Joint replacement surgery

For many people with arthritis, joint surgery becomes inevitable. The joint has become increasingly damaged, the pain very severe, mobility decreased and the ability to maintain a normal lifestyle severely curtailed. The decision will require considerable thought, investigation and assessment.

It may have followed other procedures such as a biopsy or arthroscopy to allow the surgeon to look inside your joint through a small incision with a special instrument called an arthroscope. Other surgery may have been required to repair tendons, relieve pressure on the nerves or remove swollen lining of the joints - called a synovectomy.

Modern surgery allows the repair of many joints in our body and complete or partial joint replacements can be undertaken on shoulders, elbows, wrists, ankles, fingers and toes. The most common and successful joint replacements are for the hips and knees.

What are the benefits of joint replacement?

The main benefit to the patient after joint replacement is pain relief, which is often quite dramatic. Most patients will have some soreness in the replaced joint after the replacement, but this is due to the surgery and because the muscles around the joint are weak from inactivity.

The soreness may last for several weeks or months. Muscle power, lost through inactivity, usually returns with exercise when the pain subsides.

Motion of the joint will generally improve. The extent of the improvement will depend on how stiff the joint was before the operation. An extremely stiff joint will continue to be stiff for some time.

What are the risks of joint replacement?

There are risks associated with any surgical procedure, and you should discuss these with your doctor when surgery is being considered. Make sure your surgeon is aware of any additional medical conditions you have that may complicate the procedure. Similarly, discuss with the anaesthetist the type of anaesthetic and possible risks involved.

The major potential complication of the surgery is infection. It may occur just in the region of the wound, or deep around the prosthesis. It may occur while in hospital or after you go home, even years later. It could spread from another part of the body. It must be treated promptly with antibiotics.

Other complications which may occur include the loosening of the prosthesis ( if this is significant, another replacement joint may be required ), dislocation (usually able to be relocated manually ), wear, breakage, or impaired nerve function.

Preparing for your operation

There are some important things you need to think about before your surgery.

Are you planning some form of travel after the operation?

• You will be unable to drive a car for approximately 6 weeks after the operation.
• Long journeys should be avoided for at least 6 weeks. If you need to travel, it is recommended that you make stops regularly and take a short break.

Are you going to need help at home after discharge from hospital?

• All going well, you can expect to be discharged within a week of your surgery. You will appreciate assistance, and may consider staying with someone, or having some one to assist you at home.
• Discuss with the nursing staff or occupational therapist your needs when returning home. They will be able to give advice on other assistance such as home-help, aids in the home (trolleys, pick-up sticks etc), and community services that are available. You can also expect to use crutches for approximately 6 weeks after the operation.

What recreational activities do you enjoy?

• You will be restricted from some recreational activities for about 3 months after the operation - eg. bowls, golf, gardening.
• It is important to stay as active as possible before your operation. Though this may be difficult, it will help you to recover more quicklyr after the surgery.

Surgery for people with arthritis can offer less pain and greater enjoyment of life as mobility returns. It is always traumatic, but greater understanding of what is involved and what to expect, can relieve anxiety.

Always ask your doctor and health professionals as many questions as necessary in order to understand the procedure and rehabilitation procedures. This will ensure that your surgery is effected with much less stress and discomfort.

Original material provided by Arthritis New Zealand. Edited by everybody, July 2005.