The future is bright for those who choose to have a total joint replacement to achieve an improved quality of life through greater independence and healthier pain-free activity.
Is it time to talk to a doctor about joint replacement surgery?
- Does your affected joint hurt one or more days per week?
- Does the pain interfere with your sleep?
- Is it painful for you when you perform everyday activities?
- Are pain medications no longer working?
- Is joint pain limiting your participation in activities you love?
If you answered yes to any of the questions above, you may be ready to learn more about joint replacement surgery.
What is a Joint?
A joint is formed by the ends of two or more bones that are connected by thick tissues. For example, the knee joint is formed by the lower leg bone (tibia and fibula) and the thighbone (femur). The hip is a ball and socket joint, formed by the upper end of the femur (the ball), and a part of the pelvis, called the acetabulum (the socket).
What Can Happen to My Joints?
Joints can be damaged by arthritis and other diseases, injuries, or other causes. This can cause pain, stiffness, and swelling. Osteoarthritis = breakdown of a joints cartilage and affects 27 million Americans. Cartilage is part of the joint cushions at the end of the bones and allows easy movement. Breakdown of cartilage causes the bones to rub against each other causing stiffness pain and loss of movement in the joint.
- Muscle weakness
- Soreness often overuse/activity
- Stiffness in morning or end of the day
- Poor coordination
Goal to improve ability to function and control pain and then symptoms
- Weight control
- Joint protection
- Physical Therapy/Occupational Therapy
What Is Joint Replacement Surgery?
Joint replacement surgery is removing the damaged or worn ends of bone and replacing it with low friction metal and plastic. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts.
The doctor may suggest a joint replacement to improve how you live. Replacing a joint can relieve pain and help you move and feel better. Hips and knees are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles, and elbows.
Why is Total Joint Replacement Necessary?
The goal is to relieve the pain in the joint caused by the damage done to the cartilage. The pain may be so severe that a person will avoid using the joint. Weakening the muscles around the joint and could make it even more difficult to move the joint. A physical examination, and possibly some laboratory tests and X-rays, will show the extent of damage to the joint. Total joint replacement will be considered if other treatment options will not relieve the pain and disability.
Do Many People Have Joints Replaced?
Joint replacement is becoming more common than ever before. About 773,000 Americans have a hip or knee replaced each year. Research has shown that even if you are older, joint replacement can help you move around and feel better.
Any surgery has risks. Risks of joint surgery will depend on your health before surgery, how severe your arthritis is, and the type of surgery done. Many hospitals and doctors have been replacing joints for several decades and this experience results in better patient outcomes. For answers to their questions, some people talk with their doctor or someone who has had the surgery. A doctor specializing in joints will work with you before, during, and after surgery to make sure you heal quickly and recover successfully.
How is a Total Joint Replacement Performed?
You will be given several different types of anesthetic and the surgeon will replace the damaged parts of the joint. For example, in an arthritic knee the damaged ends of the bones and cartilage are replaced with metal and plastic surfaces that are specifically shaped to restore knee movement and function. One of the most recent improvements in joint replacements is improved pain control after surgery.
The materials used in a total joint replacement are designed to enable the joint to move just like a normal joint.
A new joint, called a prosthesis is generally composed of two parts: a metal piece that fits closely into a matching sturdy plastic piece. Several materials are used, including ceramic, plastics, alloys of cobalt and chrome, and titanium. The plastic material (polyethylene) is durable and wear resistant. A bone cement may be used to anchor the prosthesis into the bone.
Joint replacements also can be implanted without cement when the prosthesis and the bone are designed to fit and lock together directly.
What Happens After Surgery?
With knee or hip surgery, you may be able to go home in 1 to 3 days. If you are elderly or have any disabilities, you may then need to spend several weeks in an intermediate-care facility before going home. You and your team of doctors will determine how long you stay in the hospital and the best course for additional rehabilitation.
After hip or knee replacement, you will often stand or begin walking the day of your surgery. At first, you will walk with the use of a walker or crutches.
Physical therapy begins the day of surgery to help strengthen the muscles around the new joint and help you regain motion in the joint. A physical therapist will help you with gentle, range-of-motion exercises. Before you leave the hospital your therapist will show you how to do home exercises.
We hope the motion of your joint will generally improve after surgery. The extent of improvement will depend on how stiff your joint was before the surgery and how quickly you start and how hard you work in physical therapy.
After you have healed from your surgery, you may be permitted to play golf, walk, and dance. More strenuous sports, such as running, soccer, and football may be discouraged.
What are the Complications?
Tell your orthopaedic surgeon about any medical conditions that might affect the surgery. Joint replacement surgery is successful in more than 9 out of 10 people. When complications occur, most are successfully treatable. Infection may occur in the wound or deep around the prosthesis. This may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the prosthesis. Antibiotics are given right before surgery and for 24 hours after the procedure to minimize the risk.
Blood clots result from several factors, including your decreased mobility causing sluggish movement of the blood through your leg veins. Blood clots may be suspected if pain and swelling develop in your calf or thigh. If this occurs, your orthopaedic surgeon may consider tests to evaluate the veins of your leg. Several measures may be used to reduce the possibility of blood clots, including:
- Blood thinning medications (anticoagulants)
- Exercises to increase blood flow in the leg muscles
- Plastic stockings that inflate with air to sequentially compress the legs help to prevent clots.
Blood clots are a rare event. If you develop swelling, redness or pain in your leg following discharge from the hospital, you should contact your orthopaedic surgeon.
Loosening of the prosthesis within the bone may occur after a total joint replacement. This may cause pain. If the loosening is significant, a revision of the joint replacement may be needed. The ration is believed to be approximately 1% a year. New methods of fixing the prosthesis to bone should minimize this problem.
Some wear can be found in all joint replacements. Excessive wear may contribute to loosening and may require revision surgery.
Breakage of the metal or plastic joint replacement is rare, but can occur. A revision surgery is necessary if this occurs.
Occasionally, after total hip replacement the ball can be dislodged from the socket. In most cases, the hip can be relocated without surgery. A brace may be worn for a period of time if a dislocation occurs. Most commonly, dislocations are more frequent after complex revision surgery.
Nerves in the vicinity of the total joint replacement may be damaged during the total replacement surgery, although this type of injury is infrequent. This is more likely to occur when the surgery involves correction of major joint deformity or lengthening of a shortened limb due to an arthritic deformity. Over time, these nerve injuries often improve and may completely recover.
How Do You Prepare for Total Joint Replacement?
Before surgery, your orthopaedic surgeon will make some recommendations, such as:
- Donate some of your own blood so that, if needed, you may receive it during or after surgery
- Stop taking some drugs before surgery
- Begin exercises including Physical Therapy to speed your recovery after surgery
- Evaluate your need for discharge planning, home therapy and rehabilitation after surgery
Is Total Joint Replacement Permanent?
Most older persons can expect their total joint replacement to last 10-15 years or more. It will give years of pain-free living that would not have been possible otherwise.
Younger joint replacement patients may need a second total joint replacement. Materials and surgical techniques are improving through the efforts of orthopaedic surgeons working with engineers and other scientists prolonging the life expectancy of the artificial joint.
Co-developed by Dr. Clay Wellborn, Nirschl Orthopaedic Center, and the American Orthopaedic Society for Sports Medicine