Joint Replacement Surgery
articles and medical information from Dr. Nichols

Joint Replacement Surgery

When you find yourself doing less and less and limiting your activities because of joint pain, you may benefit from a joint replacement surgery.  Worn joints can be the result of a serious injury, a chronic illness, or just constant use over the years causing arthritis in the joint.

If even simple activities such as walking, getting up from a chair, or simply dressing yourself are difficult because of pain and stiffness in a joint, you may get relief from the pain and improve your quality of life.  Joint replacement surgery can give years of easier movement and allow you to do your daily tasks.

The Joint and Arthritis

A joint is the moving connection between the ends of two or more bones.  The ends of the bones are covered by a smooth, protective material called cartilage and are connected together with flexible ligaments.  The synovium is the tissue that covers the joint and produces a lubricating substance called synovial fluid.  Joints are surrounded by muscle and tendons that power their movement.  All these components need to be working well for the body to move free and easily.

Arthritis breaks down the components involved in joint function through a process that is not completely clear at this point.  But although the process is not clear, the effects of arthritis on joints are well known.  In osteoarthritis the cartilage begins to wear and become rough and thin causing the bones to rub together.  This leads to pain and inflammation in the joint.  Rheumatoid arthritis involves the synovium which becomes inflamed and attacks the cartilage.  In both types of arthritis the joint becomes stiff and painful leading the arthritis sufferer to avoid moving the painful joint.  This worsens the condition by weakening structures adjoining the joint and making movement more difficult.

Total Joint Replacement Surgery

Total joint replacement surgery involves replacing the worn out ends of the joint with artificial parts fashioned from metal and high-density plastic.  This is called a prosthesis.  The surgeon cuts away the diseased ends of the bone and implants the prosthesis in their place.  The implants are attached to the bone with cement or they have a porous coating, which the bone can grow directly into over time.

Cemented joints are actually glued to the natural bone.  The advantage of this method is faster healing time and the ability to bear weight quickly.  However, these types of joint replacements tend to loosen faster and require revision surgery in the future.  About 50% of cemented joints require revision in 10 to 20 years.  Cemented joints are best used in older patients with poor bone quality who need to begin moving quickly.  Uncemented implants have porous material into which the bone can grow and attach itself.  Theoretically, these joint implants should last longer because the bone growth should increase and get stronger.  Decisions about joint replacement must be made on an individual basis.  These factors include the patient’s age, activity level, and bone quality.  You and your orthopaedic surgeon can discuss these issues.

Benefits of Total Joint Replacement Surgery

After this surgery you can expect to move more easily.  Almost always the surgery reduces joint pain.  This allows you to increase you strength and enjoy your activities.  You do not have to live with the joint pain for the rest of your life.  Your orthopaedic surgeon can explain in detail the actual surgery, your hospital stay, recovery at home, and return to your activities.

References

Di Lima, S. N. (Ed.) Orthopaedic Patient Education Resource Manual.  Aspen Publishers, Inc.: Gaithersburg, Maryland. 1996. 2:17-19.