Hip and Knee Joint Replacement

One of the most common problems that affect our aging population is degenerative joint disease. Our joint cartilage is unable to reproduce itself once we reach maturity and will suffer from normal wear and tear from daily activities.

Introduction
FAQs
Results of Joint Replacement Surgery
Risks of Joint Replacement Surgery
Looking Ahead
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Introduction
A time will come when the worn out joint starts to become stiff and painful. The pain may initially only occur with vigorous activities but will later become more constant and affect normal daily activities. In some instances, this joint arthritis is accelerated after injuries during sports and work so that a person may be in his late forties or fifties when arthritis strikes. The treatment usually begins with anti-inflammatory medication, physical therapy and occasional injections of a synthetic synovial (joint) fluid into the affected joint. When these methods fail then surgery is necessary to allow daily activities to continue normally.

Joint replacement surgery is the method of choice in severe arthritis. The damaged cartilage is precisely removed using special instruments and the joint is resurfaced using the most modern materials.

This will permit a large range of movement thus allowing normal activities to take place. One important step to obtain good function is to balance the ligaments which often have contractures from the long standing joint disease. It has been shown that joint replacement surgery yields a very high patient satisfaction rate. Following several weeks of rehabilitation and exercises most should be able to walk independently and can then progress with regular exercises to get optimum function.

FAQs

Joint Replacement

Who needs joint replacement?
Joint replacement is usually considered once other therapies, such as pain medications, have failed. Most people undergo joint replacement as a result of osteoarthritis. Joint replacement is also used in people with severe trauma, rheumatoid arthritis and other medical conditions. Joint replacement used to be reserved for adults aged 60 and above, but improved technology has made longer-lasting artificial joints that are feasible for more active, younger people. However, another surgery may be necessary to replace worn out artificial joints after 15 or 20 years.

How is joint replacement performed?
Hip replacement surgery involves replacing the femoral head- the “ball” of your thighbone- with a metal ball. The metal ball attaches to a metal stem that fits into your thighbone. A plastic and metal socket is implanted into your pelvic bone to replace the damaged socket.

Similarly, knee replacement involves replacing the upper and lower parts of the knee joint with metal and plastic implants. Sometimes, the kneecap is replaced as well.

What happens after joint replacement surgery?
Hospital stay is usually between 1 to 5 days. You will be encouraged to sit up and even try walking with crutches or a walker. A physical therapist will help you with exercises to do in the hospital and at home. You might need to make some modifications at home, such as getting a raised toilet seat, and having a friend or relative prepare some meals for you.
Most people resume their normal activities by 6 to 8 weeks. Standard follow-ups are done at 2 weeks, 4 weeks, 6 months and 1 year. After this, yearly follow-up with X-rays is recommended, to allow early detection of possible problems with the prosthesis.

Results of Joint Replacement Surgery
Expect your new joint to reduce the pain you felt before your surgery, but don’t expect to do anything you couldn’t do before surgery. High-impact activities such as running or playing basketball are not recommended. You may be able to swim, play golf, walk or ride a bike comfortably. Travelling should be possible. You can expect to be pain-free for 10 to 15 years after surgery.

 

Risks of Joint Replacement Surgery
Complications are rare but includes the following:

• Blood clots may form in the legs after surgery. Blood- thinning medications, compression stockings and exercise will reduce this risk.
• Infection risk is approximately 1:50 to 1:100. Most infections are treated with antibiotics, but a major infection may require surgery to remove and replace the prosthesis. If you are undergoing dental, gynaecologic, bladder or bowel surgery it may be good to take prophylactic antibiotics to prevent infection of the joint. Discuss this with your doctor.
• Loosening. Over time your new joint may loosen, causing pain. Surgery might be needed to fix the problem.
• Dislocation. Certain positions can cause the ball of the hip joint to become dislodged. To avoid this, don’t bend more than 90 degrees at the hip and don’t let your legs cross the midline of your body.

Looking Ahead
New techniques are on the horizon for hip replacement surgery. Minimal incision hip replacement requires only a 2 to 5-inch incision- a departure from the current 10 to 12-inch incision. Some studies have shown that people who undergo minimally invasive hip replacement have an easier and less painful recovery, spend less time in the hospital and have fewer complications.

For knee replacement surgery, there are also new techniques utilizing less invasive approaches to optimize rehabilitation and shorten recovery times. In some cases, the use of computer guidance can improve the accuracy of the procedure and lead to better functional outcome.