Joint replacement surgery removes damaged or diseased portions of a joint and replaces them with new, man-made parts. Replacing a joint can reduce pain and help you move and feel better. Hips and knees are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles, and elbows. Arthroplasty, also called joint replacement, is surgery to replace a damaged joint with an artificial joint (made of metal, ceramic or plastic). Providers usually replace the entire joint (total joint replacement). Less often, they replace only the damaged part of the joint. Hips, knees and shoulders are the most common joints they replace.

Who needs arthroplasty (joint replacement)?

Your surgeon may recommend arthroplasty if you have:

• Joint pain that hasn’t gotten better with nonsurgical treatments such as physical therapy (PT), medications, bracing, injections, walking assistive devices and rest.
• Joint stiffness and limited mobility that make it difficult or impossible for you to do your everyday activities.
• Swelling (inflammation) that doesn’t improve with medications or lifestyle changes.

These symptoms can result from several conditions, including:

• Arthritis, specifically osteoarthritis.
• Rheumatoid arthritis.
• Fractures, including a hip fracture.
• Joint abnormalities, such as hip dysplasia.
• Avascular necrosis (lack of blood supply to the bone).

These symptoms can result from several conditions, including:

• Arthritis, specifically osteoarthritis.
• Rheumatoid arthritis.
• Fractures, including a hip fracture.
• Joint abnormalities, such as hip dysplasia.
• Avascular necrosis (lack of blood supply to the bone).

What joints do orthopedic surgeons replace?

Most often, surgeons replace the hip joint, knee joint or shoulder joint. Providers call these procedures hip arthroplasty, total knee arthroplasty and shoulder arthroplasty.

Currently, surgeons can replace all of the following joints:

• Ankles.
• Elbows.
• Hips.
• Knees.
• Shoulders.
• Toes.
• Wrists.

What are the advantages of arthroplasty (joint replacement)?

Joint replacement procedures can help you move without pain and stiffness. After a joint replacement, many people can take part in activities they once enjoyed. These surgeries greatly improve quality of life and overall health by allowing people to have an active lifestyle.

Total Knee Replacement

If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities, such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.

If nonsurgical treatments like medications and using walking supports are no longer helpful, you may want to consider total knee replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume normal activities.

Cause

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and posttraumatic arthritis.

• Osteoarthritis. This is an age-related wear and tear type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.

Osteoarthritis often results in bone rubbing on bone. Bone spurs are a common feature of this form of arthritis.

• Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed "inflammatory arthritis."
• Posttraumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

When Surgery Is Recommended

There are several reasons why your doctor may recommend knee replacement surgery. People who benefit from total knee replacement often have: 

• Severe knee pain or stiffness that limits everyday activities, including walking, climbing stairs, and getting in and out of chairs.  It may be hard to walk more than a few blocks without significant pain and it may be necessary to use a cane or walker
• Moderate or severe knee pain while resting, either day or night Chronic knee inflammation and swelling that does not improve with rest or medications
• Knee deformity — a bowing in or out of the knee
• Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, lubricating injections, physical therapy, or other surgeries

Hip Replacement

Common Causes of Hip Pain

The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

• Osteoarthritis. This is an age-related wear and tear type of arthritis. It usually occurs in people 50 years of age and older and often in individuals with a family history of arthritis. The cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness. Osteoarthritis may also be caused or accelerated by subtle irregularities in how the hip developed in childhood.
• Rheumatoid arthritis. This is an autoimmune disease in which the synovial membrane becomes inflamed and thickened. This chronic inflammation can damage the cartilage, leading to pain and stiffness. Rheumatoid arthritis is the most common type of a group of disorders termed inflammatory arthritis.
• Posttraumatic arthritis. This can follow a serious hip injury or fracture. The cartilage may become damaged and lead to hip pain and stiffness over time.
• Osteonecrosis. An injury to the hip, such as a dislocation or fracture, may limit the blood supply to the femoral head. This is called osteonecrosis (also sometimes referred to as avascular necrosis). The lack of blood may cause the surface of the bone to collapse, and arthritis will result. Some diseases can also cause osteonecrosis.
• Childhood hip disease. Some infants and children have hip problems. Even though the problems are successfully treated during childhood, they may still cause arthritis later in life. This happens because the hip may not grow normally, and the joint surfaces are affected.

Is Hip Replacement Surgery for You?

The decision to have hip replacement surgery should be a cooperative one made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation. 

When Surgery Is Recommended

There are several reasons why your doctor may recommend hip replacement surgery. People who benefit from hip replacement surgery often have:

• Hip pain that limits everyday activities, such as walking or bending
• Hip pain that continues while resting, either day or night
• Stiffness in a hip that limits the ability to move or lift the leg
• Inadequate pain relief from anti-inflammatory drugs, physical therapy, or walking supports

Candidates for Surgery

There are no absolute age or weight restrictions for total hip replacements.

Recommendations for surgery are based on a patient's pain and disability, not age. Most patients who undergo total hip replacement are age 50 to 80, but orthopaedic surgeons evaluate patients individually. Total hip replacements have been performed successfully at all ages, from the young teenager with juvenile arthritis to the elderly patient with degenerative arthritis.

Deciding to Have Hip Replacement Surgery

Talk With Your Doctor Your orthopaedic surgeon will review the results of your evaluation with you and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility. Other treatment options — such as medications, physical therapy, or other types of surgery — also may be considered.

In addition, your orthopaedic surgeon will explain the potential risks and complications of hip replacement surgery, including those related to the surgery itself and those that can occur over time after your surgery.

Never hesitate to ask your doctor questions when you do not understand. The more you know, the better you will be able to manage the changes that hip replacement surgery will make in your life.

Realistic Expectations

An important factor in deciding whether to have hip replacement surgery is understanding what the procedure can and cannot do. Most people who undergo hip replacement surgery experience a dramatic reduction of hip pain and a significant improvement in their ability to perform the common activities of daily living.

With normal use and activity, the material between the head and the socket of every hip replacement implant begins to wear. Excessive activity or being overweight may speed up this normal wear and cause the hip replacement to loosen and become painful. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports.

Realistic activities following total hip replacement include unlimited walking, swimming, golf, driving, hiking, biking, dancing, and other low- impact sports.

With appropriate activity modification, hip replacements can last for many years.