery can improve the quality of your life. Being able to move around without pain and assistance can make you feel more independent. Types of hip replacement surgery

There are two main types which are

Total Hip Replacement: In a total hip replacement surgery, the surgeon replaces both the femoral head and acetabulum with artificial implants.

Partial Hip Replacement: Here, the surgeon replaces only the femoral head. Those with a fracture in the femoral head are good candidates for this. The acetabulum is usually not replaced in such cases. two different methods for Hip replacement.:

Open Surgery: Here, the surgeon makes a 10-12-inch long incision on the side of the hip. It gives a clear view of the dislocated or injured hip after splitting the muscles. Then, the artificial implants replace the ball and socket with screws to hold it in place.

Minimally Invasive Surgery: This surgery needs only two or three small cuts instead of a long incision. Recovery will be faster here, and there will be lesser issues. However, it may not be fit for all. The doctor will decide the right type as per your condition.


In a total hip replacement (also called total hip arthroplasty), the damaged bone and cartilage is removed and replaced with prosthetic components.

The damaged femoral head is removed and replaced with a metal stem that is placed into the hollow centre of the femur. The femoral stem may be either cemented or "press fit" into the bone.

A metal or ceramic ball is placed on the upper part of the stem. This ball replaces the damaged femoral head that was removed.

The damaged cartilage surface of the socket (acetabulum) is removed and replaced with a metal socket. Screws or cement are sometimes used to hold the socket in place.

A plastic, ceramic, or metal spacer is inserted between the new ball and the socket to allow for a smooth gliding surface.

Structure of shoulder joint

Articulating Surfaces

The shoulder joint is formed by the articulation of the head of the humerus with the glenoid cavity (or fossa) of the scapula. alternate name for the shoulder joint – the glenohumeral joint.

Like most synovial joints, the articulating surfaces are covered with hyaline cartilage. The head of the humerus is much larger than the glenoid fossa, giving the joint a wide range of movement more than stability. the glenoid fossa is deepened by a fibrocartilage rim, called the glenoid labrum.

The synovial membrane lines the inner surface of the joint capsule, and produces synovial fluid to reduce friction between the articular surfaces.

To reduce friction in the shoulder joint, several synovial bursae are present. A bursa is a synovial fluid filled sac, which acts as a cushion between tendons and other joint structures.

Sabscapular bursae
Sabacromial bursae

The shoulder joint has tendons that connect bone to muscle and ligaments that connect bones to bones. These tendons and ligaments essentially encase the movable parts of the joint, providing support for the integrity of the joint while allowing for full range of motion.

Conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.

  •  Osteoarthritis (Degenerative Joint Disease)
  •  Rheumatoid Arthritis.
  •  Post-traumatic Arthritis.
  •  Rotator Cuff Tear Arthropathy.
  •  Avascular Necrosis (Osteonecrosis)
  •  Severe Fractures
  •  Previous replacement not successful.
Why I needed surgery?

Severe shoulder pain that interferes with everyday activities, such as reaching, dressing, toileting, and washing.

Moderate to severe pain while resting. This pain may be severe enough to prevent a good night's sleep.

Loss of motion and/or weakness in the shoulder.

Failure other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.

Shoulder replacement

There are different types of shoulder replacements. Your surgeon will evaluate your situation carefully before making any decisions. He or she will discuss with you which type of replacement would best meet your health needs.

The procedure to replace your shoulder joint with an operation usually takes 1 to 2 hours.

Your surgeon will make a cut on the front of your shoulder and remove the damaged ball (head of the humerus). They will examine the socket which lies on your shoulder blade. They will replace the ball and sometimes also the socket. The new ball is made of metal and the socket is usually made of plastic.

Your shoulder replacement is fixed into the bone using a special coating on your arm side of your shoulder joint

After surgery, you will be moved to the recovery room, where you will remain for several hours while your recovery from anesthesia is monitored. After you wake up, you will be taken to your hospital room.

Total Shoulder Replacement

The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

These components come in various sizes. They may be either cemented or "press fit" into the bone. If the bone is of good quality, your surgeon may choose to use a non-cemented (press-fit) humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid (socket) component is implanted with bone cement.

Stemmed Hemiarthroplasty

Depending on the condition of your shoulder, your surgeon may replace only the ball. This procedure is called a hemiarthroplasty. In a traditional hemiarthroplasty, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty.

Some surgeons recommend hemiarthroplasty when the humeral head is severely fractured but the socket is normal. Other indications for a hemiarthroplasty include:

Arthritis that only involves the head of the humerus with a glenoid that has a healthy and intact cartilage surface

Shoulders with severely weakened bone in the glenoid

Some shoulders with severely torn rotator cuff tendons and arthritis

Sometimes, surgeons make the decision between a total shoulder replacement and a hemiarthroplasty in the operating room at the time of the surgery.

Studies show that patients with osteoarthritis get better pain relief from total shoulder arthroplasty than from hemiarthroplasty.

Resurfacing Hemiarthroplasty

Resurfacing hemiarthroplasty involves replacing just the joint surface of the humeral head with a cap-like prosthesis without a stem. With its bone preserving advantage, it offers those with arthritis of the shoulder an alternative to the standard stemmed shoulder replacement.

Reverse Total Shoulder Replacement

Another type of shoulder replacement is called reverse total shoulder replacement. Reverse total shoulder replacement is used for people who have:

Completely torn rotator cuffs with severe arm weakness

The effects of severe arthritis and rotator cuff tearing (cuff tear arthropathy)

Had a previous shoulder replacement that failed.


