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Also called arthroplasty, total joint replacement is a surgical procedure
in which both sides of a joint are removed and replaced by artificial implants
(prostheses) that are anchored to the bones.
In osteoarthritis (OA), the soft, movement-easing cartilage at the ends of
joint bones breaks down and wears away as the person grows older. Eventually
the bones rub directly against each other whenever the joint moves, causing
pain and stiffness. The rest of the body's joint surfaces are covered with
a smooth tissue lining called the synovium: In rheumatoid arthritis (RA), chemical
changes in the synovium cause it to destroy cartilage. In post-traumatic arthritis,
joint pain and stiffness may develop after injury to the joint; the resulting
failure of the bone and cartilage to heal properly causes the roughened joint
surfaces to grind together. For more information on arthritis and knee, hip,
or shoulder joint pain, go to: Joint Pain
Homepage.
This is a very personal decision that only you can make with the help of an
orthopaedic surgeon's evaluation of your pain and its effects on your daily
life. For helpful insights into whether now may be the time for you to consider
joint replacement, take our quick Self-Test: Should You Consider Joint Replacement?
or read the article, "Learn When to Consider Joint Replacement."
When other treatment options no longer provide relief, joint replacement may
be recommended — not only to relieve pain but also to prevent the disability
it can cause. For example, experiencing joint pain day after day without relief
can lead to "staying off" the joint — which often weakens the
muscles around it so it becomes even more difficult to move. Your orthopaedic
surgeon will tell you whether you might benefit from joint replacement and
explain the reasons why it may, or may not, be right for you at this time.
To prepare for this important discussion, go to: 10
Questions to Ask your Doctor.
You can find an orthopaedic specialist near you by using our Physician Locator. Your personal or family doctor can also give you a referral.
You may need routine blood tests, urinalysis, a physical examination, and you may need, if you're over 50 or your doctor thinks they're advisable, an electrocardiogram (EKG) and chest X-ray as well. Your own doctor or the hospital where you'll have the surgery may perform these preoperative tests and evaluations. You may also be asked to donate blood preoperatively or to have a designated donor — usually a family member or relative — do this. Your doctor or orthopaedic surgeon will specify exactly which tests and evaluations you will need and when you should have them. He or she may also recommend that you take an iron supplement before your surgery, and you may be asked to stop taking certain medications — for example, aspirin and other medications that thin the blood. Your doctor or orthopaedic surgeon will also specify how these and any other medication concerns apply to you. Finally, your doctor may advise you not to eat or drink after midnight on the day your surgery takes place.
Following joint replacement surgery, hospital stays vary depending on insurance coverage and individual medical status; a total of 4 days (including the day of the surgery) is typical. The standard surgery may take from 2 to 3 hours; you may spend about the same amount of time in the recovery room. On the first day after your surgery, you may be able to get out of bed and begin physical and occupational therapy, typically several brief sessions a day — first steps on your way to getting back into your life! Usually a case manager is assigned to work with you as you move through your rehabilitation routines. When you're ready for discharge, the decision will be made concerning whether you can best continue to recover at home (the usual procedure) or in another facility where you may receive specialized rehabilitation help. If you do go to another facility, the goal will be to return you to your home, able to move about with a safe level of independence, within 3 to 5 days.
You shouldn't be surprised if you feel a little shaky and uncertain for the
first day or two after you're discharged. But soon you'll likely get a routine
going and gain confidence in your new joint — the start of a new life
with less pain. (As with any surgery, you'll probably take pain medication
for a few days while you are healing.) Be aware that you'll probably need a
walker and/or crutches for about 6 weeks, then use a cane for another 6 weeks
or so. You'll be in touch with your doctor or orthopaedic surgeon as well as
your case manager, so you'll have plenty of opportunities to ask questions
or discuss concerns as well as to report your progress.
This is a decision that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines that your doctor may give you:
Individual results may vary.