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 restore the integrity and function of a joint. A joint can be restored by resurfacing the bones. An artificial joint (called a prosthesis) may also be used.

Various types of arthritis may affect the joints. Osteoarthritis, or degenerative joint disease, is a loss of the cartilage or cushion in a joint, and is the most common reason for arthroplasty.

Anatomy of the joint

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Joints are formed where bones meet. Most joints are mobile, allowing the bones to move. Joints consist of the following:

• Cartilage. A type of tissue that covers the surface of a bone at a joint. Cartilage 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.
• Meniscus. A curved part of cartilage in the knees and other joints that acts as a shock absorber.

Reasons for the procedure

Arthroplasty may be used when medical treatments no longer provide adequate relief from joint pain and/or disability . Some medical treatments for osteoarthritis that may be used prior to arthroplasty 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
• Viscosupplementation injections (to add lubrication into the joint to make joint movement less painful)
• Weight loss (for obese people)
• Glucosamine and chondroitin sulfate
• Exercise and conditioning

People who have arthroplasty generally have substantial improvement in their joint pain, ability to perform activities, and quality of life, so these are important reasons for the procedure as well.

Most joint surgery involves the hip and knee, with surgery on the ankle, elbow, shoulder, and fingers being performed less often.

There may be other reasons for your doctor 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
• Loosening of prosthetic parts

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 on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor 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 doctor 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 doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor 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 health care provider.
• 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.
• Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

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

Arthroplasty may be performed while you are asleep under general anesthesia, or while you are awake under localized anesthesia. Your anesthesiologist 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. If there is excessive hair at the surgical site, it may be clipped off.
6. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
7. The skin over the surgical site will be cleansed with an antiseptic solution.
8. The doctor will make an incision in the area of the joint.
9. The doctor will remove the damaged surfaces of the knee joint and resurface the knee joint with the prosthesis. The knee prosthesis is made up of metal and plastic. The two most common types of artificial knee prostheses used are cemented prostheses and uncemented prostheses. A cemented prosthesis attaches to the bone with surgical cement. An uncemented prosthesis attaches to the bone with a porous surface onto which the bone grows to attach to the prosthesis. Sometimes, a combination of the two types is used to replace a knee.
10. The incision will be closed with stitches or surgical staples.
11. A sterile bandage or 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 doctor 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 doctor 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 doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Notify your doctor 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 doctor advises you differently.

You should not drive until your doctor 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 doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.