Joint Replacement Surgery

Severe or “end-stage” arthritis can be caused by a variety of problems including osteoarthritis, rheumatoid arthritis and other inflammatory joint problems, previous joint injuries and fractures, joint infections and other rare conditions such as osteonecrosis (also called avascular necrosis). All of these problems result in damage to the different structures in the joint and eventually lead to significant irreversible damage and dysfunctional joint.

Certain types of arthritis, such as rheumatoid arthritis and other inflammatory types of arthritis may be best treated by a rheumatologist, who specializes in treatment of these disorders. More common joint problems like osteoarthritis are typically treated by a primary care doctor, rheumatologist, or orthopedic surgeon. When medical treatment for arthritis recommended by your doctor becomes less effective, joint replacement surgery may be an option for you. These professionals are better qualified to determine if joint replacement therapy is an appropriate treatment choice for you.

The definition of “appropriate” for total joint replacement surgery changes continuously. In general, there is no set upper age limit for joint replacement candidates. Instead, the decision is perhaps best made based on your general medical condition and fitness for surgery, and how much your arthritis affects your quality of life.

While few patients are in perfect health, most people undergoing joint replacement must be sufficiently healthy or medically “tuned up” to allow their surgery to be performed safely. Before joint replacement surgery, talk to your primary care doctor to ensure your health is good enough to undergo the anesthesia and rehabilitation associated with the surgery.

For nearly all patients, arthritis or other joint problems that are typically treated with joint replacement surgery can be diagnosed with simple x-rays. Other causes for hip or knee pain should be considered since referred back pain can be easily confused for pain associated with arthritis of the hip or knee, and pain from an arthritic hip can occasionally be referred to the knee. Inflammation of the soft tissue structures around the joint also can cause tendonitis or bursitis which can be confused with the pain associated with arthritis. A careful examination by your doctor and routine x-rays usually can determine the actual cause of your pain.

Your need for joint replacement surgery can be minimized by comprehensive medical treatment of your arthritis. Arthritis medications, exercise modification to low impact activities (e.g. swimming, walking, biking, etc.), weight loss, nutritional supplements, and joint injections can help you live with your arthritis for as long as possible. When these treatments are no longer effective and you experience pain as well as decrease in function, joint replacement surgery can relieve the pain and restore the quality of life lost due to arthritis.

Despite improvement in total joint replacement surgery, these operations are not likely to last a lifetime in young, active patients with arthritis. In some of these cases, joint preserving procedures such as osteotomies (removal of dead bone and repositioning of bone), joint debridement or “cleanouts,” and cartilage transplantation may be helpful in delaying joint replacement surgery.

Following a relatively short period of recovery after surgery, patients undergoing joint replacement surgery typically return to a high level of activity. Speed of recovery following surgery depends on your level of activity before surgery, general health and overall physical fitness, degree and duration of physical impairment before surgery, the type of surgery you had, and your expectations and motivation. Physical therapy and occupational therapy after joint replacement are very important.

Long term physical limitations after surgery are nearly always due to other orthopedic or rheumatologic problems (significant arthritis in other joints, chronic low back pain) or major health problems (heart, breathing, other chronic illnesses) rather than due to any limitations of the joint replacement. In general, those undergoing hip and knee replacements can return to unlimited low impact activities such as swimming, water exercise, walking, biking, low impact aerobics, golf, and doubles tennis.

Most orthopedic surgeons advise against high impact and joint overloading activities that involve heavy lifting, running, and jumping. However, many patients resume their normal activities of daily living following hip or knee replacement without limitation.

Although patients typically obtain a functional amount of motion following hip replacement surgery, occasionally the limits of motion of a total hip replacement can be exceeded, resulting in dislocation out of its normal position. Patient education and an understanding of the limitations of total hip replacement, especially regarding the potential for dislocation and range of motion restrictions, can help minimize the occurrence of this complication. Patients should be encouraged to discuss specific limitations, precautions, and activity restrictions following total joint replacement with their surgeons.