Overview on Joint Replacement:
Total joint replacement is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic or ceramic device called a prosthesis. The prosthesis is designed to replicate the movement of a normal, healthy joint.
In 2011, almost 1 million total joint replacements were performed in the United States. Hip and knee replacements are the most commonly performed joint replacements, but replacement surgery can be performed on other joints, as well, including the ankle, wrist, shoulder, and elbow.
In a joint replacement, the abnormal bone and lining structures of the joint are removed surgical-ly, and new parts are inserted in their places. These new parts may be made of special metal or plastic or specific kinds of carbon-coated implants. The new parts allow the joints to move again with little or no pain. Finger joints (called PIP), knuckle joints (called MP) and wrist joints can all be replaced.
Artificial joints in the hand may help:
- Reduce joint pain
- Restore or maintain joint motion
- Improve the look and alignment of the joint(s)
- Improve overall hand function
Joint replacement surgery is designed to replace the damaged cartilage and any bone loss. During the procedure, the damaged joint is resurfaced, and the patient’s muscles and ligaments are used for support and function.
Most common replacements:
The three most common joint replacement surgeries are hip, knee, and shoulder.
Hip replacement
Total hip replacement is a surgery for replacing the hip socket and the “ball” or head of the thigh bone (femur). The surgeon resurfaces the socket and ball where cartilage and bone have been lost, and then inserts an artificial ball and socket into healthy bone.
Most people who have total hip replacements have serious changes in the hip joint caused by arthritis. A hip replacement is recommended if the person cannot bear the joint pain, and when the person can’t perform activities of daily living because the damaged hip is preventing it.
Knee replacement:
Knee replacement surgery is performed to treat advanced or end-stage arthritis. When arthritis in the knee joint or joints has advanced to the point where it cannot be treated with medicine alone, or the deformity has become severe and keeps the patient from using the knee, replacement surgery may be recommended.
The need for knee replacement surgery is the damage to the coating or gliding surface called the articular cartilage. Depending on the amount of damage, ordinary activities such as walking and climbing stairs may become difficult. Damage to the knee joint cartilage and bone may also cause deformity. Knock-knee or bow-legged deformities and unusual knee sounds (crepitus) may become more noticeable as the deterioration gets worse.
Knee replacement surgery is designed to replace this damaged cartilage or gliding surface, as well as any loss of bone structure or ligament support. The material used for knee replacement is similar to that used for hip replacements.
Shoulder replacement
Total shoulder joint replacement is usually needed for people who have advanced forms of osteoarthritis or rheumatoid arthritis, and sometimes for those who have had severe injury from a shoulder fracture. The main goal of total shoulder replacement surgery is to relieve pain; other goals include improving motion, strength, and function.
Similar to the hip joint, the shoulder is a large ball-and-socket joint. The main reason for a total shoulder replacement is pain that is not being relieved with therapy or other treatment methods.
When is it recommended?
Several conditions can cause joint pain and disability and lead patients to consider joint replacement surgery. In many cases, joint pain is caused by damage to the cartilage that lines the ends of the bones (articular cartilage)—either from arthritis, a fracture, or another condition.
If nonsurgical treatments like medications, physical therapy, and changes to your everyday activities do not relieve your pain and disability, your doctor may recommend total joint replacement.
In a normal joint, bones have a smooth surface made of a substance called articular cartilage on their ends that allows one bone to glide easily against another. Joints are lubricated by a thin layer of fluid (synovial fluid) that acts like oil in an engine to keep parts gliding smoothly. When the articular cartilage wears out, is damaged, or the joint fluid is abnormal, problems develop, and joints often become stiff and painful. This is arthritis, which may be possible to treat with this procedure.
Preparing for Surgery:
In the weeks before your surgery, your surgical team and primary care doctor will spend time preparing you for your upcoming procedure. For example, your primary care doctor may check your general health, and your surgeon may require several tests — such as blood tests and a cardiogram — to help plan your surgery.
There are also many things you can do to prepare. Talk to your doctor and ask questions. Prepare yourself physically by eating right and exercising. Take steps to manage your first weeks at home by arranging for help and obtaining assistive items, such as a shower bench, handrails, or a long-handled reacher. By planning ahead, you can help ensure a smooth surgery an
d speedy recovery.
Each surgery is different. How long it takes depends on how badly the joint is damaged and how the surgery is done. 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 for 1 to 2 hours until you are fully awake or the numbness goes away.
Surgical Procedure:
Total joint replacement surgery takes a few hours. The procedure is performed in a hospital or outpatient surgery center.
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.
Complications:
Your doctor will explain the potential risks and complications of total joint replacement, including those related to the surgery itself and those that can occur over time after your surgery.
Most complications can be treated successfully. Some of the more common complications of joint replacement surgery include infection, blood clots, nerve injury, and prosthesis problems like loosening or dislocation.
What Is a New Joint Like?
A new joint, called a prosthesis (praas-THEE-sis), can be made of plastic, metal, or ceramic parts. It may be cemented into place or not cemented, so that your bone will grow into it. Both methods may be combined 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. 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.
Recovery:
Recovery and rehabilitation will be different for each person. In general, your doctor will encourage you to use your “new” joint shortly after your operation. Although it may be challenging at times, following your doctor’s instructions will speed your recovery.
Most patients will experience some temporary pain in the replaced joint because the surrounding muscles are weak from inactivity, the body is adjusting to the new joint, and the tissues are healing. This pain should resolve in a few months.
Exercise is an important part of the recovery process. Your doctor or physical therapist will provide you with specific exercises to help restore movement and strengthen the joint.
If you have any questions about limitations on your activities after total joint replacement, please consult your doctor.
Risks:
Some risks of this procedure include:
- Implant loosening, fracturing or wearing down over time, which may require subsequent surgery
- Infection
- Joint stiffness or pain if the procedure or implant fails
- Dislocation of the artificial joint
- Damage to vessels, nerves or other structures in the region of the surgery
Alternatives:
Some alternate procedures for treating arthritis include:
- Joint injections
- Oral medications such as aspirin or anti-inflammatory medicines
- Hand therapy exercises and protective splints
- Arthrodesis surgery to fuse bones together, which relieves pain by eliminating motion be-tween damaged joint surfaces
- Resection arthroplasty, which is a surgery to remove arthritic surfaces and/or bone
- Surgery on tendons or ligaments to repair related joint injuries
Long-Term Outcomes:
The majority of patients are able to perform daily activities more easily after joint replacement surgery. Most people can expect their joint replacement to last for many years, providing them with an improved quality of life that includes less pain, along with improved motion and strength that would not have been possible otherwise.