Joint Replacement Surgery
What Is Joint Replacement Surgery?
Joint replacement surgery is removing a damaged joint and putting in a new one. A joint is where two or more bones come together, like the knee, hip, and shoulder. The surgery is usually done by a physician called an orthopaedic surgeon. Sometimes, the surgeon will not remove the whole joint, but will only replace or fix the damaged parts.
The physician may suggest a joint replacement to improve how you live. Replacing a joint can relieve pain and help you move and feel better. Hips and knees are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles, and elbows.
What Can Happen to My Joints?
Joints can be damaged by arthritis and other diseases, injuries, or other causes. Arthritis or simply years of use may cause the joint to wear away. This can cause pain, stiffness, and swelling. Bones are alive, and they need blood to be healthy, grow, and repair themselves. Diseases and damage inside a joint can limit blood flow, causing problems.
What Is a New Joint Like?
A new joint, called a prosthesis, can be made of plastic, metal, or both. It may be cemented into place or not cemented, so that your bone will grow into it. Both methods may be combined to keep the new joint in place.
A cemented joint is used more often in older people who do not move around as much and in people with "weak" bones. The cement holds the new joint to the bone. An uncemented joint is often recommended for younger, more active people and those with good bone quality. It may take longer to heal, because it takes longer for bone to grow and attach to it.
New joints generally last at least 10 to 15 years. Therefore, younger patients may need to have the same damaged joint replaced more than once.
Do Many People Have Joints Replaced?
Joint replacement is becoming more common. About 773,000 Americans have a hip or knee replaced each year. Research has shown that even if you are older, joint replacement can help you move around and feel better.
What Are Some Potential Risks?
Any surgery has risks. Risks of joint surgery will depend on your health before surgery, how severe your arthritis is, and the type of surgery done. Many hospitals and doctors have been replacing joints for several decades, and this experience results in better patient outcomes. For answers to their questions, some people talk with their doctor or someone who has had the surgery. A doctor specializing in joints will probably work with you before, during, and after surgery to make sure you heal quickly and recover successfully.
Do I Need to Have My Joint Replaced?
Only a doctor can tell if you need a joint replaced. He or she will look at your joint with an x-ray machine or another machine. The doctor may put a small, lighted tube (arthroscope) into your joint to look for damage. A small sample of your tissue could also be tested.
After looking at your joint, the doctor may say that you should consider exercise, walking aids such as braces or canes, physical therapy, or medicines and vitamin supplements.
If these treatments do not work, the doctor may suggest an operation called an osteotomy, where the surgeon "aligns" the joint. Here, the surgeon cuts the bone or bones around the joint to improve alignment. This may be simpler than replacing a joint, but it may take longer to recover. However, this operation is not commonly done today.
Joint replacement is often the answer if you have constant pain and can’t move the joint well – for example, if you have trouble with things such as walking, climbing stairs, and taking a bath.
What Happens During Surgery?
First, the surgical team will give you medicine so you won’t feel pain (anesthesia). The medicine may block the pain only in one part of the body (regional), or it may put your whole body to sleep (general). The team will then replace the damaged joint with a prosthesis.
Each surgery is different. How long it takes depends on how badly the joint is damaged and how the surgery is done. To replace a knee or a hip takes about 2 hours or less, unless there are complicating factors. After surgery, you will be moved to a recovery room for 1 to 2 hours until you are fully awake or the numbness goes away.
What Happens After Surgery?
Your family will be able to visit you in your room in the Center for Joint Replacement. If your family is large, one or two members should do the calling and share the information with the rest of the family. This allows the nurses to give all of their attention to the care of their patients.
When you wake up from surgery, you can expect to feel tired and groggy. Your knee will be covered with an ace dressing. You will be wearing support hose (TED Hose) on the unoperated knee. A drain tube may be used by your surgeon to collect blood from the operated knee. This drain may be removed on day 1 or 2 of your hospital stay. Not all surgeons use drains.
With knee or hip surgery, you may be able to go home in 3 to 5 days. If you are elderly or have additional disabilities, you may then need to spend several weeks in an intermediate-care facility before going home. You and your team of doctors will determine how long you stay in the hospital.
After hip or knee replacement, you will often stand or begin walking the day of surgery. At first, you will walk with a walker or crutches. You may have some temporary pain in the new joint because your muscles are weak from not being used. Also, your body is healing. The pain can be helped with medicines and should end in a few weeks or months.
Physical therapy can begin the day after surgery to help strengthen the muscles around the new joint and help you regain motion in the joint. If you have your shoulder joint replaced, you can usually begin exercising the same day of your surgery! A physical therapist will help you with gentle, range-of-motion exercises. Before you leave the hospital (usually 2 or 3 days after surgery), your therapist will show you how to use a pulley device to help bend and extend your arm.
Surgical Discomfort is felt differently by everyone. There are a variety of ways to control discomfort. You and your doctor will discuss your options. Options are:
- Epidurals: thread-like catheter placed in the area outside your spinal cord to bathe the nerve roots in painkillers. If an Epidural catheter is selected, it will be placed before surgery.
- PCA Machines: a unit placed on your IV pole that delivers small doses of a narcotic through your IV when you press a button.
- Oral Medications: which we will use as soon as you can tolerate them and will continue throughout your hospitalization and when you go home.
We encourage you to use your medication to relieve your discomfort because refusing it will only slow your rehabilitation; the sooner and more you move, the better. If your medicine is causing you any discomfort or unusual feelings, please tell your nurse.
On the first day after surgery, the dressings over your incision will be changed and may be removed after several days when there is no more drainage. Also on this day, the tube in your bladder will be removed. At this time, you may change into your own loose fitting, comfortable clothes.