The bone ends of a joint are covered with a smooth layer called cartilage. Normal cartilage allows nearly frictionless and pain-free movement. When the cartilage is damaged by injury or diseased by arthritis or simpleage-related wear can make a joint stiff and painful. It does not move easily and may get deformed. When this arthritic or damaged joint is removed and replaced with prosthesis it is called a joint replacement. Total joint replacement will be considered if other treatment options will not relieve the pain and disability. This surgery can be done on many joints but I commonly replace Knee, Hip and Shoulder joints. Joint replacement prostheses are commonly anchored in to the bone with cement but can be implanted without cement when the prosthesis and the bone are designed to fit and lock together directly. The development of successful joint replacement surgery was a great invention in the history of medicine and these operations are amongst the most successful surgeries of any surgical specialty
These surgeries have transformed the lives of patients crippled with joint diseases. They brought the “quality of life” back in to the lives of people.
A joint is where two or more bones come together, like the knee, hip, and shoulder. Joint replacement surgery is removing a damaged joint and putting in an artificial joint, called prosthesis. Joint replacement, or arthroplasty, represents a significant advance in the treatment of painful and disabling joint pathologies. Total joint replacement can be performed on any joints of the body, including the hip, knee, ankle, foot, shoulder, elbow, wrist, and fingers. Of these procedures, hip and knee total joint replacements, are by far the most common. Treatment of the diseased hip or knee joint does not end with surgical replacement. The ultimate goal is ensuring the pain-free function of the joint to improve the patient’s quality of life. Postoperative rehabilitation is of the utmost importance.
The doctor usually arranges a general medical evaluation before joint replacement surgery to assess the patient’s general health condition and risk for anesthesia. Patients are advised to take a daily iron and a multivitamin supplement some weeks before surgery. Several types of tests are usually required, including blood tests, a cardiogram, a urine sample, and a chest x-ray. Patients may be required to stop taking certain medications like blood thinning drugs – aspirin until surgery is over.
With knee or hip surgery, you may be able to go home in 3 to 5 days. If you are elderly or have additional disabilities, you may then need to stay a little longer in the hospital. After hip or knee replacement, you will often stand or begin walking the day following surgery. At first, you will walk with a walker or crutches. You may have some pain in the new joint because of surgery and that your muscles are weak from not being used for a long time till the operation. Also, your body is healing. The pain can be helped with medicines and should improve gradually. Physiotherapy can begin on the day of 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 within your pain limits as soon as you can. The physiotherapist will help you with gentle, range-of-motion exercises.
The success of a person’s joint replacement surgery depends a great deal on what they do once they return home. It is important for the person to follow their doctor’s advice concerning what they should eat, the medications they should take, and how they should exercise. It is important for the person to speak with their doctor about any pain or difficulties with moving. Joint replacement is a success in greater than ninety-percent of those who have it. When problems do happen, most of them are treatable.
Living with joint replacement
Following a relatively short period of recovery after surgery, patients undergoing joint replacement surgery typically return to a high level of activity. The speed of recovery following surgery depends on your level of activity before surgery, general health and overall physical fitness, degree and duration of physical impairment before surgery, the type of surgery you had, and your expectations and motivation. Physical therapy after joint replacement is very important.
Long-term physical limitations after surgery are nearly always due to other orthopedic or rheumatologic problems (significant arthritis in other joints, chronic low back pain) or major health problems (heart, breathing, other chronic illnesses) rather than due to any limitations of the joint replacement. In general, those undergoing hip and knee replacements can return to unlimited low impact activities such as swimming, water exercise, walking, biking, low impact aerobics, golf, and doubles tennis.
Most orthopedic surgeons advise against high impact and joint overloading activities that involve heavy lifting, running, and jumping. However, few patients have any significant restrictions on their normal activities of daily living following hip or knee replacement.
Although patients typically obtain a functional amount of motion following hip replacement surgery, occasionally the limits of motion of a total hip replacement can be exceeded, resulting in dislocation out of its normal position. Patient education and understanding of the limitations of total hip replacement, especially regarding the potential for dislocation and range of motion restrictions, can help minimize the occurrence of this complication. Patients should be encouraged to discuss specific limitations and activity restrictions following total joint replacement with their surgeons.