Bringing New Life to Old Joints

The old days of simply ‘dealing with’ joint pain are long gone, thanks to advancing medical technologies. In fact, about 435,000 Americans receive a hip or knee joint replacement each year, allowing better mobility and quality of life.

Simply put, joint replacement surgery involves removing a damaged joint and putting in a new one. The extent of the replacement varies by case, as some patients need a full replacement while others only need portions of joints replaced. Though hips and knees are the most common joints replaced, surgeons can also address the shoulders, fingers, ankles and elbows.

What happened to my joints?

Joints can be damaged by injuries, arthritis and other diseases or any number of other causes. Arthritis – a common culprit that is essentially caused by years of life – may cause the joint to wear away, which causes pain, stiffness and swelling.

Do I need my joint replaced?

Only a doctor will know for sure. He or she will carefully examine your troubled joint with the aid of X-rays and other diagnostic tools. The doctor may also put an arthoscope (a small, lighted tube) into the joint itself to look for damage. A small sample of your tissue might also be taken for further testing.

Unless the joint is in total disrepair, most doctors recommend less invasive options before surgery. These can include specific exercises, walking aids like braces or canes, physical therapy, medication and even supplements. Depending on the type of arthritis, the doctor may prescribe corticosteroids or similar drugs – though these drugs may cause side effects, including bone loss.

If these treatments do not work, the doctor may suggest an operation called an osteotomy, which involves a surgeon aligning the joint by cutting the bone or bones around the joint. In many cases this may be simpler than a total replacement, but it takes much longer to recover and isn’t done very often today.

Joint replacement is the usual remedy if joint pain is constant and prohibits daily activities like walking, climbing stairs and taking baths.

What is a new joint like?

The new joint, called a prosthesis, is constructed of either metal, plastic or a combination of the two. Sometimes the new joint is cemented into place, but other times it is not cemented so that your bone will actually grow into it. Surgeons will often use a combination of the two techniques.

Joints are typically cemented in older patients who have weaker bones and aren’t as physically active. Those with good bone quality and higher activity levels (usually younger patients) usually receive uncemented joints, even though it takes longer to heal because the bone literally must grow and attach itself to it.

Replacement joints usually perform well for at least 10 to 15 years. While this is an impressive feat, it does mean that younger patients may need the same joint replaced again when the original replacement wears out.

What are the risks?

Every surgery has risks. Your health
before the surgery, the type and extent of the surgery itself and even the severity of your arthritis can affect this risk. However, because many hospitals and doctors have been replacing joints for decades, this experience results in better patient outcomes.

What happens during the surgery?

Just like people, every surgery is different. How long it takes depends largely on how badly the joint is damaged and how extensive the actual surgery is. Barring complicating factors, a typical knee or hip replacement takes about two hours.

What happens after surgery?

Following a knee or hip surgery, you may be able to go home within three to five days. Though elderly patients, or those with additional handicaps may spend several weeks in an intermediate care facility before going home.

After a hip or knee replacement, it’s not uncommon to stand and begin walking the same day as the surgery. Physical therapy usually begins the day after surgery to strengthen the muscles around the new joint and help regain motion. Often times, it’s even possible to begin physical therapy on the same day as the surgery.

As you move your new joint and let your muscles grow strong again, the pain will usually lesson, flexibility will increase and range of motion will improve.

What about complications?

More than 90 percent of joint replacement recipients report success. But, like any surgical procedure, there are always risks. These include:

- Nerve and blood vessel injury. Nerves near the replaced joint may get damaged during surgery, though this doesn’t happen often. Similarly, blood vessels may also get damaged. But over time, the damage often heals and in many cases disappears entirely.
- Wear. Some wear can be found in all joint replacements. Too much wear may cause loosening. An additional operation may be necessary if the prosthesis comes loose. Sometimes plastic pieces can wear thin; in these cases doctors are often able to replace those parts rather than the entire joint.
- Dislocation. Sometimes the prosthesis can come out of its socket. In most cases, this can be corrected without surgery. A brace is often worn if a dislocation occurs.
- Loosening. The new joint may loosen from the bone, which causes pain. If the loosening is severe, it may require corrective surgery.
- Blood clots. If you blood moves too slowly, it may begin to form lumps (or 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 thin your blood, or special stockings, exercises and/or boots may be prescribed to help the blood move faster. If this develops after you’ve left the hospital, contact your doctor right away.
- Infection. Areas in the wound or around the new joint may get infected. It may happen in the hospital or after you’ve gone home, and may even occur years later. Minor infections are usually successfully treated with drugs. Deep infections, however, may require additional surgery or even another replacement.

How many people have joints replaced?

Joint replacement is becoming more common. Plus, research is showing that even on older patients, joint replacement can increase mobility and make people feel better.

Is any additional research being done?

Scientists are constantly studying replacement joints to determine the best ways to improve movement and flexibility, stronger materials and ways to improve the surgery itself. They are also studying joint damage itself – specifically what causes it and ways to prevent it.

Some researchers are studying a condition called osteolysis, a condition where bone is lost around the implant in response to inflammation. This sometimes causes the prosthesis to loosen and may require a second surgery.

Still other scientists are studying why so many people who need surgery don’t get it. They’re studying the emotional side of surgery, such as what factors make a difference in choosing (or not choosing) treatment, as well as perceptions about recovery.

What is osteoarthritis

Osteoarthritis is a joint disease that mostly affects the cartilage. When the cartilage is healthy, it allows the bones to glide over each other while also absorbing the shock of movement.

In osteoarthritis, the top layer of cartilage breaks down or wears away. This allows the bones underneath to rub together, which causes pain, swelling and loss of motion. Over time, the joint may lose its shape and bone spurs may even grow on the edges of the joint. In addition, bits of bone or cartilage can break off and float inside the joint space, which causes more pain and damage.

- Osteoarthritis usually occurs in older people, though younger people can experience it – usually as result of an injury.
- The exact cause of osteoarthritis is still unknown, but scientists have determined several risk factors, particularly being overweight, age and joint injury or stress.
- Osteoarthritis can occur in any joint, but it is most frequent in hands, knees, hips and the spine. Warning signs include pain, stiffness after being stationary, swelling, tenderness or a crunching feeling or sound of bone on bone.
- There is no one single test that accurately diagnoses osteoarthritis, so doctors usually use a battery of exams that may include a physical inspection, X-rays, blood tests or fluid tests.
- Once diagnosed, doctors can put together custom treatments to fit the patient’s individual needs. They often include exercise, weight control, pain relief, medication, alternative therapies and sometimes even surgery.
- Researchers are continuously studying osteoarthritis, particularly its causes and the most effective treatments. They are also testing how genetics, tissue engineering, pain relief medicines, acupuncture, vitamins and dietary supplements may affect the disease.