Adult Joint Replacement
Total Hip Replacement (THR)
Total hip replacement – also called hip arthroplasty – is an often-used and very effective remedy for hip pain caused by arthritis. Damaged hip tissue is replaced with an artificial ball and socket that function like a natural joint. According to the National Center for Health Statistics, 193,000 hip replacements were performed in 2002.
Options for total hip replacement:
Traditional THR uses a five to eight inch incision. It has been done successfully for more than 40 years with few changes to the original procedure. It has a success rate above 90 percent with 10 years of follow-up data on which to base the success rate. It is considered by many to be one of the most important surgical innovations of the last century.
Mini-incision or minimally-invasive THR
In a mini-incision THR procedure, the incision is reduced to three and one-half inches. This is possible through the use of special lighting instruments and retractors. Physicians undergo specialized training to perform the mini-incision procedure.
Patients can typically expect recovery time to be reduced by 50 percent as well as experience less discomfort and less bleeding. The procedure also offers a more cosmetically appealing scar.
Would I Benefit from traditional THR or minimally invasive THR?
You may receive benefits from these procedures, if:
You have evidence of significant damage to the articular cartilage;
You experience pain deep in the upper thigh, groin, or buttock or pain that prevents you from sleeping;
Anti-inflammatory medicine provides little or no relief of your pain;
You have trouble walking up and down stairs or dressing;
You have difficulty getting up from a seated position;
Your discomfort is preventing you from enjoying routine activities.
If you have poor overall health, uncontrolled high blood pressure, an active infection or disabling heart disease, you may be disqualified from hip replacement surgery.
Total Knee Replacement
If you have arthritis and severe pain of the knee, you may be a candidate for total knee replacement (TKR) or minimally-invasive/mini-incision TKR – also known as knee arthroplasty. As with any surgical procedure, non-surgical alternatives should be explored fully – such as modifying activity, anti-inflammatory medicine, or injections – before considering surgery.
TKR has been practiced for more than 30 years with 10-year success rates of over 90 percent. The National Institutes of Health states, “. . . for persons suffering from intractable and persistent knee pain and disability, TKR surgery is a safe and cost-effective therapy that restores mobility and alleviates discomfort. Over 20 years of follow-up data indicate that the procedure is successful in the vast majority of patients.”
Options for total knee replacement:
In a traditional TKR, a seven or eight-inch incision is made over the knee and specialized tools are used to remove enough bone from the shin bone (tibia), thigh bone (femur) and underneath the kneecap (patella) to allow insertion of the joint replacement implants. The size and placement of the implants is key to a successful outcome as well as careful adjustment of surrounding ligaments. After the surgeon is certain that the implants fit and allow complete mobility, the implants are cemented into place with special bone cement and the incision is closed.
TKR can be performed under general, epidural or spinal anesthesia, although epidural anesthesia is the preferred method, because it offers post-operative relief.
Patients can expect to spend three to five days in the hospital. Thereafter, the patient would typically use a walker or cane for support for one to three months.
Minimally invasive or mini-incision TKR
A mini-incision or minimally invasive TKR allows the same joint replacement implants as used in traditional TKR to be inserted through a much smaller incision – three to three and one-half inches – with little damage to surrounding muscles and tendons. Surgeons use state-of-the-art lighting equipment and extractors that require specialized training.
Because of the smaller incision, the patient’s hospital stay is shortened to one or two days, there is far less blood loss, and the recovery period is considerably less: Patients often walk unassisted within two weeks and can also expect to feel less pain.
Partial Knee Replacement
Partial or “unicompartmental” knee replacements have been performed since the 1970s. It is the resurfacing or replacing of one compartment of the knee.
You may be a candidate for partial knee replacement if:
You have pain bearing weight on one side of your knee;
Non-surgical treatment has not reduced your discomfort;
You have an X-ray indicating narrowing mostly on one side of the joint.
Total Shoulder Replacement
If you have shoulder arthritis, the joint surface may be destroyed as a result of inflammation, injury, normal wear and tear or a previous surgery. This causes the shoulder to be painful and stiff.
Other causes of shoulder damage are osteoarthritis, rheumatoid arthritis or degenerative joint disease.
Total shoulder replacement, also known as arthroplasty, can help patients regain use of their shoulders and eliminate pain. The goal of arthroplasty is to restore use of the shoulder by rebalancing muscles, removing scar tissue and replacing the destroyed joint with an artificial joint.
The components of shoulder joint replacement include a metal humeral ball and a plastic glenoid component. The glenoid component is attached to the shoulder blade using special bone cement, and the humeral ball is fixed to the arm ball with the humeral stem.
A clinical exam by a shoulder surgeon determines if arthritis is the cause of the discomfort and if surgery would be helpful. A successful outcome is likely if the patient is motivated and in good health.
The procedure is performed under general anesthesia and generally takes about two hours.
Movement of the shoulder begins immediately after surgery, and patients learn to undertake their own physical therapy. Patients can expect to be discharged within three days of surgery if feeling comfortable and showing a good range of passive motion. Patients might expect to take up to a year to regain complete strength and function.