Health News
Health News
April 1, 2020
Joint Replacement Surgery

Have you heard someone talk about getting a knee or hip replaced?  You probably have, because both procedures have become a fairly common treatment for people suffering from pain and damage in these joints. Knees and hips are the most common joints to be replaced, but people can also have replacement surgeries performed on shoulders, wrists, ankles and elbows. 

So, how exactly does joint replacement work? Who is a candidate for this type of surgery and what’s involved?  Are there risks? How long does it take to recover?  Privia Medical Group North Texas includes a number of highly-respected orthopedic surgeons with extensive experience with joint replacement surgery – and they are here to answer your questions.

What is a Joint?

Joints are the parts of our body where two bones meet.  There are two types of joints: hinge joints and ball and socket joints. The knee is an example of a hinge joint, because it allows the lower leg to swing back and forth, just like a door swings open and shut. 

The hip and shoulder are examples of ball and socket joints. With these joints, the rounded end of one bone rests inside the hollowed-out area of another bone, providing for a range of motion.  There are a lot of joints in our body: shoulders, elbows, wrists, knuckles, hips, knees, ankles, as well as the joints in our toes. 

“Our joints are remarkable parts of our bodies,” says Dr. Joseph Milne, a doctor of orthopedic sports medicine and orthopedic surgeon.  “They allow us to walk, bend, wave, eat, drink and more.  Any movement we engage in during the day involves one or more of our joints.  It’s easy to take our joints for granted – until something goes wrong with them.”

Joint Injuries and Osteoarthritis

Joints can become damaged or wear out over time, with osteoarthritis being a major cause of joint ailments.  Other causes of joint damage include rheumatoid arthritis and a condition known as osteonecrosis, which can occur when blood flow to the joint is inhibited due to a fracture or dislocation.   

Osteoarthritis occurs when the cartilage, the hard and slippery tissue between our joints, wears down.  Cartilage helps the bones glide over one another when we bend our joints.   If the cartilage deteriorates completely, the result is bone rubbing against bone.  This causes pain, swelling and stiffness.  Bone spurs may also result, and if a piece of bone or cartilage breaks off and floats in the joint, more pain and discomfort is possible.  The most commonly affected joints are the ones in the fingers closest to the nails, thumbs, lower back, knees, neck and hips. 

While age and normal wear and tear are major contributing factors to cartilage loss and the onset of arthritis, there are other risk factors, as well.  Women are more likely than men to develop osteoarthritis.  An injury to a joint can cause damage to the cartilage, accelerating the development of arthritis, even in younger people.  Obesity is also a significant risk factor for arthritis in the knees, spine and hips.  The extra weight causes added stress to these joints and can hasten cartilage loss.  Finally, some types of arthritis can be hereditary.

When someone has osteoarthritis, motion in the affected joint may become increasingly restricted as the pain, stiffness and swelling worsen.  This can impact everything from walking to getting dressed.

Osteoarthritis Treatment

For someone dealing with joint pain, there are several treatment strategies your physician may recommend before considering joint replacement surgery.  And while there is not a cure for osteoarthritis, various treatments can ease the severity and frequency of symptoms. 

One of the most effective treatments is exercise.  Strength exercise – using weights or resistance bands – helps to strengthen the muscles that support the joints.  Aerobic exercise improves blood flow and helps to control weight.  Low-impact exercises, such as cycling or swimming, provide a range of motion for joints and also promote healthy cartilage. 

Managing weight is a key component of arthritis treatment – carrying around extra pounds puts greater strain on the hips and knees, worsening symptoms.  Properly and frequently resting affected joints helps them to recover, reducing pain and swelling. 

Medicine can also help.  Over-the-counter drugs such as acetaminophen provide pain relief, while ibuprofen and naproxen help with pain and reduce inflammation.  However, there can be side effects to taking these medications, so be sure to consult with your doctor before taking any medication on a regular basis.  There are also some prescription drugs your physician may recommend. 

A relatively new approach to treating osteoarthritis is the use of regenerative stem cell therapy, which can be used to regrow cartilage in the joints.  The Privia Medical Group North Texas Bone and Joint Clinic, one of the oldest and most established orthopedic practices in North Texas, has provided stem cell treatments to patients since 2014. 

For patients who have difficulty walking due to hip pain, using a walking aid, such as a cane or walker, may help with mobility. 

Finally, for patients with joint damage that cannot be treated effectively through other means, surgery is an option.  An orthopedic surgeon can smooth out the surfaces in the joint or reposition them, if necessary.   For severely damaged joints, a total or partial replacement may be an option. 

