Joint Replacement Surgery

Overview

In a joint replacement, the abnormal bone and lining structures of the joint are removed surgically, 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

Why may joint replacement surgery be needed?

Joints may need to be replaced when they are damaged from:

Arthritis.
Years of use.
Disease.

Your doctor will likely first suggest other treatments to reduce pain and help you move better, such as:

Walking aids, such as a cane or walker.
An exercise program.
Physical therapy.
Medications.

Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x-ray to look at the joint. If the x-ray shows damage and your joint hurts, you may need a joint replacement.

Causes

The most common causes of the joints not working properly are osteoarthritis and rheumatoid arthritis. While nobody is certain what causes arthritis, several things may contribute to joint weakening and lead to arthritis, including:

Heredity (runs in the family)
Problems with the development of the joint
Genetic (inherited) tendency to problems with the cartilage
Minor repetitive injuries
Severe trauma to the joint cartilage (the cushioning tissue at the end of the bones)

While being overweight does not necessarily cause arthritis, it can contribute to early joint problems that can get worse quickly.

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

What happens during joint replacement surgery?

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. The prosthesis (replacement joint) is made of titanium, cobalt chrome, stainless steel, ceramic material, and polyethylene (plastic). It can be attached to the bone with acrylic cement or it can be press-fit, which allows the bone to grow into the implant. Once the joint replacement is in place, the patient has physical therapy to be able to move and use the joint.

The 3 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.

ALTERNATIVES

Some alternate procedures for treating arthritis include:

Joint injections
Oral medications such as aspirin or anti-inflammatory medicine
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

Joint replacement surgery removes damaged or diseased parts of a joint and replaces them with new, man-made parts. Replacing a joint can reduce 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.