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Joint Replacement

Joint Replacement

Joint replacement means removing part or all of a damaged joint and installing hardware to allow the limb to move without pain or limitations. The replacement hardware is called a prosthesis. These are made of plastic, metal, ceramic, or a combination of these materials. Most joint replacements are performed to treat damage from arthritis to the knees or hips. Orthopedic surgeons do the procedure under general anesthesia.

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Damaged cartilage and bone are removed from the knee joint. Man-made pieces are then placed in the knee.
These pieces may be placed in the following places in the knee joint:
  • The lower end of the thigh bone -- This bone is called the femur. The replacement part is usually made of metal.
  • The upper end of the shin bone, which is the large bone in your lower leg -- This bone is called the tibia. The replacement part is usually made from metal and strong plastic.
  • The backside of your kneecap -- Your kneecap is called the patella. The replacement part is usually made from strong plastic.
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You will not feel any pain during the surgery. You will have one of these two types of anesthesia:
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  • General anesthesia -- This means you will be asleep and unable to feel pain.
  • Regional (spinal or epidural) anesthesia -- Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy. And you may get medicine that will make you forget about the procedure, even though you are not fully asleep.
After you receive anesthesia, your surgeon will make a cut over your knee to open it up. This cut is often 8 to 10 inches (20 to 25 centimeters) long. Then your surgeon will:
  • Move your kneecap (patella) out of the way, then cut the ends of your thigh bone and shin (lower leg) bone to fit the replacement part.
  • Cut the underside of your kneecap to prepare it for the new pieces that will be attached there.
  • Fasten the two parts of the prosthesis to your bones. One part will be attached to the end of your thigh bone and the other part will be attached to your shin bone. The pieces can be attached using bone cement or screws.
  • Attach the underside of your kneecap. Special bone cement is used to attach this part.
  • Repair your muscles and tendons around the new joint and close the surgical cut.
The surgery takes about 2 hours.
Most artificial knees have both metal and plastic parts. Some surgeons now use different materials, including metal on metal, ceramic on ceramic, or ceramic on plastic.
The decision to replace a joint depends on several factors:
  • How bad are the symptoms? Moderate to severe pain, stiffness, and limited function of the joint may indicate the need for a new joint.
  • How bad is the damage to the joint? An x-ray or other imaging tests can show if the bone and cartilage in the joint have deteriorated. The joint may also become misaligned. Moderate to severe joint damage is an indication for joint replacement.
  • Does the joint problem limit daily activities and compromise a person's quality of life? This, too, indicates that joint replacement may be beneficial.
Like any major operation, joint replacement surgery carries the risk of possible complications. For example, there are small risks that you may have a reaction to the anesthesia, develop a blood clot, or contract an infection.
Age by itself does not prevent a person from getting a new joint, but being overweight or having a chronic health condition, such as heart disease, might raise the risks. It's also possible for the prosthesis to break, making it necessary to do a so-called revision procedure to fix it.
A hospital stay of a day or two is typical for knee or hip joint replacement. Physical therapy then helps the muscles around the new joint to get strong. Joint hardware can last 15 to 20 years or more, depending on the type and the person's level of physical activity.




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