The rotator cuff is a collection of muscles and tendons that surround the shoulder, giving it support and allowing a wide range of motion.

Your rotator cuff is a group of tendons and muscles in your shoulder. It helps you lift and rotate your arm. It also helps keep your shoulder joint in place. But sometimes, the rotator cuff tendons tear or get pinched by the bones around them.

An injury, like falling on your arm, can cause this to happen. But wear and tear over time can take its toll on your shoulder, too. The pain can be severe.

You may need surgery if:

Your shoulder hasn’t improved after 6 to 12 months

You’ve lost a lot of strength in your shoulder and find it painful to move You have a tear in your rotator cuff tendon

You’re active and rely on your shoulder strength for your job or to play sports

What Type of Surgery Do I Need?

The most common types are:

Arthroscopic repair. After making one or two very small cuts in your skin, a surgeon will insert a tiny camera called an arthroscope and special, thin tools into your shoulder. These will let him see which parts of your rotator cuff are damaged and how best to fix them.

Open tendon repair. This surgery has been around a long time. It was the first technique used to repair the rotator cuff. If you have a tear that’s very large or complex, your surgeon may choose this method.

Three common techniques are used to repair a rotator cuff tear:

During open repair, a surgical incision is made and a large muscle (the deltoid) is gently moved out the way to do the surgery. Open repair is done for large or more complex tears.

During arthroscopy, the arthroscope is inserted through small incision. The scope is connected to a video monitor. This allows the surgeon to view the inside of the shoulder. One to three additional small incisions are made to allow other instruments to be inserted.

During mini-open repair, any damaged tissue or bone spurs are removed or repaired using an arthroscope. Then during the open part of the surgery, a 2- to 3-inch (5 to 7.5 centimetres) incision is made to repair the rotator cuff.

Structure of elbow joint;

The elbow joint is a synovial joint found in the upper limb between the arm and the forearm. It is the point of articulation of three bones: the humerus of the arm and the radius and the ulna of the forearm.

It”s a synovial joint.

The articular surfaces of the bones at these joints are separated from each other by a layer of hyaline cartilage.

Smooth movement at these joints is provided by a highly viscous synovial fluid, which acts as a lubricant.

Condition that treated by elbow replacement

  •  Rheumatoid Arthritis
  •  Osteoarthritis (Degenerative Joint Disease)
  •  Post-traumatic Arthritis.
  •  Severe fractures.
  •  Instability.
When I need Surgery?

The indications for total elbow arthroplasty include severe pain, loss of motion, deformity, instability or destruction of the elbow joint. The symptoms are often due to traumatic or rheumatoid arthritis.

Traumatic arthritis of the elbow is a disorder occurring after a fracture or break within the elbow. It is characterised by pain and wearing a way of cartilage and the most common symptoms associated with this are stiffness, pain and swelling of the joint.


In elbow replacements both sides of the joint are replaced. The upper arm and forearm components (humeral and ulnar components) are made of both metal and plastic. The operation will be carried out using a general and/or a local anaesthetic. The elbow joint is usually opened from the back and the muscles moved back. The parts of the bone with damaged joint surfaces are then removed and the shafts of the prepared ulna and humerus have the components inserted, which are usually cemented in. Most designs have a hinge or pivot between the two halves.

Types of elbow replacement

In some cases, you may need a replacement of just one portion of the joint. For example, if only the head of one of your forearm bones (radius) is damaged, it can be replaced with an artificial head.

If the entire joint needs to be replaced, the ends of the bones that come together in the elbow will be removed. Bones are hard tubes that contain a soft centre. The long, slender ends of the artificial joint are inserted into the softer central part of the bones.

There are two main types of prosthetic devices available:

Linked. This type of prosthesis acts somewhat like a loose hinge because all the parts of the replacement joint are connected. This provides good joint stability, but the stresses of movement can sometimes result in the prosthesis working itself loose from where it's inserted into the arm bones.

Unlinked. This type of device comes in two separate pieces that aren't connected to each other. This design depends on the surrounding ligaments to help hold the joint together, which can make it more prone to dislocation.


You should be able to go home after 2 to 5 days.

need to use a support for your elbow for 6 weeks.

Regular exercise should help you to return to normal activities

Most people make a good recovery, have less pain, and can move their elbow better. An artificial elbow never feels quite the same as a normal elbow.

An elbow replacement can wear out with time.

Procedure Cost Range in India (USD) Days in India Required Medical Test
ACL Reconstruction $3000 - $4300 Hospital - 5 days
Outside the hospital around 12 days.
Total – 17 Days
Lachman Test, Anterior Drawer Test and Pivot Shift Test
Knee Replacement (Single) – with implants $4000 - $6500 Hospital - 5 days
Outside the hospital around 15 days.
Total – 20 Days
X-Ray and MRI
Knee Replacement (Double) – with implants $8000 - $12000 Hospital - 5 days
Outside the hospital around 15 days.
Total – 20 Days
X-Ray and MRI
Shoulder Replacement Surgery Cost in India $7000 - $8400 Hospital - 5 days
Outside the hospital around 8 days.
Total – 13 Days
X-Rays, MRI Scan and Blood Tests(occasionally)
Hip Replacement (Single) – with implants $5400 - $7500 Hospital - 5 to 7 days
Outside the Hospital - 14
Total – 21 Days
blood tests, an MRI and an X-Ray
Hip Replacement (Double) – with implants $7300 - $12300 Hospital - 5 to 7 days
Outside the Hospital - 14
Total – 21 Days
blood tests, an MRI and an X-Ray
Rotator cuff surgery      
Elbow replacement