Sarah Lewis, PharmD
What is arthroplasty?
Arthroplasty, sometimes called joint replacement surgery, is the replacement or repair of a diseased joint. Joints are the areas where two bones meet. Common types of arthroplasty include hip, knee, and shoulder repair or replacement.
Joints contain ligaments, tendons, cartilage, and lubricating fluid. Arthroplasty involves removing arthritic or damaged surfaces of bone and replacing them with artificial material or an implant called a prosthesis. Arthroplasty can restore pain-free motion and full function in a diseased joint.
Looking for a Doctor?
Arthroplasty is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having an arthroplasty.
Types of arthroplasty
The types of arthroplasty procedures include:
Hemiarthroplasty (partial arthroplasty) is the removal and replacement of one side or part of the joint.
Total arthroplasty is the removal and replacement of an entire joint.
Why is arthroplasty performed?
Your doctor may recommend an arthroplasty to treat severe joint damage caused by:
Joint infections, also called septic arthritis
Joint injuries, including fractures, torn ligaments, and torn cartilage, which may lead to irreversible joint damage
Osteoarthritis, or degenerative joint disease, a breakdown of cartilage and bones within the joint, resulting in pain, stiffness and swelling. It is the most common reason for arthroplasty.
Osteonecrosis, or death of bone. Osteonecrosis is a rare condition.
Rheumatoid arthritis, an autoimmune disease characterized by joint inflammation
Your surgeon may only consider arthroplasty for you if other treatments that involve less risk of complications have been ineffective. Ask your surgeon about all of your treatment options and consider getting a second opinion before deciding on arthroplasty.
Who performs arthroplasty?
An orthopedic surgeon or podiatric surgeon performs arthroplasty. Orthopedic surgeons specialize in conditions of the bones and connective tissues. Podiatric surgeons are podiatrists who specialize in foot and ankle surgery.
How is arthroplasty performed?
Your arthroplasty will be performed in a hospital. The surgery involves making an incision in the joint to remove damaged cartilage and bone. Your surgeon then replaces the damaged areas with artificial material or an implant called a prosthesis.
Surgical approaches to arthroplasty
Your surgeon will perform an arthroplasty using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an arthroscope through small incisions in the joint. The arthroscope is a thin, lighted instrument with a small camera that sends pictures to a video screen. Your surgeon sees the inside of your joint on the video screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon uses small incisions instead of a larger one used in open surgery. Surgical tools are threaded around structures, such as muscle or tendons, instead of cutting through or displacing them as in open surgery.
Open surgery involves making a large incision in the joint. An open incision allows your surgeon to directly see and access the joint. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for some patients.
Your surgeon may combine a minimally invasive procedure with an open surgery. Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of arthroplasty and ask why your surgeon will use a particular type for you.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different arthroplasty procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform your arthroplasty using either general anesthesia or regional anesthesia, depending on the specific procedure.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your arthroplasty
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of arthroplasty?
As with all surgeries, an arthroplasty involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can occur during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of arthroplasty
Potential complications of arthroplasty include:
Allergic reaction to the new joint
Dislocation of the new joint, particularly hip replacement joints
Loosening of the new joint causing pain and the possibility of additional surgery to secure the new joint
Nerve, muscle, or blood vessel damage
Wear and tear of the new joint requiring another replacement
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my arthroplasty?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for arthroplasty by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan. Your surgeon may delay surgery until you have lost the excess weight.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need arthroplasty? Are there any other options for treating my condition?
What type of arthroplasty procedure will I need?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
Will I need physical therapy or rehabilitation?
How do I take my medications?
How will you treat my pain?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my arthroplasty?
Knowing what to expect can help make your road to recovery after arthroplasty as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are fully alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You might feel a little drowsy for 24 hours after surgery if you had a narcotic pain medication, a sedative, or general anesthesia. You may also have some nausea. Tell your doctor if you are nauseated so it can be treated.
Some patients stay in a rehabilitation center after discharge from the hospital. Rehabilitation helps improve mobility and joint function so you can return home safely.
Recovery after surgery is a gradual process. Recovery time varies depending on the joint treated, procedure, your general health, age, and other factors. Full recovery takes weeks to months.
Will I feel pain?
Pain control is important to healing and a smooth recovery. There will be discomfort after your surgery/procedure. Your surgeon will treat your pain so you are comfortable and can get the rest you need. Call your surgeon if your pain gets worse or changes in any way because it may be a sign of a complication.
You may have some residual numbness for a short period if you had a nerve block. Contact your doctor if you have numbness longer than expected.
When should I call my surgeon?
It is important to keep your follow-up and physical therapy appointments after arthroplasty. Contact your surgeon for questions and concerns between appointments. Call your surgeon right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness or tingling in the affected extremity
Pain that is not controlled by your pain medication
Uncontrolled or heavy bleeding
Unexpected drainage, pus, redness or swelling of your incision
How might arthroplasty affect my everyday life?
Arthroplasty can relieve joint pain and allow you to move better and lead a more active life. People who have arthroplasty generally have few limitations or restrictions to everyday activities. In fact, most people enjoy activities they were not able to do before surgery, such as hiking and biking.
You may need to avoid the following activities to avoid damaging your new joint:
- Contact sports
- High impact activities such as running and jumping
- Joint overloading activities such as heavy lifting
- Gaining excessive weight
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