Orthopedic Services
Joint Replacement At Saint Mary’s
When a hip, knee or shoulder no longer functions properly and other forms of treatment have been exhausted, joint replacement may be the answer. Saint Mary’s provides the region’s leading surgeons, most advanced technologies and state-of-the-art facilities to give you the best results before, during and after surgery.
Joint replacement
Hip replacement
Knee replacement
Shoulder replacement
Joint replacement class at Saint Mary’s
Pre-registration/admission process for surgery
Joint replacement
What is joint replacement surgery?
Joint replacement surgery is removing a damaged joint and putting in a new one. A joint is where two or more bones come together, like the knee, hip and shoulder. The surgery is usually done by an orthopedic surgeon. Sometimes, the surgeon will not remove the whole joint but will only replace or fix the damaged parts.
The doctor may suggest a joint replacement to improve how you live. Replacing a joint can help you relieve pain and move and feel better. Joints that can be replaced include the shoulders, fingers, ankles and elbows. Hips and knees are replaced most often.
What is a new joint like?
A new joint, called a prosthesis, can be made of plastic, metal or both. It may be cemented into place or not cemented, so that your bone will grow into it. Both methods may be combined to keep the new joint in place.
A cemented joint is used more often in older people who do not move around as much and in people with "weak" bones. The cement holds the new joint to the bone. An uncemented joint is often recommended for younger, more active people and those with good bone quality. It may take longer to heal because it takes longer for bone to grow and attach to it.
New joints generally last at least 10 to 15 years. Younger patients may need to have the same damaged joint replaced more than once.
Do many people have joints replaced?
Joint replacement is becoming more common. About 435,000 Americans have a hip or knee replaced each year. Research has shown that even if you are older, joint replacement can help you move around and feel better.
Any surgery has risks. Risks of joint surgery will depend on your health before surgery, how severe your arthritis is and the type of surgery done. More hospitals and doctors have been replacing joints for several decades, and this experience results in better patient outcomes. For answers to their questions, some people talk with their doctors or someone who has had the surgery. A doctor specializing in joints will probably work with you before, during and after surgery to make sure you heal quickly and recover successfully.
Do I need to have my joint replaced?
Only a doctor can tell if you need a joint replaced. He or she will look at your joint with an x-ray machine or other machines. The doctor may put a small, lighted tube (arthroscope) into your joint to look for damage. A small sample of your tissue could also be tested.
After looking at your joint, the doctor may say that you should consider exercise, walking aids like braces or canes, physical therapy or medicines and supplements. Medicines for arthritis include drugs that reduce inflammation. Depending on the type of arthritis, the doctor may prescribe corticosteroids or other drugs. However, all drugs may cause side effects, including bone loss.
If these treatments do not work, the doctor may suggest an operation called an osteotomy where the surgeon "aligns" the joint. Here, the surgeon cuts the bone or bones around the joint to improve alignment. This may be simpler than replacing a joint, but it may take longer to recover. However, it is not commonly done today.
Joint replacement is often the answer if you have constant pain and can't move the joint well; for example, if you have trouble with things like walking, climbing stairs and taking a bath.
What happens during surgery?
First, the surgical team will give you medicine so you won't feel pain (anesthesia). The medicine may block the pain only in one part of the body (regional), or it may put your whole body to sleep (general). The team will then replace the damaged joint with a prosthesis.
Each surgery is different. How long it takes depends on how badly the joint is damaged and how the surgery is done. To replace a knee or a hip takes about 2 hours or less, unless there are complicating factors. After surgery, you will be moved to a recovery room for 1 to 2 hours until you are fully awake or the numbness goes away.
What happens after surgery?
With knee or hip surgery, you may be able to go home in 3-5 days. If you are elderly or have additional handicaps, then you may then need to spend several weeks in an intermediate care facility before going home. How long you stay in the hospital will be determined by you and your team of doctors.
After hip or knee replacement, you will often stand and begin walking sometimes even the day of surgery. At first, you will walk with a walker or crutches. You may have some temporary pain in the new joint because your muscles are weak from not being used. Also, your body is healing. The pain can be helped with medicines and should end in a few weeks or months.
Physical therapy can begin the day after surgery to help strengthen the muscles around the new joint and help you regain motion in the joint. If you have your shoulder joint replaced, you can usually begin exercising the same day of your surgery. A physical therapist will help you with gentle, range-of-motion exercises. Before you leave the hospital (usually two or three days after surgery), your therapist will show you how to use a pulley device to help bend and extend your arm.
