Take Charge of Your Health - Joint Replacement
In the US, surgeons perform more than 600,000 knee replacements, about
330,000 hip replacements, and approx. 53,000 shoulder replacements each year.
- Health Statistics
When a patient meets with their doctor about chronic joint pain in the knee, hip, or shoulder, the first options for treatment are typically non-surgical and include natural supplements, exercise, physical therapy, medications, and injection therapy. If all of these fail and the joint pain is affecting quality of life, it can be time to consider a joint replacement. A replacement is major surgery and takes a significant amount of rehabilitation, but can dramatically improve one’s personal, family, and professional life. Many people who undergo these surgeries say that they wish they had not waited so long.
What are the signals that can indicate a knee, hip, or shoulder replacement is required?
Impact on your quality of life so you can no longer participate in things you love to do – travel, hobbies, or sports as examples
It is difficult to complete routine daily tasks (ex: Decreased range of motion, difficulty getting in and out of chairs, or cars)
Pain is significant and keeps you up at night, even when you take over the counter medications
Pain that makes it hard to walk and bend over; limited mobility; stiffness
Difficulty bending, straightening, or rotating the affected joint
Instability; feeling like the joint is “giving way” or buckling
Swelling and deformity of the joint
The orthopedic expert you trust says that other treatments are very unlikely to help your pain
Imaging tests show advanced arthritis or significant joint damage. Bone-on-bone contact with significant cartilage loss and bone grinding against bone indicate advanced osteoarthritis.
If you are experiencing these symptoms, it is time to meet with an orthopedic specialist who can properly diagnose the extent of your joint damage, and recommend the most appropriate treatment plan.
Knee
Knee replacement surgery replaces parts of injured or worn-out knee joints (knee arthroplasty). The surgeon removes and replaces damaged bone and cartilage with parts/implants most often made of metal and plastic. The best artificial joints and surgical techniques will depend on your age, weight, activity level, knee size and shape, and overall health. If only a part of the knee is damaged, surgeons may be able to do a partial knee replacement of just that part. If the entire joint needs to be replaced (“a total knee replacement”), then up to three bone surfaces can be replaced and resurfaced – the lower end of the femur (thighbone), the top of the tibia (shinbone), and the back surface of the patella (kneecap) with a dome-shaped piece of polyethylene that duplicates the shape of the patella. In some cases, the patella does not need to be resurfaced.
Hip
The hip is a ball-and-socket joint where your thigh bone (femur) connects to your pelvis. After your knees, the hip is the second largest joint in your body. The hip joint allows for a wide range of motion in multiple directions. Specific signs that may suggest the need for a hip replacement:
Pain that does not improve or subside with rest, pain relievers, or physical therapy. Pain even when you are not moving
Limited mobility - Difficulty walking, climbing stairs, bending to put on shoes and socks
Stiffness especially after sleeping or resting and when you try to walk
Difficulty lifting your leg
Difficulty picking something up from the floor
Difficulty sitting and getting up from low chairs
Pain that radiates from the hip to the groin, thigh, or the knee
Swelling
Grating or grinding sound (crepitus) when moving the hip
Other health conditions that can damage the joints and lead to hip replacement include:
Osteoarthritis. Damages the cartilage that covers the ends of bones and helps the hip joint move smoothly.
Rheumatoid arthritis. Caused by an overactive immune system, rheumatoid arthritis produces a type of inflammation that can erode cartilage and sometimes bone.
Osteonecrosis. If there is not enough blood supplied to the ball portion of the hip joint, the bone might collapse and change shape. Osteonecrosis might result from a dislocation or fracture that disrupts the blood supply to the hip bone.
Shoulder
The shoulder is where the upper arm bone (the humerus) connects to the shoulder blade (the scapula). The shoulder is another ball and socket joint -- the ball-shaped top of the humerus fits into the cup-shaped socket in your scapula (the glenoid). Like in the hip, ligaments and tendons hold the joint together. Ligaments connect the bones and tendons connect the muscles to the bone. A layer of cartilage keeps the bones apart so they do not rub against each other. The shoulder’s ball and socket joint enables us to move our arms up and down, back and forward, and in circles.
There are varied causes for shoulder replacement. While a few are unique to the shoulder, many of the conditions that can damage the hip joint also can also affect the shoulder joint, including:
Osteoarthritis -- which damages the cartilage at the end of the shoulder bones that helps the joints move smoothly
Rheumatoid arthritis and other inflammatory disorders
Rotator cuff injuries --The rotator cuff is a group of muscles and tendons that surround the shoulder joint
Fractures -- Fractures of the upper end of the humerus
Osteonecrosis -- which affects and limits blood flow to the humerus
These conditions and damage to the shoulder joint can cause pain, weakness, limited mobility, swelling, and stiffness. Most people who require a shoulder replacement have shoulder arthritis – either osteoarthritis or rheumatoid arthritis.
