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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 an arthroscope (a small, lighted tube), which they will put into your joint to look for damage. A small sample of your tissue may also be tested.

After looking at your joint, the doctor may suggest exercise, walking aids such as braces or canes, physical therapy, or medicines and vitamin supplements. Medicines for arthritis include drugs that reduce inflammation or, 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 then suggest an operation called an osteotomy (pronounced aas-tee-AAHT-oh-me), 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, this operation 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 such as walking, climbing stairs, and taking a bath.

Knowing what to expect if you are going in for surgery can help make the process less intimidating. First, the surgical team will provide you anesthesia so you won’t feel pain. 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, 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.

With knee or hip surgery, you may be able to go home in 3 to 5 days. If you are elderly or have additional disabilities, you may then need to spend several weeks in an intermediate-care facility before going home. You and your team of doctors will determine how long you stay in the hospital.

After hip or knee replacement, you will often stand or begin walking 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 2 or 3 days after surgery), your therapist will show you how to use a pulley device to help bend and extend your arm.

The success of your surgery depends a lot on what you do when you go 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 you’re still 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, 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 cause loosening. The doctor may need to operate again if this occurs. 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.