Will my surgery be successful?
The success of your surgery depends a lot on what you do when you come home. Follow your doctor's advice about what you eat, what medicines to take and how to exercise. Talk with your doctor about any pain or trouble moving.
Joint replacement is usually a success in more than 90 percent of people who have it. When problems do occur, most are treatable. Possible problems include:
- Infection - Areas in the wound or around the new joint may get infected. It may happen while in the hospital or after you go home. It may even occur years later. Minor infections in the wound are usually treated with drugs. Deep infections may need a second operation to treat the infection or replace the joint.
- Blood Clots - If your blood moves too slowly, it may begin to form lumps of blood parts called clots. If pain and swelling develop in your legs after hip or knee surgery, blood clots may be the cause. The doctor may suggest drugs to make your blood thin, or special stockings, exercises and/or boots to help your blood move faster. If swelling, redness or pain occurs in your leg after you leave the hospital, contact your doctor right away.
- Loosening - The new joint may loosen, causing pain. If the loosening is bad, you may need another operation. New ways to attach the joint to the bone should help.
- Dislocation - Sometimes after hip or other joint replacement, the ball of the prosthesis can come out of its socket. In most cases, the hip can be corrected without surgery. A brace may be worn for a while if a dislocation occurs.
- Wear - Some wear can be found in all joint replacements. Too much wear may help cause loosening. The doctor may need to operate again if the prosthesis comes loose. Sometimes, the plastic can wear thin and the doctor may just replace the plastic and not the whole joint.
- Nerve and Blood Vessel Injury - Nerves near the replaced joint may be damaged during surgery, but this does not happen often. Over time, the damage often improves and may disappear. Blood vessels may also be injured.
As you move your new joint and let your muscles grow strong again, pain will lessen, flexibility will increase and movement will improve.
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Hip replacement
Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint and relieving pain.
Who should have hip replacement surgery?
People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.
In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.
Today, a person's overall health and activity level are more important than age in predicting a hip replacement's success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson's disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.
Why do people have hip replacement surgery?
For the majority of people who have hip replacement surgery, the procedure results in:
- A decrease in pain
- Increased mobility
- Improvements in activities of daily living
- Improved quality of life.
What are alternatives to hip replacement?
Before considering a total hip replacement, the doctor may try other methods of treatment, such as exercise, walking aids and medication. An exercise program can strengthen the muscles around the hip joint. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged hips and help you to avoid or delay surgery.
For hip pain withoutinflammation, doctors usually recommend the analgesic medication acetminophen.
For hip pain withinflammation, treatment usually consists of nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen. If you need to take NSAIDs on a long-term basis or at doses that are higher than those obtainable over the counter, you should do so only under a doctor's supervision. When neither NSAIDs nor analgesics are sufficient to relieve pain, doctors sometimes recommend combining the two. Again, this should be done only under a doctor's supervision.
In some cases, a stronger analgesic medication such as tramadol or a product containing both acetaminophen and a narcotic analgesic such as codeine may be necessary to control pain.
Topical analgesic products such as capsaicin and methylsalicylate may provide additional relief. Some people find that the nutritional supplement combination of glucosamine and chondroitin helps ease pain. People taking nutritional supplements, herbs and other complementary and alternative medicines should inform their doctors to avoid harmful drug interactions.
In a small number of cases, doctors may prescribe corticosteroid medications, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. The downside of corticosteroids is that they can cause further damage to the bones in the joint. Also, they carry the risk of side effects such as increased appetite, weight gain and lower resistance to infections. A doctor must prescribe and monitor corticosteroid treatment. Because corticosteroids alter the body's natural hormone production, which is essential for the body to function, you should not stop taking them suddenly, and you should follow the doctor's instructions for discontinuing treatment.
Sometimes, corticosteroids are injected into the hip joint. A joint lubricant such as Hyaluronan may also be injected into the hip joint to relieve pain.
If exercise and medication do not relieve pain and improve joint function, the doctor may suggest a less complex corrective surgery before proceeding to hip replacement. One common alternative to hip replacement is an osteotomy. This procedure involves cutting and realigning bone, to shift the weight from a damaged and painful bone surface to a healthier one. Recovery from an osteotomy takes 6 to 12 months. Afterward, the function of the hip joint may continue to worsen and additional treatment may be needed. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.
