Surgery is usually the last line of treatment, when all other treatments – including physical therapy and medications – have not helped the patient. Joint replacement surgery is a highly effective way of eliminating joint pain, correcting a deformity, and helping improve the patient’s mobility (movement). Joint replacement surgery is also performed to treat advanced arthritis
People who are considered for joint replacement surgery often have severe joint pain, stiffness, limping, muscle weakness, limited motion, and swelling. Depending on the joint that is affected and the amount of damage, patients may have trouble with ordinary activities such as walking, putting on socks and shoes, getting into and out of cars, and climbing stairs.
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 injures
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.
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 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.
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 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.
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.
Hip replacement post-operative management
Most patients can stand at their bedside on the first day after surgery and can even begin exercises. By the second day after surgery, most patients begin walking with a walker or with crutches, and can apply 50 to 75% of their weight on the affected leg.
Most patients leave the hospital by the first or second day after surgery. Older individuals and patients who have major health problems are usually referred to a rehabilitation facility for 7 to 10 days for more therapy.
All patients will use either crutches or a walker for about 4 weeks after surgery. They are then allowed to place full weight on the affected leg while using a cane for balance. The cane also prevents the muscles from becoming tired.
Generally, by 6 to 12 weeks after surgery, the person can stop using the cane or walker (if the doctor or therapist agrees) and the hip can support the person’s full weight. Patients who have weaker muscles may need to use the cane or walker for a longer period.
Once you have completed therapy after the total hip replacement, you can take part in most activities, such as walking, bike riding, skiing, and golf. Activities in which there is repeated or frequent impact on the joint (such as tennis and racquetball) should be avoided or practiced only occasionally.
Knee replacement post-operative management
Most patients who have total knee surgery have a dramatic improvement within three months of the surgery. The pain caused by the damaged knee is relieved when a new gliding surface is built.
Patients who have knee replacement surgery are usually standing and moving the joint the day after surgery. After about 6 weeks, most patients are walking comfortably with very little support; however, it may take 6 months to a year before the most benefit is achieved. After muscle strength returns, patients who have knee replacement surgery can enjoy most activities (except running and jumping).
Approximately 85% of knee implants will last 20 years. Improvements in surgical techniques, prosthetic designs, bearing surfaces, and fixation methods may allow these implants to last even longer.
Shoulder replacement post-operative management
A successful result of your total shoulder joint replacement strongly depends on your performing the exercises that were prescribed for you. Through this structured exercise program, your muscles will be regularly and increasingly stretched and strengthened over one year’s time. The goal is to get your shoulder replacement working as well as it can.
In certain situations, patients may need extensive formal physical therapy after being discharged from the hospital. This can be done during outpatient therapy at home. Most patients, however, do not need any formal outpatient therapy.
Your rehabilitation will be continuing and always moving forward. It may take 6 months to 1 year to reach the most benefit. It is important to realize that progress is sometimes slow and not always steady. You must continue your therapy program without getting discouraged. Your doctor will check your progress during visits, which will be every 6 weeks for the first 4 to 5 months, and then less frequently for 1 year.
With improvements in materials, prosthetic designs, and surgical techniques, more than 95% of total joint replacement procedures should last 15 to 20 years or more. Follow-up after recovery from surgery should include X-rays after the first, third, fifth, and seventh years. After that, X-rays should be taken every 2 years to make sure that there is no wear on the replaced joint.