Joint Replacement

Joint replacement surgery is becoming more common. In total joint replacement, the damaged joint is replaced with artificial implants. In partial joint replacement, only the diseased or damaged joint surfaces are removed and replaced with artificial parts. A joint is where two or more bones come together, like the knee, hip and shoulder. (Read about "The Knee" "The Shoulder" "The Hip") The surgery is usually done by a doctor called an orthopedic or orthopaedic surgeon. (Read about "Orthopedics")

Replacing a joint can help you relieve pain and move and feel better. Joints that can be replaced include the shoulders, fingers, ankles and elbows. Hips and knees are replaced most often, according to National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Joints can be damaged by arthritis (Read about "Arthritis & Rheumatic Diseases") and other diseases, injuries or other causes. Arthritis or simply years of use may cause the joint to wear away. This can cause pain, stiffness and swelling. Bones are alive, and need blood to be healthy, grow and repair themselves. Diseases and damage inside a joint can limit blood flow, causing problems.

A new joint, called a prosthesis, can be made of various materials including plastic, metal, ceramic or a combination of materials. NIAMS says it may be cemented into place or not cemented, so that your bone will grow into it. Both methods are sometimes used at the same location, to keep the new joint in place.

A cemented joint is used more often in older people who do not move around as much and in people with "weak" bones. (Read about "Osteoporosis") The cement holds the new joint to the bone. An uncemented joint is often recommended for younger, more active people and those with good bone quality. It may take longer to heal, because it takes longer for bone to grow and attach to it. New joints generally last at least 10 to 15 years. Therefore, younger patients may need to have the same damaged joint replaced more than once, according to NIAMS.

Joint replacement is becoming more common. The number of people having the surgery is approaching half-a-million a year, according to the federal government. Hospitals and doctors have been replacing joints for several decades, and this experience is resulting in more and more success for the patients.

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.

If you are having pain and discomfort in a joint, you should consult with your healthcare provider. Only a doctor can tell if you need a joint replaced. He or she will look at your joint with an x-ray machine or other machines. (Read about "X-rays") The doctor may put a small, lighted tube (arthroscope) into your joint to look for damage. (Read about "Arthroscopy") A small sample of your tissue could also be tested. After looking at your joint, the doctor may say that you should consider exercise, walking aids like braces or canes, physical therapy, or medicines and supplements. Medicines for arthritis include drugs that reduce inflammation. Depending on the type of arthritis, the doctor may prescribe corticosteroids or other drugs. However, all drugs may cause side effects, including bone loss.

If all these fail to help, the doctor may then suggest replacement surgery. Joint replacement may be the answer if you have constant pain and can't move the joint well; for example, if you have trouble with things like walking, climbing stairs and taking a bath.

If the decision is made to have surgery, you will be usually admitted to the hospital. (Read about "At the Hospital: For Patients") The surgical team will give you medicine so you won't feel pain. (Read about "Anesthesia") The medicine may block the pain only in one part of the body (regional), or it may put your whole body to sleep (general). The team will then perform the surgery.

Each surgery is different. How long it takes depends on how badly the joint is damaged and how the surgery is done. NIAMS says to replace a knee or a hip takes about 2 hours or less, unless there are complicating factors. After surgery, you will be moved to a recovery room until you are fully awake.

With knee or hip surgery, you may be able to go home in one to five days, depending on the extent of the damage before the surgery and the type of procedure being performed. If you are elderly or have additional handicaps, you may then need to spend several weeks in an intermediate care facility before going home. How long you stay in the hospital will be determined by you and your team of doctors. (Read about "The Hip")

After hip or knee replacement, you will often stand and begin walking sometimes even the day of surgery. At first, you will walk with a walker or crutches. You may have some temporary pain in the new joint because your muscles are weak from not being used. Also, your body is healing. The pain can be helped with medicines and should end in a few weeks or months.

Physical therapy (Read about "Rehabilitation") can begin the day after surgery to help strengthen the muscles around the new joint and help you regain motion in the joint. If you have your shoulder joint replaced, you can usually begin exercising the same day of your surgery. A physical therapist will help you with gentle, range-of-motion exercises. Before you leave the hospital (usually two or three days after surgery), your therapist will show you how to use a pulley device to help bend and extend your arm.

NIAMS says joint replacement is usually a success in more than 90 percent of people who have it. When problems do occur, most are treatable. Possible problems include:

• Infection - Areas in the wound or around the new joint may get infected. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound are usually treated with drugs. Deep infections may need a second operation to treat the infection or replace the joint. (Read about "Microorganisms")
• Blood Clots - If your blood moves too slowly, it may begin to form lumps of blood parts called clots. If pain and swelling develop in your legs after hip or knee surgery, blood clots may be the cause. The doctor may suggest drugs to make your blood thin, or special stockings, exercises, and/or boots to help your blood move faster. If swelling, redness or pain occurs in your leg after you leave the hospital, contact your doctor right away.
• Loosening - The new joint may loosen, causing pain. If the loosening is bad, you may need another operation. New ways to attach the joint to the bone should help.
• Dislocation - Sometimes after hip or other joint replacement, the ball of the prosthesis can come out of its socket. In most cases, the hip can be corrected without surgery. A brace may be worn for a while if a dislocation occurs.
• Wear - Some wear can be found in all joint replacements. Too much wear may result in loosening. The doctor may need to operate again if the prosthesis comes loose. Sometimes, the plastic can wear thin, and the doctor may just replace the plastic and not the whole joint.

Joint replacement is not for everyone. You should discuss your particular needs with a qualified doctor.

Related Information:

    Joint Resurfacing

    Skeletal System