What does hip replacement surgery involve?
The hip joint is located where the upper end of the femur, or thigh bone, meets the pelvis, or hip bone. A ball at the end of the femur, called the femoral head, fits in a socket (the acetabulum) in the pelvis to allow a wide range of motion.
During a traditional hip replacement, which lasts from 1 to 2 hours, the surgeon makes a 6- to 8-inch incision over the side of the hip through the muscles and removes the diseased bone tissue and cartilage from the hip joint, while leaving the healthy parts of the joint intact. Then, the surgeon replaces the head of the femur and acetabulum with new, artificial parts. The new hip is made of materials that allow a natural gliding motion of the joint.
In recent years, some surgeons have begun performing what is called a minimally invasive, or mini-incision, hip replacement, which requires smaller incisions and a shorter recovery time than traditional hip replacement. Candidates for this type of surgery are usually age 50 or younger, of normal weight based on body mass index and healthier than candidates for traditional surgery. Joint resurfacing is also being used.
Regardless of whether you have traditional or minimally invasive surgery, the parts used to replace the joint are the same and come in two general varieties: cemented and uncemented.
Cemented parts are fastened to existing, healthy bone with a special glue or cement. Hip replacement using these parts is referred to as a "cemented" procedure. Uncemented parts rely on a process called biologic fixation, which holds them in place. This means that the parts are made with a porous surface that allows your own bone to grow into the pores and hold the new parts in place. Sometimes a doctor will use a cemented femur part and uncemented acetabular part. This combination is referred to as a hybrid replacement.
Is a cemented or uncemented prosthesis better?
The answer to this question is different for different people. Because each person's condition is unique, the doctor and you must weigh the advantages and disadvantages.
Cemented replacements are more frequently used for older, less active people and people with weak bones, such as those who have osteoporosis, while uncemented replacements are more frequently used for younger, more active people.
Studies show that cemented and uncemented prostheses have comparable rates of success. Studies also indicate that if you need an additional hip replacement, or revision, the rates of success for cemented and uncemented prostheses are comparable. However, more long-term data are available in the United States for hip replacements with cemented prostheses, because doctors have been using them here since the late 1960s, whereas uncemented prostheses were not introduced until the late 1970s.
The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, a person with uncemented replacements must limit activities for up to 3 months to protect the hip joint. Also, it is more common for someone with an uncemented prosthesis to experience thigh pain in the months following the surgery, while the bone is growing into the prosthesis.
How to prepare for surgery and recovery
People can do many things before and after they have surgery to make everyday tasks easier and help speed their recovery.
Before surgery
- Learn what to expect. Request information written for patients from the doctor, or contact one of the organizations listed near the end of this booklet.
- Arrange for someone to help you around the house for a week or two after coming home from the hospital.
- Arrange for transportation to and from the hospital.
- Set up a "recovery station" at home. Place the television remote control, radio, telephone, medicine, tissues, wastebasket and pitcher and glass next to the spot where you will spend the most time while you recover.
- Place items you use every day at arm level to avoid reaching up or bending down.
- Stock up on kitchen supplies and prepare food in advance, such as frozen casseroles or soups that can be reheated and served easily.
After surgery
- Follow the doctor's instructions.
- Work with a physical therapist or other health care professional to rehabilitate your hip.
- Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
- Use a long-handled "reacher" to turn on lights or grab things that are beyond arm's length. Hospital personnel may provide one of these or suggest where to buy one.
What can be expected immediately after surgery?
You will be allowed only limited movement immediately after hip replacement surgery. When you are in bed, pillows or a special device are usually used to brace the hip in the correct position. You may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid, and a type of tube called a catheter may be used to drain urine until you are able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.
On the day after surgery or sometimes on the day of surgery, therapists will teach you exercises to improve recovery. A respiratory therapist may ask you to breathe deeply, cough or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.
As early as 1 to 2 days after surgery, you may be able to sit on the edge of the bed, stand and even walk with assistance.
While you are still in the hospital, a physical therapist may teach you exercises such as contracting and relaxing certain muscles, which can strengthen the hip. Because the new, artificial hip has a more limited range of movement than a natural, healthy hip, the physical therapist also will teach you the proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to your new hip.
How long are recovery and rehabilitation?
Usually, people do not spend more than 3 to 5 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, your overall health and the success of your rehabilitation.
What are possible complications of hip replacement surgery?