When shoulder replacement surgery (called a shoulder arthroplasty) is recommended, the objective is to remove damaged areas of bone and connective tissue and replace them with implants made of metal and plastic. These shoulder implants are available in different shapes and sizes. Replacement options include partial and total, using either anatomic or reverse implants. Depending on the type of joint damage the orthopedic surgeon will recommend one of the following:
An anatomic total shoulder replacement where the ball and the socket in the scapula are replaced with implants that mirror the natural shape of the bones. This is the most common type.
A reverse total shoulder replacement where both the ball and the socket are replaced, but the implants are reversed. The ball is attached to the shoulder blade and the socket is attached to the upper arm bone. This procedure is often recommended if the rotator cuff is severely damaged. A reverse replacement allows the deltoid muscle to compensate for the damaged rotator cuff, restores shoulder mobility, and reduces pain.
A partial shoulder replacement is where only the head or ball of the joint is replaced. This can be recommended when only the ball side of the joint is damaged. When the socket is not damaged but the ball is replaced, the procedure is called a hemiarthroplasty.
While shoulder replacement surgery usually takes around two to three hours, it can take several months to recover from the surgery. You will need to wear a sling for at least a few weeks, will be given an exercise program to regain strength and mobility in your shoulder, and then will start PT a few weeks after surgery. Most people can resume light daily activities with their shoulders (getting dressed or doing simple chores) approximately three weeks after surgery, but patients will need to avoid lifting heavy objects, playing sports, or working out for several months.
General:
Safe and effective, joint replacement surgery can reduce pain and other symptoms, however rare complications can include blood clots, damage of the blood vessels, fractures around the implant, nerve damage that can result in numbness, weakness and/or pain, the implant loosening, wearing out, or dislocating, and infection at the incision site or in the deeper tissue. While the materials used for implants are durable, they can become worn over time and another surgery could be required. Typically replacement joints are expected to last 15-20 years and may last longer based on the materials used, the patient’s age, and activity level. However, if the first joint replacement is unsuccessful for some reason such as infection or parts loosen over time, a second (or third) operation may be necessary. It is important to note that this "revision surgery" is technically more difficult, recovery can take longer, and success rates can be lower than “first” replacement operations.
Pre-operative Tips and Questions to Ask:
Finding an experienced surgeon you trust and the best hospital can make a big difference in the success of your operation and your peace of mind. Chances are you will have a better result and fewer complications if your surgeon performs the replacement operation at least 100 times a year and operates in a well-respected facility where replacements are routinely done. Remember. do not hesitate to get a second opinion; it is a common practice and a cornerstone of Taking Charge of Your Health.
Some of the primary questions to ask your surgeon include the following, but remember there are no silly questions. If you have a concern in a particular area - ASK:
Are you board-certified in orthopedic surgery? Are you fellowship trained?
What are my surgery/treatment options and the pros/cons?
What type of joint replacement surgery do you recommend? Why?
How often do you perform this specific surgery? How many have you done?
How long will I be in the hospital/surgery center?
How is post-operative pain managed? Will I need to take a combination of prescription and/or over-the-counter medications?
What complications occur most frequently, and how do you manage them?
What kind of results would you expect for someone my age and in my condition of health?
What is the recovery period and will I need to go to a rehab facility? Will I need to have someone with me for the first several weeks?
What do you expect in terms of my activity level upon recovery (ask about your specific activities)?
What are the key milestones and timelines to full recovery?
Do you usually work with a particular physical therapist or rehabilitation center? Who are they and where are they located? What kind of PT will I need and for how long?
Will I need to use a cane or a walker or have a sling during the recovery process? Is there any other equipment I will need?
How will my activities be restricted after surgery? When do you expect I will be able to drive? Return to work?
What are the signs of complications I should look out for during the recovery period?
How long will the replaced joint last? Will I need another surgery in the future?
Who is the best person to speak with about my mental health concerns? (stress, anxiety, depression, isolation, mood swings…)
Whether it be your knee, hip, or shoulder, reduced mobility of a joint can have significant impact on your mental well-being. Chronic pain and lack of sleep are very stressful and can lead to both depression and anxiety, affecting your personal and professional life. In addition to talking to your medical team about your potential joint replacement be sure to mention your mental health concerns and seek their guidance. A hip, knee, or shoulder replacement can improve your quality of life and restore your mobility so you can get back to doing the things you love, with the people you love!