[dropcap]J[dropcap]oint replacement surgery has been a game-changer in the medical world. It’s a procedure that has given countless individuals a second chance at a pain-free life. Annually, the United States witnesses the performance of more than 450,000 hip replacements and an estimated 790,000 total knee replacements. As the global population ages, the demand for these surgeries is rising. Hence, it’s more important than ever to understand what this surgery entails and its significance in orthopedics.
Whether you’re considering the surgery for yourself or a loved one, or you’re simply curious, understanding the procedure is crucial. In this guide, we will cover everything from the basics to what to do after surgery so that you may make the best decisions possible.
What is Joint Replacement Surgery?
Joint replacement surgery, also known as arthroplasty, is a surgical procedure where a damaged joint is replaced with an artificial one to restore pain-free mobility and function to the affected limb. A prosthesis is the term for an artificial replacement part. These are constructed from ceramic, metal, plastic, or a combination of these substances. Joint replacement surgery aims to reduce pain and restore normal function. It’s a life-changing procedure for many, offering a new lease on life.
Understanding the Basics: The Anatomy of a Joint
Knowing what a joint is and what it does is the first step in understanding why and how it is replaced.
Joints are the attachments of two or more bones that allow motion and serve as structural supports for the human body. They’re like amazing works of art created by nature!
There are approximately 206 bones and 300 joints in the mature human skeleton.
Types of Joints
There are many types of joints in the body that are assigned to different tasks and degrees of movement. A few ones facilitate motion, such as bending one’s knee. Some restrict movement from occurring, such as the fixed joints that bind the cranial skeleton together. A third type of joint, such as the vertebrae in the spine, connects bones while allowing minimal motion.
Inside a joint, there’s a smooth tissue called cartilage that cushions the bones and lets them glide over each other. Surrounding this is the synovial membrane, which produces a lubricating fluid. This fluid ensures smooth, friction-free movement. However, when the cartilage wears out, bones can rub against each other, leading to pain and stiffness. The main types of joints are:
- Fibrous joints contain connective tissue that connects the joints, providing stability and little movement.
- Cartilaginous joints, including primary and secondary types, are held together by cartilage, enabling limited motion, with secondary joints having fibrocartilage cushions.
- But the most common and most movable of them are Synovial joints. They are categorized according to the movements they enable, such as gliding, bending, straightening, rotating, pivoting, and swiveling.
Ball and socket joints, commonly replaced through surgical procedures, are the most well-known due to their multidirectional motion. These joints, such as the hip and shoulder, allow the ball-shaped end of one bone to rotate within the cup-shaped end of another.
Hinge joints, similar to a door hinge, possess the ability to both bend and erect, albeit in a single direction. The knee and elbow joints are hinge joints.
When is Joint Replacement Surgery Recommended or Considered?
But why might someone need this surgery? The reasons vary, as the human body is amazing, but it’s not indestructible. Joint pain, contrary to popular belief, isn’t just a side effect of aging. They often stem from conditions that wear down joint cartilage, like osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis. Over time, this wear and tear can lead to severe pain and restricted movement, making daily tasks challenging.
Here are some of the main reasons one can opt for surgery, in a brief description:
- Consistent Pain: Joint replacement might be the best option for you if you’re in constant, excruciating pain that’s limiting your daily activities.
- Arthritis: As we age, our joints wear out, and conditions like osteoarthritis and rheumatoid arthritis can make even non-surgical treatments like medication, physical therapy, and lifestyle changes ineffective. Thus, surgery will be required in the long run. Learn more about joint aging here.
- Wear and tear: Wear and tear on a joint can occur from repetitive motion, tension, or overuse from a demanding job, stressful life events, strenuous exercise, or simply old age.
- Dysplasia: Dysplasia (abnormality of bones) can also make one a good candidate for replacement procedures. The same procedure is followed to fix the prosthesis. Common ones are hip, shoulder, and elbow dysplasia.
- Severe Injury: When the whole joint gets injured or broken, and there are no possibilities for fracture treatment, joint replacement surgery is considered. It occurs in really rare cases, such as injuries in young people.
Patients generally undergo the procedure when knee discomfort prevents them from engaging in activities they once enjoyed. The surgery may be a viable option when it becomes impracticable to engage in routine activities of daily living, such as shopping or walking, due to the discomfort or incapability caused by the pain.
Always keep in mind that it is only when more conservative and non-invasive therapies like medicine, physical therapy, lifestyle modifications, and injections have failed that joint replacement surgery is considered to manage pain and improve joint function.