According to the American Academy of Orthopaedic Surgeons, more than 193,000 total hip replacements are performed each year in the United States and more than 90 percent of these do not require revision.
New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.
The most common problem that may arise soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest.
The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation. Less common complications of hip replacement surgery include infection, blood clots and heterotopic bone formation (bone growth beyond the normal edges of bone). Studies are also looking at the use of bisphosphonates, ciprofloxacin, pentoxifylline and other medications to prevent this bone resorption around the implants.
When is revision surgery necessary?
Hip replacement is one of the most successful orthopaedic surgeries performed. Studies have shown that more than 90 percent of people who have hip replacement surgery will never need to replace an artificial joint. However, because more people are having hip replacements at a younger age, and wearing away of the joint surface becomes a problem after 15 to 20 years, replacement of an artificial joint, which is also known as revision surgery, is becoming more common. It is more difficult than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.
Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x rays of the hip show damage to the bone around the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts and infection.
What types of exercise are most suitable for someone with a total hip replacement?
Proper exercise can reduce stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most of these programs begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when you can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as basketball, jogging and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are walking, stationary bicycling, swimming and cross-country skiing. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.
http://www.nlm.nih.gov/medlineplus/ency/presentations/100006_1.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100006_2.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100006_3.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100006_4.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100006_5.htm
Source: The U.S. National Library of Medicine and the National Institutes of Health
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Knee replacement
Saint Mary’s was the first and still is the only in West Michigan to perform computer-assisted surgery for knee replacement.
Advances in total knee replacement technology in the past 10 to 15 years have enhanced the design and fit of knee implants. The new joint, called a prosthesis, can be made of plastic, metal or both. It may be cemented into place or uncemented. An uncemented prosthesis is designed so that bones will grow into it.
Total knee replacement is often the answer for people when x rays and other tests show joint damage; when moderate-to-severe, persistent pain does not improve adequately with nonsurgical treatment; and when the limited range of motion in their knee joint diminishes their quality of life.
In the past, patients between 60 and 75 years of age were considered to be the best candidates for total knee replacement. Over the past two decades, however, the age range has been broadened to include more patients older than 75, who are likely to have other health issues, and patients younger than 60, who are generally more physically active and whose implants will probably be exposed to greater mechanical stress.
About 90 percent of patients appear to experience rapid and substantial reduction in pain, feel better in general and enjoy improved joint function. While most total knee replacement surgeries are successful, failure does occur and revision is sometimes necessary. Risk factors include being younger than 55 years old; being male; being obese; and having osteoarthritis or other illnesses.
Carticel – an alternative to knee replacement
One of the most difficult surgical challenges facing orthopedists has been trying to treat patients who have lost portions of cartilage in their knees but are too young or too active for a total knee replacement. The Carticel procedure offered at Saint Mary’s provides a safe means of culturing and multiplying the patient's own cartilage cells that are then re-implanted in the patient.
http://www.nlm.nih.gov/medlineplus/ency/presentations/100088_1.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100088_2.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100088_3.htm
http://www.nlm.nih.gov/medlineplus/ency/presentations/100088_4.htm
Source: The U.S. National Library of Medicine and the National Institutes of Health
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Shoulder replacement
Saint Mary’s was the first in West Michigan to perform reverse total shoulder replacement surgery for rotator cuff tears and failed shoulder replacements.
When nonoperative treatment of arthritis of the shoulder fails to relieve pain or improve function, or when there is severe wear and tear of the joint causing parts to loosen and move out of place, shoulder joint replacement (arthroplasty) may provide better results. In this operation, a surgeon replaces the shoulder joint with an artificial ball for the top of the humerus and a cap (glenoid) for the scapula. Passive shoulder exercises (where someone else moves the arm to rotate the shoulder joint) are started soon after surgery. Patients begin exercising on their own about 3 to 6 weeks after surgery. Eventually, stretching and strengthening exercises become a major part of the rehabilitation program. The success of the operation often depends on the condition of rotator cuff muscles prior to surgery and the degree to which the patient follows the exercise program.
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Joint replacement class at Saint Mary’s
Saint Mary’s Orthopedic Services offers a Joint Replacement Class before surgery to familiarize you with what will happen before, during and after your procedure. Patient education materials and DVDs are also available to inform you, to allay your fears and to give you a look ahead at a healthy, active life post-surgery.
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Source: National Institutes for Health
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