Arthroplasty comes from the words arthro (joint) and plasty (to replace or make new). Arthroplasty means a degenerative or diseased joint is replaced with a metal and plastic joint to improve function and decrease pain.
A recent survey found that over 7 million patients are currently living with either a hip or knee replacement. Knee replacements are performed about twice as often as hip replacements. The majority of those with replacements are women compared with men for a variety of reasons, including higher rates of arthritis in women.
Total joint replacement, specifically hip and knee replacements, are some of the most successful procedures available. After getting a hip or knee replacement, many patients state that they should have done it sooner!
More information about hip and knee replacement surgery can be obtained through the Academy of Orthopedic Surgeons (AAOS) as well as more specific information from the American Association of Hip and Knee Surgeons.
Most insurances cover hip and knee replacement surgery. Most patients needing hip and knee replacements are in the Medicare population, and Medicare covers this procedure entirely.
Degenerative osteoarthritis or just normal “wear and tear” is associated with degeneration of a joint. In this process, the cartilage itself is worn off of the cap of the joint. The underlying bone is then exposed, where there are many nerve endings. That leads to a process people commonly refer to as “bone-on-bone” arthritis. The subchondral bone is very sensitive, and it becomes very painful. Rheumatoid arthritis and avascular necrosis are some other common diseases associated with joint degeneration.
Another condition that can lead to a patient requiring a joint replacement is a condition called congenital hip dysplasia, a congenital issue where the pelvis itself is malformed. This means that the femoral head (the “ball” on your thigh bone) is not completely covered by the bones in the hip “socket,” leading to early degenerative changes in the hip and erosion of the cartilage surface. This condition is more common in females and is the most common reason for younger patients to require joint replacement surgery.
For someone suffering from a hip-related condition such as degenerative osteoarthritis, typically the first sign of something wrong is pain. This pain is located predominantly in the groin but can radiate down the front of the thigh. Sometimes this pain can also be on the lateral (outside) part of the hip and can be associated with activities such as prolonged walking or even something as simple as tying your shoes. A lot of people also discover that once the hip starts be painful, they start to have less mobility in the joint itself, decreasing their range of motion and therefore limiting the types of activities they can do. Finally, once you start to have a degenerative joint, it can affect the other parts of your body in other ways, such as the way you walk and the way you carry yourself, affecting the longevity of your other joints as well as your low back.
In the knees, typically the symptoms are pain either on the inside or outside parts of the knee, depending on where the localized arthritis is. A lot of patients will start to feel some instability and difficulty performing activities of daily living. They have difficulty walking longer distances as well as decreased range of motion.
It’s up to you, your activity, and what you want out of the joint. If the pain is so bad that you are no longer participating in the activities that you enjoy and must use a lot of pain medications, then it may be a good idea to consider joint replacement surgery.
Patients who are good candidates for this surgery have already failed the conservative measures including physical therapy, anti-inflammatory medicines, as well as injection treatments. Discuss with your doctor issues such as your overall health and what you expect to be able to do after the surgery to decide if arthroplasty is for you.
Going through formal preoperative physical therapy or “prehab” improves your conditioning prior to surgery, leaving you stronger going in, and making you stronger during recovery. Another way to optimize your surgery and its outcome is to control your medical conditions. This includes managing blood sugars: Usually, a patient must have an A1C value of less than 7.0 to have the most successful surgery. Any cardiac issues must be controlled as well.
Joint replacement is one of the most successful surgeries in orthopedics, but it takes time to recover from your joint replacement surgery. In hip replacement surgery, the femoral acetabular components (“ball and socket”) grow into the patient’s natural bone over time. This requires at least three months to happen. During this time, patients need to avoid high-risk activities such as high-impact jumping or climbing. Those types of activities could potentially dislodge the prosthesis and ultimately decrease the chance for true bonding of the implant to the patient’s natural bone.
Most of the risks are anesthesia related, the risk of going to sleep and potentially not waking up. Thankfully that’s very low in the US. Risks that may cause complications include cardiac conditions, heart attack, and pulmonary problems and are more likely a direct result of the anesthesia itself than of the joint replacement.
The surgery itself has a risk of infection, neurovascular injury, stiffness, and, particularly with the hips, dislocation of the implant. Many of these risks are quite low. Other risks include loosening of the implant itself in the hip. If this occurs, deep bonding of the surface that grows into the implant would be required. In the knees, loosening of the cement that holds the knee replacement in place can occur with time. Many of the risks associated with older implants were wear-related conditions such as wearing out the prosthesis. This is less common these days as the implants are made with more integrity and longer lasting implants.
Complication rates for hip and knee replacement are quite low. The incidence of infection is less than 1% for hip replacements and between 1 to 2% for knee replacements. This procedure is one of the most successful surgeries in orthopedics.
Joint replacement is actually one of the most successful surgeries in orthopedic surgery and one of the most successful surgeries overall. The hip replacement is slightly more successful in terms of patient satisfaction rates than the knee replacement, but together these surgeries have greater than 90% satisfaction rates for patients who are now living with their new replaced joint.
When you’re discharged from the hospital with either your hip or knee replacement, you will go home with a bandage in place. You will be asked to leave the bandage in place and to not submerge the incision itself under water. The dressing is waterproof and should be patted dry with a clean cloth and kept clean. In approximately 10 days, the dressing will be removed by your healthcare provider, who will check to ensure proper healing. It is normal to experience some pain and discomfort during the first few days following surgery, and most patients will require the use of a walker for a few days. After the walker, patients usually use a cane to aid their walking for about a week.
A family member, friend, or neighbor must to be able to come to your home and stay with you for the first few days following discharge to ensure your safety and decrease the risk of falls.
The patient typically will make tremendous progress from two weeks to six weeks post-surgery. The patient will see much improvement in their mobility, strength, and pain relief. In hip replacement surgery, the bone should grow into the implant uneventfully. Therefore, high-impact activities should be avoided during this time so that bone can grow in without any complications.
Typically following both hip and knee replacement, many patients will feel mostly recovered by three to four months post surgery. However, multiple studies demonstrate that patients continue to benefit from their joint replacement even after one year, particularly with knees.
Following joint replacement surgery, you will require some light narcotic medicines in addition to anti-inflammatory medications. All patients are discharged with a very specific protocol for their personal pain relief. All of these medicines will be gone over very carefully prior to the patient’s discharge.
The procedure takes about an hour and a half to complete.
With the anterior approach to hip replacement surgery, many patients can be discharged from the hospital the same day. In fact, many of these surgeries are being performed at outpatient surgery centers. If a patient chooses to stay overnight, he or she is typically released the following morning following a physical therapy session. Some patients require a longer stay, particularly if they have been using a walker, cane, or wheelchair leading up to surgery.
Patients must avoid swimming or any other activity that submerges their incision in water for at least four to six weeks following their surgery to decrease their risk of infection.
Walking around multiple times a day, with the use of a walker, allows your new joint to move and improves the pain relief. It also allows for decreased risk of blood clots as well as any pulmonary issues or complications.
Typically, with right-sided replacement surgery, patients can start driving after three weeks. Patients must be off of a walker and not using any narcotic medications. They must feel that they can slam on the brakes in case of emergency.