Joint replacement surgery is removing a damaged joint and putting in a new one. 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.
The new joint can be made of plastic, metal, or ceramic parts. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts. Types of new joints include:
- Cemented joints: 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.
- Uncemented joints: 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.
- Hybrid replacements: Use both methods to keep the new joint in place.
Why It May Be Needed
Pain, stiffness, and swelling may be due to joint damage caused by:
- Years of use.
To see if you need a joint replaced, your doctor may:
- Look at your joint with an x-ray or another machine.
- Put a small, lighted tube (arthroscope) into your joint to look for damage.
- Take a small sample of your tissue for testing.
After looking at your joint, the doctor may recommend:
- Walking aids, such as braces or canes.
- Physical therapy.
- Medicines and vitamin supplements.
- Osteotomy, which involves cutting and lining up bone. This may be simpler than replacing a joint, but it may take longer to recover. However, this operation has become less common.
If you still have constant pain and have trouble with things such as walking, climbing stairs, and taking a bath, your doctor may recommend joint replacement.
What to Expect During
During joint replacement surgery your doctors will:
- Give you medicine so you won’t feel pain. The medicine may block the pain only in one part of the body, or it may put your whole body to sleep.
- Replace the damaged joint with a new man-made joint.
- Move you to a recovery room until you are fully awake or the numbness goes away.
New technology and advances in surgical techniques have greatly reduced the complications involved with joint replacements. 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 you’re still 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.
- 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, 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 to reattach the joint to the bone.
- 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 help cause 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.
- Nerve and blood vessel injury. Nerves near the replaced joint may be damaged during surgery, but this does not happen often. Over time, the damage often improves and may disappear. Blood vessels may also be injured.
As you move your new joint and let your muscles grow strong again, pain will lessen, flexibility will increase, and movement will improve.
What to Expect After
With knee or hip surgery, you will probably need to stay in the hospital for a few days. If you are elderly or have additional 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.
After hip or knee replacement, you will often stand or begin walking 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 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, your therapist will show you how to use a pulley device to help bend and extend your arm.
Research on joint replacement surgery is exploring:
- The various forms of arthritis to stop or slow joint damage.
- New joint materials and other ways to improve surgery and decrease complications.
- Why some people who need surgery don’t choose it.