Total Joint Replacement

Orthopedic surgery is a subgroup of the overall field of surgery involved in the preservation or restoration of function of bones and joints. Many persons with painful joints are frequently told that they have arthritis. Arthritis is a general term that implies an inflammation or swelling of the joint with some changes in the characteristics of the joint itself. This could be either from a birth abnormality, an accident, or developed insidiously.

For a person with painful joints that do not respond to non-surgical management, total joint replacement represents a successful means of gaining pain relief and improving function.

What is total joint replacement?

Total joint replacement is a surgical procedure whereby the diseased surfaces of a joint are replaced with smooth artificial surfaces. The amount of surface replaced in the joint and the type of replacement parts are decided by the particular joint that is diseased.

Who needs a total joint replacement?

The majority of people who have a painful joint do not need total joint replacement. Total joint replacement is reserved as the last resort for those people who have such PAIN and loss of function due to disease in joint that no medical treatment or therapy is able to alleviate the discomfort. This is usually seen in patients with rheumatoid arthritis or osteoarthritis, but could also be present from an accident or birth defect. In general, patients greater than 60 years old are considered better candidates for total joint replacement due to some limitations that are required after the procedure is done. However, recent advances have made the age group of 50-60 more feasible candidates.

Which joints can be replaced?

With the present technology, most of the joints of the upper and lower limbs can be replaced under the appropriate conditions. Excluding the replacement of the knuckles of the hand and big toe, hip joint replacement is the most frequently performed operation. Knees, ankles, shoulder, and elbow replacements are also available.

What do these artificial parts look like?

We have essentially two parts for the hip. One is for the replacement of the hip socket, or (the medical term) "acetabulum". The state of the art is a plastic cup with a metal lining over the back of this cup. The hip ball is replaced with a smooth metallic ball supported by a stem placed down into the leg bone to provide its support.

A similar situation exists for the knee whereby the upper part of the knee is replaced with metal, and the lower half with a plastic tray.

How are these artificial parts inserted?

The surgeon is required at operation to identify the diseased joint surfaces. The surfaces are then smoothed by removing the diseased portion and preparing it for application of the artificial part.

In general, the artificial parts have been secured to the bone with a surgical cement. (c) In studying the long term results of replacing these diseased parts, the problem that most frequently is encountered is that ultimately the inserted cement tends to loosen from the bone and the parts themselves come loose. Presently, the technology exists where in an appropriate individual, usually the younger patient with premature arthritis, artificial parts with special coatings over a portion of the component can be inserted into the leg "without the cement" applied. By this means, the person's bone can grow into this coating surrounding the part and securing it to the leg. The technology for replacing diseased parts and not utilizing cement is presently available replacing parts of the hip, knee, shoulder, and elbow.

After replacement of the Knee joint, a special continuously moving machine is used to help the patient gain mobility more rapidly.

What are the advantages of total joint replacement?

The number one indication for having a total replacement in the appropriate individual is PAIN RELIEF. Furthermore, in many cases, improved function and quality of life is possible and, in another small subset of persons, the improvement of limb alignment is accomplished.

What are some of the disadvantages of total joint replacement?

Certainly the first thought that comes to mind is the fact that this procedure requires major surgery, something that must be performed in a hospital, and requires a stay of some 10 days to 2 weeks. Problems that one must be aware of include the healing of the wound, the potential for the components to come apart or dislocate, fracture of the bone, phlebitis, and nerve and blood vessel problems. These are things that require appropriate surgical planning and skill to decrease their potential for occurring.

What limitations will the patient have after total joint replacement?

We have heard stories of people jogging after total knee replacement.  Unfortunately, these people are taking great risks to their future well being. People with total joint replacement must realize that to gain pain relief they must be dedicated to keeping the components in as good a shape as possible. Towards that end I recommend no running, jumping or tumbling be performed after a replacement in the lower part of the body. This is because, as we have discussed, loosening is the most prevalent problem with the artificial parts and, should it occur, re-operation would of course be required. As far as daily activities, walking is fine and is actually helpful. Many people can golf after replacement of the diseased part and tennis with doubles can sometimes be accomplished. Driving a car is usually permitted 10-12 weeks after surgery.

Last?

Wear of the artificial parts is no longer considered a real problem. The wear is so slow that in following these patients with replacements for long terms, we have found that this is no longer a difficulty. Studies that have been done 10 years following surgery, are now showing up to the range of 90-95% good and excellent feeling about the artificial replacement joint by the patient. Beyond that range, since the first total joint was implanted in 1969 in the United States, we do not have statistics to document.

In summary, for the appropriate individual with diseased joints that no longer respond to medicine or other therapeutic modalities, a total joint replacement remains a satisfactory means of relieving pain and restoring function, returning the individual to a more acceptable level of activity.

We are certain that there will be other question in you mind as well as your family's. We encourage you to ask us so we can help you better understand all aspects of total joint replacement.

Richard A. Conn, M.D.
Medical Director
Hip & Knee Institute