KNOWLEDGE BASE

Joint Replacement Surgery

What Is Joint Replacement Surgery?

Joint replacement surgery is removing a damaged joint and putting in a new one. A joint is where two or more bones come together, like the knee, hip, and shoulder. The surgery is usually done by a doctor called an orthopaedic (or-tho-PEE-dik) surgeon. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts.
The doctor may suggest a joint replacement to improve how you live. Replacing a joint can relieve pain and help you move and feel better. Hips and knees are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles, and elbows.

Do Many People Have Joints Replaced?

Joint replacement is becoming more common. More than 1 million Americans have a hip or knee replaced each year. Research has shown that even if you are older, joint replacement can help you move around and feel better.
Any surgery has risks. Risks of joint surgery will depend on your health before surgery, how severe your arthritis is, and the type of surgery done. Many hospitals and doctors have been replacing joints for several decades, and this experience results in better patient outcomes. For answers to their questions, some people talk with their doctor or someone who has had the surgery. A doctor specializing in joints will probably work with you before, during, and after surgery to make sure you heal quickly and recover successfully.

Do I Need to Have My Joint Replaced?

Only a doctor can tell if you need a joint replaced. He or she will look at your joint with an x-ray machine or another machine. The doctor may put a small, lighted tube (arthroscope) into your joint to look for damage. A small sample of your tissue could also be tested.
After looking at your joint, the doctor may say that you should consider exercise, walking aids such as braces or canes, physical therapy, or medicines and vitamin supplements. Medicines for arthritis include drugs that reduce inflammation. Depending on the type of arthritis, the doctor may prescribe corticosteroids or other drugs.However, all drugs may cause side effects, including bone loss.
If these treatments do not work, the doctor may suggest an operation called an osteotomy (aas-tee-AAHT-oh-me), where the surgeon “aligns” the joint. Here, the surgeon cuts the bone or bones around the joint to improve alignment. This may be simpler than replacing a joint, but it may take longer to recover. However, this operation has become less common.
Joint replacement is often the answer if you have constant pain and can’t move the joint well—for example, if you have trouble with things such as walking, climbing stairs, and taking a bath.

What Happens During Surgery?

First, the surgical team will give you medicine so you won’t feel pain (anesthesia). The medicine may block the pain only in one part of the body (regional), or it may put your whole body to sleep (general). The team will then replace the damaged joint with a prosthesis.
Each surgery is different. How long it takes depends on how badly the joint is damaged and how the surgery is done. To replace a knee or a hip takes about 2 hours or less, unless there are complicating factors. After surgery, you will be moved to a recovery room for 1 to 2 hours until you are fully awake or the numbness goes away.

What Happens After Surgery?

With knee or hip surgery, you will probably need to stay in the hospital for a few days. If you are elderly or have additional disabilities, you may then need to spend several weeks in an intermediate-care facility before going home. You and your team of doctors will determine how long you stay in the hospital.
After hip or knee replacement, you will often stand or begin walking the day of surgery. At first, you will walk with a walker or crutches. You may have some temporary pain in the new joint because your muscles are weak from not being used. Also, your body is healing. The pain can be helped with medicines and should end in a few weeks or months.
Physical therapy can begin the day after 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 the same day of your surgery! A physical therapist will help you with gentle, range-of-motion exercises. Before you leave the hospital, your therapist will show you how to use a pulley device to help bend and extend your arm.

Will My Surgery Be Successful?

The success of your surgery depends a lot on what you do when you go home. Follow your doctor’s advice about what you eat, what medicines to take, and how to exercise. Talk with your doctor about any pain or trouble moving.
Joint replacement is usually a success in most people who have it. When problems do occur, most are treatable. Possible problems include:

Arthroscopy

Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and treat problems inside a joint.
The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint."
In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.
By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee. This lets the surgeon see the cartilage, ligaments, and under the kneecap. The surgeon can determine the amount or type of injury and then repair or correct the problem, if it is necessary.

Why is arthroscopy necessary?

Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as magnetic resonance imaging (MRI) or computed tomography (CT) also scan may be needed.
Through the arthroscope, a final diagnosis is made, which may be more accurate than through "open" surgery or from X-ray studies.
Disease and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are:

How is arthroscopy performed?

Arthroscopic surgery, although much easier in terms of recovery than "open" surgery, still requires the use of anesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anesthetic, depending on the joint or suspected problem.
A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Several other incisions may be made to see other parts of the joint or insert other instruments.
When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.For instance, most meniscal tears in the knee can be treated successfully with arthroscopic surgery.
After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications.
Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.
The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The extensive "open" surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.

What are the possible complications?

Although uncommon, complications do occur occasionally during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in far less than 1 percent of all arthroscopic procedures.

What are the advantages?

Although arthroscopic surgery has received a lot of public attention because it is used to treat well-known athletes, it is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than "open" surgery. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.

What is recovery like after arthroscopy?

The small puncture wounds take several days to heal. The operative dressing can usually be removed the morning after surgery and adhesive strips can be applied to cover the small healing incisions.
Although the puncture wounds are small and pain in the joint that underwent arthroscopy is minimal, it takes several weeks for the joint to maximally recover. A specific activity and rehabilitation program may be suggested to speed your recover and protect future joint function.
It is not unusual for patients to go back to work or school or resume daily activities within a few days. Athletes and others who are in good physical condition may in some cases return to athletic activities within a few weeks. Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. Recovery time will reflect that individuality.

Patient Safety

Preparing for Surgery

When we go for surgery we turn over our care to highly trained doctors, nurses, and hospital staff. However, studies show that patients who understand their treatment and recovery are more likely to have better outcomes.
Be sure to provide your healthcare team with a list of all the medications you take — including prescription drugs, over-the-counter medications, and vitamins and supplements. It is particularly important before surgery that your care team knows whether you take a blood thinner medication or diabetes medications.
Talk to your doctor about any allergies you have.
If you or a family member has had any problems with anesthesia in the past, make sure your doctor knows.

Take steps before surgery to help you manage your first weeks at home. For example:
Arrange for help with daily tasks like shopping and laundry
If your mobility will be limited while you heal, prepare your home by rearranging furniture, removing rugs, an
Talk to your doctor's office about finding assistive items such as reachers or long-handled sponges