Joint Replacement - what's involved

Why might a joint replacement be needed?

The aim of having a joint replaced is to relieve the severe pain and restricted movement that accompanies the deterioration of a weight bearing joint, most commonly as a result of osteoarthritis. Joint replacement operations are very effective for most people with sever oesteoarthritis however any surgery poses risks so a replacement should be considered only when other non-surgical treatments e.g. weight loss, exercise, medications, etc. no longer bring sufficient relief.

There are some key factors which your surgeon will take into account when assessing the need to go ahead with surgery:

How severe the pain is, and in particular whether it is causing disturbed sleep
Whether the deterioration of the joint is limiting daily activities or the ability to look after one’s self
Whether the pain and immobility is affecting the psychological wellbeing of the patient or of a carer
What economic impact is being felt by the patient & their family
Any recent and rapid deterioration in mobility or function

What happens during replacement surgery?

During a ‘total hip’ or ‘total knee’ replacement all articulating surfaces of the hip or knee joint are replaced. An artificial joint, called a prosthesis, is inserted in place of the diseased joint components. There are many different types of prosthesis, made of sturdy and hard-wearing synthetic materials such as metal, plastic or ceramic.

What should be expected after the surgery?

In most cases the operation will reduce pain, improve mobility, make day-to-day activities easier and
improve quality of life. However joint replacement is not a miracle cure. An artificial joint will not restore things to the way they were when the joint was completely healthy but time and effort spent in pre-operative preparation, both physically and mentally, has been shown to improve the final result.

An artificial joint does have a limited lifespan. Most hip and/or knee replacements survive for an average of 10 to 15 years, but in ideal conditions some can last for up to 25 years. For this reason, the longer someone can delay having to have their first replacement, the better their chances that they won’t need a revision surgery. In addition, being overweight causes an acceleration of the normal wear & tear on the artificial joint which will cause the prosthesis to become loose and painful.

It has been noted that the best outcome from a replacement surgery will be achieved with the following:

Weight loss – in addition to the positive overall health benefits that losing weight offers if you are overweight, there are also surgery-specific benefits including reduced risk of complications during surgery, shorter recovery times post-surgery and in the longer term a longer lifespan for the prosthesis.
Start an exercise or hydrotherapy program - this helps recovery whether or not you are overweight.
Quit smoking if you are a smoker - smoking is a well established risk factor for complications both during surgery and for poor would healing. Most anaesthetists recommend that patients try to stop smoking at least 6 to 8 weeks before surgery to optimise the risk reduction benefits.

See the Smoking Information module for where to go if you need help quitting.

In the weeks following the operation there is usually an intensive program of physiotherapy and muscle strengthening exercises as doses of pain medicines are tapered down as the need for them diminishes.

Complications of joint replacement surgery

Every treatment has risks and benefits, including joint replacement. The potential complications of joint replacement surgery can vary between individuals and is something that should be discussed with a surgeon.
General anaesthesia is never without risk.

Where to go to find out more about osteoarthritis and joint replacement

Arthritis Australia produces a range of brochures and provides support services for people with arthritis and has some very good information about replacement surgery. For more information, visit www.arthritisaustralia.com.au.