American Medical Association Family Medical Guide - American Medical Association [701]
Surgery
An orthopedic surgeon (a doctor who specializes in surgery on bones) can determine if surgery is necessary to relieve the pain from osteoarthritis and restore movement to a joint. Surgery is recommended only for severe, disabling osteoarthritis for which other treatments have been unsuccessful. (Most people who have osteoarthritis never need to have surgery.) If your doctor recommends surgery, get a second opinion from another doctor. Surgery may be done to prevent the joint from becoming deformed, to correct a deformity, to remove pieces of bone or cartilage from around the joint to allow greater movement, or to replace a damaged joint with an artificial one.
Arthroplasty
Artificial devices are available to replace almost any joint in the body. Arthroplasty, or joint replacement surgery, is most often done to repair hips (see next page) and knees but also is used to repair shoulders, elbows, fingers, ankles, and toes. A successful joint replacement relieves pain and restores most of the joint’s movement.
During joint replacement surgery, the surgeon first removes all the damaged bone from the joint. Artificial joint components made of metal and plastic are then cemented to the healthy bone that remains. The joint components are usually attached to the bone tissue with acrylic cement. For younger people who are more active or for older people who have strong bones, doctors sometimes use artificial joints that do not require cement to stay in place. These artificial joints are designed with spaces into which the person’s own bone can grow, holding the artificial joint in place more naturally. By avoiding the use of cement, which can weaken over time, these types of artificial joints usually stay in place longer than those that are held in place with cement.
Recovery from joint replacement surgery depends on several factors, including a person’s general health and level of activity before the surgery. For this reason, it is not a good idea to put off the surgery for long. The more active you are before your surgery, the faster your recovery is likely to be. Hip replacement and knee replacement surgery require more time for recovery than replacement of smaller joints, such as those in the fingers, wrists, toes, or ankles.
Although complications from joint replacement are rare, the new joint can become infected or slip out of place. For this reason, your doctor will ask you to come in regularly for checkups so he or she can monitor your healing and recovery. To reduce the risk of blood clots, your doctor may prescribe anticlotting medication.
Joint replacement surgery is serious and will cause a short period of disability during recovery. Complete recovery can take from 3 to 6 months. Most people who have a hip or knee replaced will need physical therapy to help regain their mobility. A physical therapist will recommend special exercises to help you build up the muscles around your new artificial joint. Physical therapy starts in the hospital shortly after surgery and continues after you are home.
Hip Replacement
Hip replacement is a surgical procedure in which a damaged hip joint is removed and replaced with an artificial ball-and-socket joint made of metal and plastic. The procedure usually takes about 2 to 3 hours. You will be hospitalized for about a week after the surgery and will start physical therapy in the hospital. You will be encouraged to try to begin walking with support within a day or two after surgery. A physical therapist will teach you how to perform exercises to help strengthen the hip and teach you how to move the joint to avoid injuring your new hip.
At home, maintain a stretching and exercise program to help keep your new joint working properly. Full recovery can take up to 6 months, depending on your overall health, whether you have any complications (such as infection, blood clots,