Joint Replacement Health Article

Definition

Joint replacement is the surgical replacement of a joint with an artificial prosthesis.

Purpose

Great advances have been made in joint replacement since the first hip replacement was performed in the United States in 1969. Improvements have been made in the endurance and compatibility of materials used and the surgical techniques to install artificial joints. Custom joints can be made using a mold of the original joint that duplicate the original with a very high degree of accuracy.

The most common joints to be replaced are hips and knees. There is ongoing work on elbow and shoulder replacement, but some joint problems are still treated with joint resection (the surgical removal of the joint in question) or interpositional reconstruction (the reassembly of the joint from constituent parts).

Seventy percent of joint replacements are performed because arthritis has caused the joint to stiffen and become painful to the point where normal daily activities are no longer possible. If the joint does not respond to conservative treatment like medication, weight loss,

activity restriction, and use of walking aids such as a cane, joint replacement is considered appropriate.

Patients with rheumatoid arthritis or other connective tissue diseases may also be candidates for joint replacement, but the results are usually less satisfactory in those patients. Elderly people who fall and break their hip often undergo hip replacement when the probability of successful bone healing is low.

More than 170,000 hip replacements are performed in the United States each year. Since the lifetime of the artificial joint is limited, the best candidates for joint replacement are over age 60.

Precautions

Joint replacements are performed successfully on an older-than-average group of patients. People with diseases

that interfere with blood clotting are not good candidates for joint replacement. Joint replacement surgery should not be done on patients with infection, or any heart, kidney or lung problems that would make it risky to undergo general anesthesia.

Description

Joint replacements are performed under general or regional anesthesia in a hospital by an orthopedic surgeon. Some medical centers specialize in joint replacement, and these centers generally have a higher success rate than less specialized facilities. The specific techniques of joint replacement vary depending on the joint involved.

Hip Replacement

The surgeon makes an incision along the top of the thigh bone (femur) and pulls the thigh bone away from the socket of the hip bone (the acetabulum). An artificial socket made of metal coated with polyethylene (plastic) to reduce friction is inserted in the hip. The top of the thigh bone is cut, and a piece of artificial thigh made of metal is fitted into the lower thigh bone on one end and the new socket on the other.

The artificial hip can either be held in place by a synthetic cement or by natural bone in-growth. The cement is an acrylic polymer. It assures good locking of the prosthesis to the remaining bone. However, bubbles left in the cement after it cures may act as weak spots, causing the development of cracks. This promotes loosening of the prosthesis later in life. If additional surgery is needed, all the cement must be removed before surgery can be performed.

An artificial hip fixed by natural bone in-growth requires more precise surgical techniques to assure maximum contact between the remaining natural bone and the prosthesis. The prosthesis is made so that it contains small pores that encourage the natural bone to grow into it. Growth begins 6 to 12 weeks after surgery. The short term outcome with non-cemented hips is less satisfactory, with patients reporting more thigh pain, but the long term out-look is better, with fewer cases of hip loosening in noncemented hips. The trend is to use the non-cemented technique. Hospital stays last from four to eight days.

Knee Replacement

The doctor puts a tourniquet above the knee, than makes a cut to expose the knee joint. The ligaments surrounding the knee are loosened, then the shin bone and thigh bone are cut and the knee removed. The artificial knee is then cemented into place on the remaining stubs of those bones. The excess cement is removed, and the knee is closed. Hospital stays range from three to six days.

In both types of surgery, preventing infection is very important. Antibiotics are given intravenously and continued in pill form after the surgery. Fluid and blood loss can be great, and sometimes blood transfusions are needed.