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Joint Replacement Surgery: Knee, Hip and Shoulder Replacement

Joint replacement involves replacing a damaged joint with an artificial joint. Joint replacements were once only offered to older people with severe arthritis of the hip or knee. Now they are increasingly performed on younger people if there is a need. This is largely due to advances in materials being used to build artificial joints, making them longer-lasting, as well as options such as partial joint replacements and other less invasive operations. The procedure is also available for shoulders, elbows, wrists, fingers, ankles, toes and intervertebral discs in the spine.

The aim of having a joint replaced is usually to relieve severe pain and restricted movement, especially when non-surgical treatments such as exercise programs and pain medications are no longer effective. These kinds of operations can improve quality of life, by reducing the pain and making getting about, exercise, hobbies, work and everyday activities easier.

Understanding Joint Replacements:

Joints are where bones fit together and move against each other. The ends of the bones are covered with hard cartilage, which allows the bones to move easily against each other. Cartilage is tough enough to resist wear, but is also sufficiently spongy to absorb pressure and cushion the bones. A normal joint also contains a small amount of fluid, called synovial fluid that further reduces friction. Muscles, tendons and ligaments keep the joints stable and in correct alignment, as well as allowing movement.

During joint replacement surgery, the surgeon replaces the damaged joint with an artificial joint. The surgeon first cuts through the skin and the underlying muscles or tissues to expose the joint. The length and exact location of the cut will vary depending on the joint being replaced, the type of operation performed, your age and physical condition and the surgeon’s preference. The surgeon then removes the damaged bone and cartilage and inserts the prosthesis (the artificial joint). The prosthesis is either held in place with special bone cement or other methods. Different types of surfacing of the implants are made to allow the bone to grow into the prosthesis over time and help keep it in place.

Your surgeon will choose the prosthesis that is best for you but it is important you understand what your surgeon is proposing and why. After the prosthesis is secured in place, the wound is closed with staples or stitches. One or two tubes may be inserted into the wound to drain blood and fluids that accumulate for the first few days following surgery.

Conditions That May Lead to Joint Replacement:

• Osteoarthritis

• Inflammatory arthritis, such as rheumatoid arthritis

• Trauma or injury

• Birth defects and growth disorders

• Certain fractures that don’t heal properly – the most common is a fracture at the top end or ‘neck’ of the thigh bone (femur) near the hip

• Avascular necrosis – interruption of the blood supply of a bone, leading to the death of bone tissue

• Severe infections of joints

• Cancer in or near a joint

Joint Replacement Surgery

Although various kinds of joint disease can lead to joint replacement, most of these operations are done to relieve severe pain and reduced mobility of advanced arthritis, particularly osteoarthritis. When the cartilage in your joint becomes damaged, the joint surfaces become rough and uneven, and your bones may actually rub together. Bone spurs can also grow on the edges of the joint. These changes cause the joint to become painful, stiff and swollen and limit its range of movement. The joint may lock or it may become unsteady. As all people with arthritis know, not only are these symptoms unpleasant, they can also make the activities of day-to-day living seriously difficult.

Also Read: Causes, Symptoms and Treatment of Buttock Pain

Although various kinds of joint disease can lead to joint replacement, most of these operations are done to relieve severe pain and reduced mobility of advanced arthritis, particularly osteoarthritis. When the cartilage in your joint becomes damaged, the joint surfaces become rough and uneven, and your bones may actually rub together. Bone spurs can also grow on the edges of the joint. These changes cause the joint to become painful, stiff and swollen and limit its range of movement. The joint may lock or it may become unsteady. As all people with arthritis know, not only are these symptoms unpleasant, they can also make the activities of day-to-day living seriously difficult.

When should you consider joint replacement?

Not every person with problems with their joints will need joint replacement surgery. This type of operation is usually an option when the joint is severely damaged and can’t be managed with other treatments. Joint replacement may be an option if:

• You have severe joint pain that does not improve with rest, medication, exercise, weight loss or other treatments.

• You have pain at night that affects your ability to sleep.

• You have major limitation in walking and everyday activities such as showering, getting dressed, preparing meals, getting out of a chair.

• Your ability to work or look after people who require your care is reduced.

How long will a new joint last?

An artificial joint does not necessarily last for the rest of your life, especially if you are younger and more active. A replacement joint may wear out and loosen over time and it is not possible to predict exactly how long the new joint will last. The average knee replacement, for example, will last 10 – 15 years.

An artificial joint tends to wear out more quickly in people who are overweight, more physically active or younger. If an artificial joint loosens or wears out, another operation will be necessary to replace all or part of the prosthesis. This is called ‘revision surgery’. Revision surgery is more difficult than the initial joint replacement surgery.

What are the possible disadvantages/ complications?

All surgery carries some risk but serious complications occur only in about one in every 100 people undergoing joint replacement surgery. It is important to know about possible complications before deciding to have surgery, but it is equally important not to assume that you will get any of these. The below given list does not cover all possible complications, but it does give you a starting point for discussing this important issue with your surgeon. The best time to discuss these and other concerns is before the operation.

• A replacement joint will never be quite as good as a natural joint and you’re still likely to have difficulties with some movements or activities.

• Loosening, wearing or breaking the prosthesis.

• Dislocation of the joint, following total hip replacement.

• Injury to nerves and blood vessels.

• Infection at the site of the operation or spreading to other parts of the body.

• Blood clots in the deep veins of the legs, which can travel to the lungs.

• Persistent pain or stiffness in the joint that may require further surgery.

• A build up of fluid in the joint.

• Failure of the wound to heal.

• Allergies to medicines used at the time of surgery, dressings or stitches.

Source: Arthritis Australia

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