Benefits of Joint Replacement Surgery
Potentially amazing advantages of joint replacement surgery exist for those who undergo it. Such as:
The Arthritis Foundation reports that pain alleviation is the primary motivation for undergoing joint replacement. Joint pain may be debilitating for those who suffer from conditions like osteoarthritis or rheumatoid arthritis or who have suffered an injury to their joints. Individuals who have joint replacement surgery often experience immediate and long-lasting pain alleviation. Also, it has been found to reduce the dependency on opioids.
Improved Mobility and a better Quality of Life
Pain in the joints may make walking or using the stairs difficult, if not impossible. However, people who have had joint replacement surgery report improved mobility and a sense of renewed freedom after the procedure.
Joint surgeries have also been shown to significantly enhance patients’ quality of life by removing chronic pain and restoring mobility. (1)(2). It has been proven in recent 2020 research that hip and knee arthroplasty has been found to improve not only the range of movement but also the quality of life among people. They may get back into what they used to love doing and have a richer, fuller life.
Research says that up to 95% of patients benefit from joint replacement surgery. Also, prostheses used to repair damaged joints are long-lasting, often functioning for 15–20 years. This lengthens the time a patient may benefit from the procedure. That means recovering complete movement without discomfort.
Return to Normal Life
Replacement of a damaged or diseased joint can greatly enhance a patient’s mobility, flexibility, and range of motion. After joint replacement surgery, people may resume their routines and even participate in low-impact sports or leisure activities. It paves the way to a more dynamic and fulfilling way of living. The best thing is that most people walk without a limp, and most don’t require a cane, even if they used one before the surgery!
Less Risk of Developing Serious Chronic Health Conditions.
When joints degrade, overall health—both physical and mental—suffers. Individuals with bad joints who do not address the issue often develop weight problems, diabetes, heart disease, and depression–all related to limited movement and poorly functioning joints.
Meanwhile, the American Academy of Orthopaedic Surgeons states that those who get a hip or knee replacement are 30–40% less likely to have a significant cardiac event like a heart attack.
With advancements in medical technology, these procedures have become more efficient and effective, ensuring patients can return to their regular activities with minimal downtime. Let’s learn about the types of surgeries we have.
Types of Replacement Surgeries
Currently, surgeons can replace all of the following joints:
Two of the most popular orthopedic procedures are hip and knee replacements. Both treatments are highly efficient in relieving suffering, restoring normal function, and enhancing mobility, allowing people to resume their previous levels of comfort with life.
In the previous two decades, total knee replacements have increased in popularity faster than hip replacements (almost 2:1).
Preparation of Joint Replacement Surgery (Arthroplasty)
Patients often go through several pre-surgery assessments and preparations before undergoing arthroplasty. Some of these measures might be:
- Physical therapy: Doctors often prescribe physical therapy and exercise regimens to help patients get in excellent condition before surgery. Patients having joint replacement surgeries can benefit from as few as two sessions of preoperative physical therapy, according to the research.
- Dietary modifications: It is common practice to advise patients to follow a certain diet plan in the days leading up to surgery.
Other than these changes, a pre-op evaluation is carried out, and the common steps in an evaluation are as follows:
- Medical Examination: Assessment of the patient’s general health may involve a range of diagnostic tests, including blood work, urine examination, and a chest X-ray. Also, a CT scan or MRI may be necessary in some situations to aid in the planning of an operation.
- Cardiac Exam: Cardiopulmonary Assessment: Consisting of an electrocardiogram (ECG) and potentially stress tests or echocardiograms, particularly in individuals with a prior cardiac condition.
- Consultation: Depending on the patient’s medical background, they may need to see their primary care physician or a specialist before surgery to rule out any other risk factors. The physician will request a comprehensive medical history from the patient, encompassing any previous surgical procedures and current medical conditions. It is essential to inform your physician of all medications you are currently using, including nutritional supplements and over-the-counter drugs. You might be required to discontinue some or all of them before the operation.
What other procedures are required before surgery or any medical exam? Let us just read it here in our dedicated article.
The Surgical Procedure
Choosing to have a joint replaced is a major life choice. But when you’ve decided, it’s time to get ready. The surgeon’s approach will differ from case to case and joint to joint.
Hospitalization is necessary after having a joint replaced. Patients will be given precise directives by their healthcare provider concerning stopping all food and liquid intake the evening before the procedure.
The arthroplasty procedure, which generally spans from one to two hours, will involve making a joint-specific surgical incision by the surgeon. By making the incision, the surgeon gains entry into the joint. Upon gaining access to the joint, the impaired cartilage and bone are surgically extracted. This stage entails meticulously removing the compromised or impacted elements in anticipation of their substitution.
