Joint Replacement Surgery

Joint replacement surgery is considered a last resort treatment option to relieve arthritis pain and restore function to the affected joint. More conservative treatment options are usually tried before surgery is recommended. Joint replacement surgery is recommended when pain is no longer well-controlled and joint damage significantly affects quality of life.

What Is Joint Replacement Surgery?

Joint replacement involves these steps:

• Cartilage is removed from both sides of a joint.
• The affected joint is resurfaced with a prosthesis, which is a new joint made of metal and plastic components.

In other words, an orthopedic surgeon takes out the damaged joint and puts in a new, artificial one. Theoretically, any joint in the body can be replaced, but most joint replacement surgeries involve the knee and hip.

What Is a Joint Replacement Made of?

New implant materials and improved surgical techniques for joint replacement have been developed over the past three decades. While a prosthesis can be made of metal, or metal and plastic, it also can be cemented with a grout-like substance, non-cemented, or a combination of both to achieve fixation. Typically, a cemented prosthesis is used in older people. The non-cemented version is more appropriate for younger, active people. This is because good bone quality is needed so that bone can grow into the prosthesis to secure it.

Joint prostheses typically are composed of alloys of titanium and cobalt chrome. A newer material being used is called tantalum -- a soft, highly porous metal. The stiffness of tantalum compares to bone. A few years ago, ceramic prostheses were popular. The composition of a joint replacement prosthesis is constantly improving and as a result, they are lasting longer. New joints are lasting about 10 to 15 years so, depending on the age of the patient, revisions and possibly multiple revisions are likely for younger patients.

How Common Is Joint Replacement Surgery?

Approximately 435,000 adults in the United States have a hip or knee replaced each year. The number grows each year because of an aging population and the solid success of joint replacement surgery.

How do you know if you need a joint replacement? Ask yourself these questions:

• Have I tried medication and other conservative pain-relieving treatment options?
• Do I have unrelenting pain in the affected joint?
• Do I have significant difficulty with usual daily activities, such as walking, climbing stairs, cooking, cleaning, and more?
• Has my quality of life suffered due to arthritis pain and joint damage?

If you are answering "yes" to most or all of the questions, consult with your healthcare provider. You may be a candidate for joint replacement surgery.

What Are the Benefits of Joint Replacement Surgery?

Typically, patients who have had joint replacement surgery return to normal daily activities and function well. Patients who participated in sports before needing surgery likely can participate in low-impact sports following surgery.

Physical therapy and a committed rehabilitation program are important to a successful outcome for surgery. The outcome and speed of recovery following joint replacement surgery depend on:

• activity level before surgery
• overall general health
• severity and duration of physical impairment before surgery
• type of surgery (i.e., cemented, non-cemented, minimally invasive)
• attitude toward recovery and motivation

Are Complications Possible With Joint Replacement Surgery?

More than 90% of joint replacement patients have a successful outcome. There is the possibility of complications with any surgery, however. It's important to know what they are and that they are treatable. Possible complications include:

• infection
• blood clots
• loosening of the prosthesis
• dislocation
• nerve or blood vessel injury near prosthesis
• problems with anesthesia

Is the Recuperation Grueling?

Most patients will begin physical therapy the day after surgery. Some will go home in three to five days, while others may spend time in a rehabilitation center focusing on physical therapy and becoming independent. There are several physical restrictions during the post-op period, all aimed at not dislocating the new prosthesis. The patient must be committed to the exercise regimen and following the restrictions. The surgeon's job is done when he leaves the operating room. At that point, the work is just beginning for the patient.

People often ask about the length of time required for a full recovery from joint replacement surgery. The answer is somewhat variable, allowing for the type of surgery performed, whether complications developed and the physical and emotional investment made by the patient. The patient should expect to become stronger and more mobile over two to three months. Pain will also decrease over time.