Total joint replacement surgery: The state of the art

For people with arthritis, total joint replacement is usually considered a last resort. Generally, health care providers recommend it when other treatments no longer work and/or pain has worsened to the point where it severely impacts quality of life. One of the single most important things to consider is that joint replacement is a decision that is made by both patient and health care provider – most commonly it is a quality of life decision.

The definition of a join is the point where two bones of the skeleton come together, usually in a way that allows motion.  Joint replacement surgery involvements removing some or all of those parts of the damaged joint and putting in new, artificial parts to recreate it.  In many cases, joint replacement can be a ‘lifesaver’, reducing pain and getting people active again after being disabled. The surgery has greatly improved over the years, especially for the time it takes to recover. Joint replacement can have an up to 90 percent success rate.

Here are commonly asked questions and answers about the procedure.

Who should get joint replacement surgery?

The surgery is for people with severe joint disease that greatly affects daily functioning; often the result of pain in the affected joint.  Knee or hip replacements are common examples of joint replacement surgery.  Most people who have knee or hip replacement are over the age of 55, with osteoarthritis (degenerative joint disease) often being the cause.  People with other forms of advanced arthritis may be good candidates for joint replacement in their 40’s or even their 30’s.

Which joints are most often replaced?

The joints most often replaced are the knees and hips. Shoulders, elbows, fingers, and ankles also can be replaced. Those procedures usually are done only in special circumstances, such as injury, as there may be more risks, complications, and longer recovery periods.

What surgical improvements have occurred over the years?

New techniques allow for joint replacement to sometimes be a minimally invasive surgical procedure. Due to computer-assisted technologies and new techniques, in some cases, such as with hip replacement, the joint replacements can now be performed with the use of only one or two incisions (cuts) in the skin.  Comparatively, the incisions are only a few inches long compared with 6 inches or longer in the past.  Additionally, such advances help to reduce surgery time, leading to less loss of blood, fewer risks related to anesthesia, a lower possibility of infection and, ultimately, improved and faster healing.

It’s important to be aware that different surgeons use different techniques.  If you are to have a joint replacement, ask your health care provider for a step-by-step overview of the planned procedure, and if a minimally invasive approach is possible.



What materials are used in joint replacement?

An artificial joint, called a prosthesis, can consist  different parts that are made of plastic, ceramic, metals such as titanium, or combinations of these materials. Prostheses are smooth, durable, and allow the new joint to “roll” or “slide” like a natural joint. The prosthesis may be cemented in place with special cement. Younger, active patients may receive an un-cemented prosthesis because their young, healthy bone will “cement” itself to the new parts. When the prosthesis is un-cemented, the surgeon selects a type of artificial joint that will allow bone to grow to bond with the new parts. Sometimes both cemented and un-cemented methods are used for the different parts of the joint.



How long is the average recovery?

It may take three to six months to recover from joint replacement surgery, depending on the joint replaced and the technique used. During the first six weeks, people gradually resume some normal activities, but likely will need a walker or crutches. During the next six weeks, people are usually able to begin to walk with a cane. Healing times vary, so talk with your health care provider to set realistic expectations for your recovery. Physical therapy is a major part of the treatment during the entire recovery period.



What are the possible complications?

Infection is the most common serious complication, and it can sometimes be difficult to treat, because the new joint doesn’t have blood flow like the bone it replaces. A dislocation of a new joint part is possible, and may sometimes require an operation to fix. The most serious complication of large joint replacement is a blood clot, which can sometimes be life-threatening. Surgeons will often prescribe a blood thinner and use other methods to try to prevent a blood clot from forming.

How long does a joint replacement last?

The timeframe varies among individuals. It depends on factors such as age, physical condition, activity level, and weight. Generally, replaced joints last between 10 and 25 years. Hip replacements have been found to last an average of 15 years in 95 percent of patients.

A major concern used to be how long the new joint would last in younger patients. It was thought that 15 years would be the maximum time it would last. However, newer materials that are now being used may wear out more slowly, making younger patients with advanced arthritis good candidates for joint replacement. Good information about how long joints with the newer types of material will last is not yet available.

What advances are on the horizon?

It is reasonable to expect to see more computer-assisted surgery, which will result in more accurate measurements for new joints and parts that are more similar to the original bones. Durable new materials are also being tested for possible use in artificial joints. Join implants that are gender-specific in design may become more common as well.

The hope is that these and other advances will lead to an even higher success rate and a wider range of options for people with arthritis.