For example, in a hip replacement, a metal ball and stem replace the damaged ball of the femur and a plastic socket is implanted into the pelvis.
Local anesthesia is the standard for this surgery. Recent studies have shown that spinal or local anesthesia, as opposed to general anesthetic, may lower the risk of problems after surgery.
Post-Surgery Care and Rehabilitation
The journey doesn’t end once the surgery is over. The patient will be monitored in the recovery room for several hours following the operation, as immediate care is essential. Once the patient’s vital signs (breathing, blood pressure, and pulse) return to normal, they will be transferred to a hospital room.
It is typical to experience discomfort and stiffness in the operated region following arthroplasty. The measures are commonly implemented to address this issue:
- Analgesics and painkillers are frequently administered intravenously to patients to alleviate discomfort and pain. During surgery, long-acting local anesthetics may be applied, and nerve blocks may be utilized to alleviate postoperative discomfort.
- Medications are prescribed to impede the development of blood clots, an especially critical function during the postoperative recovery phase.
- Elevation: Depending on the type of joint that has been replaced, healthcare providers may recommend keeping the operated joint elevated during rest. Instead of letting the affected limb rest on the floor, you can achieve it by placing it on a stool or chair. Elevating the joint helps reduce swelling and promotes better circulation, contributing to a smoother recovery process.
- The incision should be maintained in a dry, sanitary condition. Additionally, it is critical to follow the provided guidelines when cleansing and performing other routine activities. The stitches on the incision will be removed during the follow-up visits.
Rehabilitation is the next crucial step. Engaging in guided physical therapy and exercises can expedite the recovery. Postoperative physical rehabilitation is of the utmost importance for patients undergoing joint replacement surgery.
It routinely begins on the same day of operation, frequently within several hours. Joint mobilization performed early on is essential for reducing the risk of blood clots, promoting healing, and preventing the creation of scar tissue. Some patients may feel uneasy about starting right into therapy, but remember that mild, gentle motions are all required at first.
First, the physical therapist will assist with standing and walking, and they’ll show how to utilize crutches or walkers. You’ll learn a few easy stretches and strength routines that you can do from the comfort of your bed or chair.
After being discharged from the hospital, patients continue their physical therapy, which focuses on improving their strength, range of motion, gait, and balance through progressively challenging exercises. A home exercise plan is typically given and is important to follow as per the requirements and goals of the patient.
The first few days at home are often spent participating in outpatient physical therapy, which allows for continuous direction and assistance from healthcare experts throughout the healing and rehabilitation process.
Potential Risks and Complications
Joint replacement surgery, like any surgical procedure, comes with its own set of potential risks. While most of these surgeries are successful, it’s essential to be informed about possible complications.
But with the advancement in the medical field, the rate has been low. According to the AAOS, complications occur in fewer than 2% of the almost 600,000 people who receive total knee replacements annually in the United States. Some common post-surgical complications include infection, blood clots, and prosthetic joint dislocation. Additionally, there’s a risk of nerve or blood vessel damage during the procedure.
Minimizing these risks starts even before the surgery. Such as
- Choosing an experienced surgeon and medical team is paramount.
- Post-surgery, adhering to all prescribed medications and following physical therapy guidelines can significantly reduce complications. It’s also crucial to maintain a healthy lifestyle, including a balanced diet and regular exercise, to support your recovery and overall joint health.
But when should you seek medical attention? If you experience severe pain, swelling, warmth, or redness around the joint or any signs of infection like fever, you must consult your doctor immediately. Additionally, any sudden decrease in joint mobility or unusual sounds from the prosthetic joint warrant immediate medical attention. Always remember, it’s better to be safe and get any concerns addressed promptly.
The Rate of Recovery after Joint Replacement Surgery
The recovery rate after surgery is contingent upon several factors, including the type of surgery performed, the extent and duration of physical impairment before the procedure, and the level of physical activity before the operation.
As per research, most patients with knee replacement can care for themselves and return to routine daily activities, including driving, within 6 weeks of surgery. And complete recovery and full strength may take up to 4–6 months or even a year. Similar goes for hip replacement
How Long Will My New Joint Last?
The average lifespan of a replaced joint is between 15 and 25 years. The longevity of your prosthetic joint may depend on factors such as age and amount of physical activity. For instance, people who are older and less active tend to have longer longevity with prosthetic joints.
However, prosthetic joints are beneficial in the long run. In a 2019 study, almost 200,000 hip and 300,000 knee replacement surgeries were observed. It was found that about 60% of hip replacements lasted 25 years, 70% 20 years, and 90% 15 years. Whereas total knee replacements averaged 15 years, 90% 20 years, and 82% 25 years.