About Total Joints

What is Arthritis?
Arthritis occurs when the joint begins to degenerate or deteriorate, eating away the sponge-like substance that separates the joint and the bone. It results in bone rubbing against bone causing swelling and excruciating pain. At this stage, it becomes unbearable to walk or to live a normal life. It is estimated that over 40 million Americans suffer from arthritis.
What is a total joint replacement?
A total joint replacement procedure is major surgery in which the surgeon removes the painful, swollen, degenerated joint, and replaces it with a durable metal implant specifically measured for each patient. After surgery, patients usually stay 3-4 days in the hospital before the surgeon releases patients home or to a skilled nursing facility.
What is the recovery phase?
In general, your orthopaedic surgeon will encourage you to use your "new" joint shortly after your operation. Initially, you will walk with a walker. Physical therapy and exercises will be an integral part of your recovery process both in the hospital and after you return home. Most patients have some temporary pain in the replaced joint for a period of time because the surrounding muscles are weak from inactivity and the tissues are healing, but the pain should subside within a few weeks or months. The motion of your joint will generally improve after surgery. The extent of improvement will depend on how stiff your joint was before the surgery. Therefore, following sufficient recovery after your surgery, you may be permitted to play golf, walk and even dance. However, more strenuous sports such as tennis or running, may be discouraged or limited.
What are the possible complications?
While complications are not a frequent occurrence, a risk of complications can exist as with any surgical procedure. Most complications are successfully treated. Possible surgical site or prosthetic complications include but are not limited to:
Infection – Infection may occur in the wound or around the implant. It can happen while in the hospital or after you have returned home. It could even occur years later. Minor infections in the wound area are generally treated with antibiotics. Major or deep infections may require more surgery and removal of the implanted device. Since they do not have infection fighting qualities, implants become the weakest part of your body when fighting infection. Therefore, any infection in your body, whether it is urinary tract, skin, sinus or dental, can spread to your new joint implant. It is very important to stay healthy and report any infection concerns to your physician.
If for some reason you become unable to sign a written Directive, you can issue a Directive verbally or by other means of non-written communication, in the presence of your physician and appropriate witnesses.

Blood Clots – Blood clots result from several factors, including your decreased mobility causing sluggish movement of the blood through the leg veins in your lower legs. Several measures may be used to reduce the possibility of blood clots, including:
  • Blood thinning medications, also called anticoagulants
  • Elastic stockings
  • Exercises to increase blood flow in the leg muscles
  • SCDs – Sequential Compression Devices that compress the lower leg to aid in circulation
Loosening – Loosening of the prosthesis within the bone may occur after a total joint replacement. This may cause pain. If the loosening is significant, a revision of the joint replacement may be needed.

Dislocation – Occasionally, after total hip or shoulder replacement, the ball can be dislodged from the socket. In most cases, the hip can be relocated under anesthesia. A brace may be worn for a period of time if a dislocation occurs. Most commonly, dislocations are more frequent after complex revision surgery.

Wear – Some wear can be found in all joint replacements. Excessive wear may contribute to loosening and may require revision surgery.

Prosthetic Breakage – Breakage of the metal joint replacement is rare but it can occur. Surgical revision is necessary if an implant breaks. Therefore, it is very important to treat your implant with care.

Nerve Injury – Although this type of injury is infrequent, nerves in the vicinity of the total joint replacement may be damaged during the total replacement surgery, This is more likely to occur when the surgery involves correction of major joint deformity or lengthening of a shortened limb due to an arthritic deformity. Over time, these nerve injuries often improve and may completely recover.
Are there alternatives to total joint replacement?
When total joint replacement is being considered, it is important to let your orthopaedic surgeon know what your long-term goals are. If your goal is to become much more active, your physician may be able to suggest alternatives that are more compatible with your expectations. These alternatives include lifestyle changes, the use of external supports and medical management. Arthroscopic treatment (a small camera and instruments are inserted in the joint) may be an option if your symptoms are primarily mechanical (catching and locking); however, use of this treatment for joint disease is still debated among physicians. Arthrodesis (fusion of the joint) is an alternative form of hip treatment for younger people who have disease in only one hip joint.
Is a total joint replacement permanent?
Typically, older patients can expect their total joint replacement to last a decade or more depending on the care, allowing for years of pain-free living that would not otherwise be possible due to the diseased joint. Younger patients, however, may need a second total joint replacement during their lifetime.