Arthroplasty

(Hip Arthroplasty, Joint Arthroplasty, Knee Arthroplasty, Shoulder Arthroplasty, Finger Arthroplasty, Joint Replacement Surgery)

Procedure Overview

What is arthroplasty?

Arthroplasty is a surgical procedure to repair or remove and replace an arthritic or damaged joint. This is most often done when cartilage has worn away and bone has been destroyed. Arthroplasty also refers to total joint replacement.

Various types of arthritis may affect joints. Osteoarthritis, a degenerative joint disease that affects mostly middle-aged and older adults, may cause the breakdown of joint cartilage and adjacent bone. Rheumatoid arthritis, which causes inflammation of the synovial membrane and results in excessive synovial fluid, may lead to pain and stiffness. Traumatic arthritis, arthritis due to injury, may cause damage to the articular cartilage.

Other related procedures that may be used to help diagnose joint problems include joint aspiration, x-ray, bone scan, magnetic resonance imaging (MRI), computed tomography (CT scan), arthroscopy, and arthrography. Please see these procedures for additional information.

Anatomy of the joint:

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Joints are the areas where two or more bones meet. Most joints are mobile, allowing the bones to move. Joints consist of the following:

• cartilage - a type of connective tissue made up of cells and fibers that covers the surface of a bone at a joint. Cartilage is wear-resistant and helps reduce the friction of movement within a joint.
• synovial membrane - a tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
• ligament - a type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
• tendon - a type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
• bursa - a fluid-filled sac located between bones, ligaments, or other adjacent structures that helps cushion joints.
• femur - the thighbone or upper leg bone.
  
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• tibia - shin bone or larger bone of the lower leg.
• femur - thighbone or upper leg bone.
• patella - kneecap.
• meniscus - a curved part of cartilage in the knees and other joints.

Types of joints:

• ball-and-socket joints
  
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  Ball-and-socket joints, such as the shoulder and hip joints, allow backward, forward, sideways, and rotating movements.
• hinge joints
  Hinge joints, such as in the fingers, knees, elbows, and toes, allow only bending and straightening movements.
• pivot joints
  Pivot joints, such as the neck joints, allow limited rotating movements.
• ellipsoidal joints
  Ellipsoidal joints, such as the wrist joint, allow all types of movement except pivotal movements.

Reasons for the Procedure

Arthroplasty is the rebuilding of joints. A joint can be rebuilt by resurfacing or relining the ends of the bones. An artificial joint (called a prosthesis) may be considered. The most common condition that results in the need for arthroplasty is osteoarthritis.

Osteoarthritis is characterized by the breakdown of cartilage and adjacent bones in the joints. Damage to the cartilage and bones limits movement and may cause pain. Persons with severe degenerative joint disease may be unable to do normal activities that involve bending joints because they are painful.

Other forms of arthritis, such as rheumatoid arthritis and arthritis that results from a joint injury can also lead to degeneration of the joint. In addition, fractures, torn cartilage, and/or torn ligaments may lead to irreversible damage to the joint.

If medical treatments have failed to provide adequate relief from pain and/or disability, arthroplasty may be an effective treatment. Some medical treatments for degenerative joint disease may include, but are not limited to, the following:

• anti-inflammatory medications
• pain medications
• limiting painful activities
• assistive devices for walking (such as a cane)
• physical therapy
• cortisone injections into a knee joint
• weight loss (for obese persons)

Most joint replacement procedures performed often involve the hip and knee, with total joint replacement of the ankle, elbow, shoulder, and fingers performed less often.

People who have arthroplasty generally have substantial improvement in their pain, ability to perform activities, and health-related quality of life.

There may be other reasons for your physician to recommend arthroplasty. Please see hip replacement and knee replacement surgical procedures for more specific information.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to the following:

• bleeding
• infection
• blood clots in the legs or lungs

The replacement joint may become loose, be dislodged, or may not work the way it was intended. The joint may have to be replaced again in the future.

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness. The joint pain may not be relieved by the surgery.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
• You will be asked to fast for eight hours before the procedure, generally after midnight.
• You may receive a sedative prior to the procedure to help you relax.
• You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
• The area around the surgical site may be shaved.
• Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Arthroplasty requires a stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Arthroplasty may be performed while you are asleep under general anesthesia, or while you are awake under spinal or regional anesthesia. The type of anesthesia used will depend on your circumstances and the procedure to be performed. If spinal anesthesia is used, you will have no feeling from your waist down. If regional anesthesia is used, you will have no feeling in the limb undergoing the procedure. Your physician will discuss this with you in advance.

Generally, arthroplasty follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned on the operating table in a manner that provides the best access to the joint being operated on.
4. A urinary catheter may be inserted.
5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
6. The skin over the surgical site will be cleansed with an antiseptic solution.
7. The physician will make an incision in the area of the joint.
8. The physician will repair or remove the damaged parts of the joint.
9. The incision will be closed with stitches or surgical staples.
10. A sterile bandage/dressing will be applied.

After the Procedure

In the hospital:

After the surgery you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room. Arthroplasty usually requires an in-hospital stay of several days.

It is important to begin moving the new joint after surgery. A physical therapist will meet with you soon after your surgery and plan an exercise program for you. Your pain will be controlled with medication so that you can participate in the exercise. You will be given an exercise plan to follow both in the hospital and after discharge.

You will be discharged home or to a rehabilitation center. In either case, your physician will arrange for continuation of physical therapy until you regain muscle strength and good range of motion.

At home:

Once you are home, it will be important to keep the surgical area clean and dry. Your physician will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your physician to report any of the following:

• fever
• redness, swelling, bleeding, or other drainage from the incision site
• increased pain around the incision site
• numbness and/or tingling of the affected extremity

You may resume your normal diet unless your physician advises you differently.

You should not drive until your physician tells you to. Other activity restrictions may apply.

Making certain modifications to your home may help you during your recovery. These modifications include, but are not limited to, the following:

• proper handrails along all stairs
• safety handrails in the shower or bath
• shower bench or chair
• raised toilet seat
• stable chair with firm seat cushion and firm back with two arms, which will allow your knees to be positioned lower than your hips
• long-handled sponge and shower hose
• dressing stick
• sock aid
• long-handled shoe horn
• reaching stick to grab objects
• firm pillows to raise the hips above the knees when sitting
• removing loose carpets and electrical cords that may cause you to trip

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.