“Joint replacement surgery is generally the last treatment option your physician will recommend, after other forms of treatment have been exhausted,” explains Dr. Milne.  “Candidates for joint replacement surgery are those who are experiencing severe pain that interferes with daily, routine activities, such as sleeping, getting dressed, putting on shoes, walking and getting in and out of a car.”

How Joint Replacement Works

Joint replacement surgery may be performed in a hospital or an outpatient surgical center.  The procedure generally takes a few hours, with the patient completely sedated. 

The surgeon removes the damaged joint bones and cartilage and then smooths the remaining natural bone before inserting the prosthesis.  The prosthesis is made of metal, ceramic or a very hard plastic.  The new joint is adhered to the bone using a strong cement or it may be press-fit, which allows for the bone to grow into the new joint. 

Hip Replacement Surgery

The hip is a large ball and socket joint.  The socket is called the acetabulum, part of the pelvic bone. The femoral head, the upper end of the femur (thigh bone), forms the ball. 

Both the ball and socket bones are covered with cartilage, allowing a healthy joint to move without friction or pain.  This cartilage is lubricated with fluid from the synovial membrane.  Ligaments connect the ball to the socket, providing stability to the joint. 

Hip replacement surgery was first pioneered in 1960.  Today there are roughly 300,000 hip replacement surgeries performed in the United States each year. 

In a hip replacement, a metal rod is inserted into the femur, the upper part of the leg.  At the upper end of the rod is a metal femoral head that serves as the ball in the ball and socket joint.  A metal socket is inserted into the pelvic bone, with a plastic or ceramic insert for the femoral head to glide against, in place of cartilage. 

Knee Replacement Surgery

The knee is the largest joint in the body. It is composed of three bones – the lower end of the femur, the upper end of the tibia (shin bone) and the patella, otherwise known as the kneecap.  Like the hip joint, the ends of all three bones are covered with cartilage that facilitates movement.  A synovial membrane lubricates the knee cartilage and ligaments connect the tibia and femur.  The knees also contain menisci that are located between the femur and tibia – they act as a sort of shock absorber for the joint.

Knee replacement surgery is even more common than hip replacements, with 600,000-plus procedures performed each year.   In this procedure, the damaged cartilage, along with a small amount of bone, is removed.  Metal implants are inserted to replace the parts of the joint that have been removed.  The patella may then be resurfaced.  Finally, a plastic pacer is inserted in between the metal parts, creating a gliding surface where the cartilage once was. 

Recovery

Activity and exercise are crucial components of recovery from joint replacement surgery.  Recovery activity begins almost immediately after the procedure, often on the same day.  Knee and hip replacement recovery starts with use of a walker or crutches.  A physical therapist will provide specific instructions on a graduated walking program, specific exercises designed to strengthen the joint and gradually resuming regular activities, such as climbing stairs. 

Some loss of appetite is normal for a few weeks following surgery, so patients must be intentional about getting enough food to eat and staying hydrated. 

Joint replacement surgeries have a very high success rate.  However, as with any surgery, there is always some risk of complications.  Infection is a risk with any surgery.  It is important to follow wound care instructions from your surgeon, especially until stitches and sutures are removed. 

Blood clots are one of the most common complications associated with hip and knee replacement surgeries.  If a blood clot forms in the leg and breaks loose and travels to the lungs, this can create a life-threatening emergency.  Your physician will give you specific guidance on things you should do to decrease the odds of blood clots.  This may include taking blood thinning medication for a while.

Life with New Joints

A successful knee or hip replacement can dramatically improve someone’s quality of life.  Most patients experience a significant reduction in pain and are better able to accomplish daily activities.  A joint replacement does not mean you can suddenly do anything, however. 

Orthopedic doctors generally advise against high-impact activity such as jumping, running and jogging.  Low or no-impact exercises, such as walking and swimming, are recommended.  Just like the cartilage in our natural joints wears out over time, so will the plastic that replaced it.  In cases in which a patient had a hip or knee replacement at a relatively young age, a second replacement may be necessary, as the artificial joints can begin to wear down in 15-20 years.   

“For people with badly damaged joints due to injury or arthritis, joint replacement surgery may be a great option to reduce pain, restore mobility and improve quality of life,” says Dr. Milne.  “If you find yourself experiencing serious joint pain that affects your daily activities, make an appointment to see an orthopedic doctor today – we are here to help.” 

This article contains information sources from:

The American Academy of Orthopaedic Surgeons

The Mayo Clinic

The Cleveland Clinic

The National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health