Joint Replacement Surgery

Health Topics




What Is Arthroplasty?
What Is Joint Revision Surgery?
Why Is Arthroplasty Performed?
How Do I Prepare For Surgery?
How Is It Performed?
What Are The Risks Of Surgery?
Recovery Process
Is It A Permanent Fix?
How Much Does Surgery Cost?

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Arthritis of the Knee
Arthritis of the Hand
Arthritis of the Shoulder
Hip Arthritis

Terminology: Arthroplasty is also called joint replacement surgery.

What Is Arthroplasty?

Arthroplasty is a medical surgery to repair a damaged joint. The joint is partly or completely replaced with an artificial joint (called a prosthesis) made of metal or plastic. Hip and knee replacement surgery is the most commonly performed type of arthroplasty with surgery to the ankle, shoulder, elbow, fingers and toes performed less frequently. Arthroplasty is only considered where more conventional methods of treatments have failed to give relief from joint pain or restore joint movement. Some of these other treatments include anti-inflammatory medications, physical therapy, cortisone injections, viscosupplementation injections (injecting lubricant into the joints) and taking glucosamine and chondroitin sulfate supplements.

What Is Joint Revision Surgery?

Although joint replacement surgery has a high rate of success, in about 10 percent of cases the artificial implant will fail. Surgery to replace the implant with new components is called joint revision surgery. It is an extensive operation that requires lots of preplanning and specialized surgical equipment (as well as the hands of a skilled surgeon).


1. The CDC reports over a million arthroplasty operations are performed every year in the United States. Of these:
- 676,000 are knee surgeries.
- 327,000 are hip surgeries.
- The remainder surgeries are to the ankle, shoulder, wrist and hand (fingers and thumb).
2. Joint operations are massively on the increase. In 1997 for example, 259,000 total knee replacements were performed. This grew to 478,000 in 2004 and 676,000 in 2009.

Why Is Arthroplasty Performed?

The goal of surgery is to relieve joint pain and restore movement to the joint by replacing it with an artificial implant. A physical examination, X-ray and possibly CT scan or MRI scan will show the extent of damage to the joint. It will help the doctor determine if the patient is a candidate for surgery. In most cases the patient will be suffering from osteoarthritis, a disease that attacks the joints. Arthroplasty is seen as a treatment of last resort, so it is reserved for the most severely afflicted of patients (about 3 percent of those with osteoarthritis). Very few patients suffering from rheumatoid arthritis (RA), another common disease that causes chronic crippling joint pain, are candidates for arthroplasty. This is because RA not only affects multiple joints but also other parts of the body such as the immune system.

How Do I Prepare For Surgery?

Your orthopedic surgeon (the doctor who performs the surgery) will make some recommendations, possibly including:

1. Donating some of your blood, in case you need it during or after surgery.
2. Start exercising to strengthen your body for surgery and the recovery period. He may also recommend some weight loss if you are overweight or obese (several months prior to surgery).
3. You may need to stop taking medications.
4. Think about and prepare for your home therapy and rehabilitation after the operation.

How Is It Performed?

Arthroplasty requires a hospital stay, how long depends on the type of surgery you are having but it is usually several days. The procedure itself can vary according to the practice of the orthopedic surgeon. It is may be performed under general or local anesthesia. An anesthesiologist will discuss your options in advance of surgery. Generally the surgery proceeds as follows:

1. You will remove your clothes and be given a hospital gown to wear.
2. An intravenous (IV) line will be inserted into your arm or hand.
3. You will be taken to the operating room where the anesthesia is given.
4. A urinary catheter may be inserted to collect urine.
5. If there excessive hair at site of incision it may be shaved.
6. The surgical site is cleaned with an antiseptic solution and an incision is made.
7. The damaged joint will be partly or completely removed.
8. The new artificial joint is inserted.
9. The incision is closed with surgical staples or stitches and a bandage applied.

What Are The Risks Of Surgery?

Surgery is successful in 9 out of 10 cases, and where complications occur they are normally quite treatable. Possible complications include:

Infection: An infection can occur in the incision scar or around the artificial implant. It can happen in hospital, when you return home or even years later. Minor infections are treated with antibiotics but deep or major infections may require further surgery.
Blood Clots: Clots are a risk with any major surgery. You may need to wear elastic stockings and plastic boots that inflate with air to compress the leg muscles and take prescribed blood thinners (anticoagulants) to help prevent clots.
Loosening of Prosthetic: The implant may loosen after surgery causing pain. If the loosening is significant, joint revision surgery is needed. Newer techniques of fixing implants in place have reduced the number of cases requiring revision.
Nerve Damage: Nerves or blood vessels near the replaced joint may be damaged during surgery resulting in weakness or numbness, although this is quite rare. Over time, these vessels often naturally heal by themselves.

Recovery Process

In Hospital
After surgery you will be taken to the recovery room for observation. Once you are alert and your blood pressure and breathing are stable you will be taken to your hospital room. It is important to start moving your new joint as soon as possible (usually the day after surgery). You will be met by a physical therapist who will plan a specific exercise program for you. After discharge you will need to see your therapist regularly at a rehabilitation center. If you had hip or knee surgery you may need to initially walk with a cane or crutches. You probably will also be in some temporary pain as tissues around the new joint and incision heal.

At Home
Your nurse or doctor will give you instructions on keeping your surgical incision clean and dry. The stitches will be removed during your follow-up visit to the doctor. You may be given some painkillers to cope with temporary soreness. Be sure only to take medications prescribed by your doctor as aspirin and certain other drugs can increase the risk of bleeding. You may also consider buying arthritis aids and equipment to help during the recovery process, such as a raised toilet seat, long-handled shoe horn, sock aid or door grips. You can resume your normal diet unless your doctor advises otherwise. There may be restrictions on driving for a period of time.

When To Call The Doctor

Notify your medical team if you experience any of the following:

• Fever
• Bleeding, swelling or redness, or drainage from the incision wound.
• Increased pain around the incision wound.
• Numbness and/or tingling in the body.

Is It A Permanent Fix?

For many older patients, yes it is. Newer prosthesis joints have a life of up to 15 or 20 years. Younger patients will require a new joint replacement within their lifetime.

How Much Does Surgery Cost?

It depends on which surgery you are having. Typically for example a total hip replacement costs between $32,000 and $45,000; although some hospitals offer uninsured patients a discounted rate of between $20,000 and $23,000. Typically knee surgery costs about $35,000. Most joint replacement surgery is covered by health insurance unless it is experimental or specifically excluded from the policy. Even if you are covered by insurance there will still be out of pocket expenses which are on average $2,000 -$3,000. Included in the overall cost you should expect an orthopedic surgeon to perform the initial evaluation, take a medical history and X-rays and possibly other tests such as an MRI scan to check bones and tissues. The doctor will advise you on any surgery preparation such as blood tests and losing weight. Several days rest in hospital after the procedure is also covered.

  Related Articles on Arthritis

For more on joints, see the following:

Bone and joint problems: Symptom checker.
Bones of the body: Do women have more ribs than men?
Hospital departments explained: Which department treats what?

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