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Joint Care

Total joint replacement is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial hip or knee joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology.

Circumstances vary, but generally patients are considered for total joint replacement if:

  • Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
  • Pain is not relieved by more conservative methods of treatment, such as those described above, by the use of a cane, and by restricting activities
  • Stiffness in the joint is significant
  • X-rays show advanced arthritis or other problems

Joint replacement (the term orthopaedic surgeons use) is usually reserved for patients who have severe arthritic conditions.

Circumstances vary, but generally patients are considered for total joint replacement if:

  • Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living.
  • Pain is not relieved by more conservative methods of treatment— such as medications, physical therapy, arthroscopy (cleaning the joint), the use of a cane, and/or by restricting activities.
  • Stiffness in the joint is significant.
  • X-rays show advanced arthritis or other problems.

Nearly half a million hip and knee replacements are performed each year in the U.S. using conventional metal/plastic prostheses. Although these procedures have yielded positive results, over the years, the artificial joints can become loose and unstable, requiring a revision (repeat) surgery.

These issues, coupled with the facts that increasing numbers of younger and more active patients are receiving total joint replacements and that older patients are living longer, have challenged the orthopaedic industry to try to extend the life cycle of total joint replacements.

Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic prostheses and new plastic joint liners, provides orthopaedic surgeons with options that may help to increase the longevity of the prosthesis.

The most common types of arthritis include the following:

Osteoarthritis (OA)

Sometimes called degenerative arthritis because it is a “wearing out” condition involving the breakdown of cartilage and bones. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of arthritis.

Rheumatoid Arthritis (RA)

Rheumatoid Arthritis causes the synovium to become thickened and inflamed. In turn, too much synovial fluid is produced within the joint space, which causes a chronic inflammation that damages the cartilage. This results in cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body.

Post-Traumatic Arthritis

May develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth and these irregularities lead to more wear on the joint.

Avascular Necrosis

Avascular Necrosis can result when bone is deprived of its normal blood supply, which may happen after organ transplantation or long-term cortisone treatment. Without proper nutrition from the blood, the bone’s structure weakens and may collapse and damage the cartilage.

Another cause of joint pain is deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move.

Paget’s Disease

Paget’s Disease is a bone disease that often affects the hip. Bone formation is sped up, causing the density and shape of the bone to change.

You may need routine blood tests, urinalysis, a physical examination, and— if you’re over 50 or your orthopaedic surgeon thinks they are advisable— an electrocardiogram (EKG) and chest X-ray. 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 prior to joint replacement. Your orthopaedic surgeon will specify exactly which tests and evaluations you will need and when you should have them, as well as recommend that you stop taking certain medications before your surgery. You should also discuss your postoperative treatment plan with your surgeon at this time.

The standard surgery may take from 1 to 2 hours, and you may spend about the same amount of time in the recovery room.

Preparing for Joint Replacement Surgery

Preparing for a total joint replacement begins weeks before the actual surgery date. In general, you may be told to:

  • Consider autologous blood donation: while some total joint procedures do not require blood transfusion, it is possible that you may need blood during or after surgery. To avoid using donor blood, you may donate your own blood ahead of time (autologous donation).
  • Begin exercising under a physician’s supervision: it is important to be in the best possible overall health to help promote the best possible surgical experience. Increasing upper body strength is important because of the need to use a walker or crutches after hip or knee replacement. Strengthening the lower body is also key because increasing leg strength before surgery can reduce recovery time.
  • Have a general physical examination: if you are considering total joint replacement, you should be evaluated by your primary care physician to assess overall health and identify any medical conditions that could interfere with surgery or recovery.
  • Have a dental examination: although infections after joint replacement are not common, an infection can occur if bacteria enters your bloodstream. Therefore, dental procedures such as extractions and periodontal work should be completed before joint replacement surgery.
  • Stop taking certain medications: your orthopaedic surgeon can advise you which over-the-counter and prescription medications should not be taken before surgery.
  • Stop smoking: a good idea at any time, but particularly before major surgery in order to help reduce the risk of post-operative lung problems and improve healing.
  • Lose weight: if you are overweight, losing weight will help reduce stress on the new joint.
  • Arrange a pre-op visit: an important opportunity to meet with healthcare professionals at the hospital to discuss your personal hospital care plan, including anesthesia, preventing complications, pain control, and diet.
  • Have routine laboratory tests: blood tests, urine tests, an EKG or cardiogram, and chest X-ray may be prescribed to confirm that you are fit for surgery.
  • Evaluate post-surgical needs for at-home care: every patient who undergoes total joint replacement will need help at home for the first few weeks, including assistance with preparing meals and transportation.

Download and print our Pre-op Class Information .