Total joint replacement: A new lease on life

Your grandchildren are begging you to go outside and play. You’d dearly love to, but the arthritis in your hip makes it just too difficult. Walking, climbing stairs, bending and twisting can cause you to grimace from the pain.

You’ve also taken your doctor’s advice to lose weight. You take your anti-inflammatory medications, limit your activities as much as possible and rely on a cane. But despite all that, the pain is so severe that you’ve cut back on many of the activities you love to do – including playing with your grandchildren.

Total hip joint replacement, one of the many joint replacement procedures available today, may offer marked pain relief and help you enjoy life’s simple activities once more.

Implanting A New Joint

The hip and knee are the most commonly replaced joints, but implants can also replace joints in the shoulder, elbow, finger and other locations (see diagram).

The surgical procedure used to repair joints is called arthroplasty. Arthroplasty literally means "reforming of the joint." Rarely, this may involve just smoothing the ends of the bones in your joints. Today, most arthroplasties are replacement arthroplasty, or total joint replacement, in which orthopedic surgeons remove parts of the joint and replace them with an implant, also called prosthesis.

Total hip replacement was pioneered during the 1960s, and modern knee replacement was developed in the ’70s. Subsequently, orthopedic surgeons began replacing other joints in the body. With the exception of the spine, almost all joints have been subjected to attempts of replacement.

The materials used in joint replacements are designed to make your artificial joint mimic your normal joint as much as possible. Your implant will probably have two parts – a hard metallic or ceramic piece that fits closely into a matching plastic piece. In the early days of modern hip replacement surgery, doctors used stainless steel. Today, the metallic piece may be made of titanium or alloys of cobalt and chromium. The plastic material is durable and wear-resistant.

Certain porous materials applied to joint implants seem to encourage bone growth. Among new materials being used is tantalum, which is an elemental metal like titanium. Soft tissues have been shown to attach to tantalum, which gives it an advantage over some other materials.

Bone cement was and often still is used to stabilize the replacement parts. However, joint fixation may also be accomplished without bone cement. While bone cement is best in some joints, in others the joint may last longer if bone grows into the implant to achieve fixation. However, cementless implants can loosen if healthy bones don’t grow into them.

Because the success of the joint replacement is, in part, gauged by how long it lasts, it takes years to know if a new material is an improvement. The success rate for hip or knee replacement has been extended so that they now commonly last 10 or 15 years or longer.

Each joint offers basically the same challenges in replacement – fixation to bone, stability of the joint, and prevention of joint stiffness or abnormal joint movement.

Is It Time For A Replacement?

Pain that limits function is the most common reason for a joint replacement. For example, if you have arthritis in your knee, the time will probably come when your knee hurts whenever you use it. You may find you sit or lie much of the time, walk very little and avoid stairs. You may have given up participating in activities you once enjoyed.

In the case of a painful hip, you may have pain when walking, standing or sitting in one position. Or, in the case of a painful shoulder, you get tired of not being able to get dressed or comb your hair without pain. In addition to the annoyance of not being able to move without pain, you may be putting yourself at risk of cardiovascular disease because of your lack of activity. When your day-to-day function has diminished to a level unacceptable to you, and non-surgical remedies no longer control the symptoms, it may be time to consider surgery.

Your Surgery And Recovery

Hip and knee replacement surgeries are usually done under either general anesthetic or special anesthetic techniques (a spinal or epidural) that take away feeling only in the lower part of your body.

In a hip replacement, the surgeon will make an incision outside of the hip and then move aside surrounding muscle to expose the joint. The thighbone is removed from its socket and the ball of the joint is cut off. The socket in the pelvis is enlarged and sculpted to accommodate the socket that is part of the artificial joint.

The shaft of your prosthesis is inserted at an appropriate length into the marrow of the upper leg bone to anchor the implant. The other half of the implant is attached to the pelvic bone.

In knee replacement, besides implanting a joint between the upper and lower leg bones, the surgeon must also be sure the ligaments are not too tight or too loose.

Hip replacement surgery typically takes about two to three hours. Other types of joint replacement surgeries may take more or less time because each case is different and the time needed to correct all problems can vary greatly.

The length of your hospital stay will depend on such factors as the type of joint operation you have, your age and health, and whether you have any complications. In the 1960s, people stayed in bed for two to three weeks after a hip operation. Today, rehabilitation treatments, such as physical therapy, begin almost immediately and hospital stays are shorter. The average time in the hospital after total hip or knee replacement is about five days.

At first, you may walk with a walker, crutches or a cane. Temporary pain in your replaced joint is common because the surrounding muscles are weak from inactivity and your tissues are healing.

Your physical therapy treatments will include learning how to use and protect your new joint. Exercise is an important part of your recovery. It will help you improve joint motion, strengthen the muscles around the joint, reduce pain, and help you improve your mobility.

Your doctor will help you decide when to return to your favorite activities. He or she will also help you identify movements or activities to avoid.

Joint replacement can require a few months to a full year of recovery before your bones and muscles heal completely and you regain your strength, stability and mobility. But many people have less pain and swelling and easier movements within weeks after surgery.

Even with a successful joint operation, you may need to avoid high-impact activities, such as running. But, depending on which joint was replaced, you can often resume an active life that includes walking, dancing, golfing, swimming and bicycling.

Fuller Life

If joint is stopping you from doing the things you enjoy, total joint replacement sur-gery may give you a whole new lease on life. Although replacement joints may not be as good as the ones your body came with, they usually enable you to live a fuller life than you might have otherwise.

And remember, if you do have a joint replaced, follow your doctor’s recommendation to do the proper exercises, protect your joint from injury and infections, and have routine, follow-up care with x-rays to assure your new joint is performing as it should.

If everything works well, you can become active once again. It will be a new ball game, literally and figuratively!