Arthroplasty (Joint Replacement)

What is arthroplasty?

Arthroplasty is a surgical procedure to replace some or all of a joint. Healthcare providers also call it joint replacement surgery or joint replacement.

A surgeon will remove the worn-out or damaged parts of your natural joint and replace them with an artificial joint (a prosthesis) made of metal, plastic or ceramic.

Types of arthroplasties

Any large joint can be replaced with an arthroplasty, including your:

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

Your surgeon will suggest either a total or a partial joint replacement:

• Total joint replacement (total arthroplasty): During a total joint replacement, your surgeon will replace all the parts of your joint with a prosthetic joint.
• Partial joint replacement (partial arthroplasty): A partial joint replacement is just what it sounds like. Your surgeon will replace only some parts of your joint. Some healthcare providers sometimes refer to this as joint resurfacing.

What does arthroplasty help treat?

A healthcare provider might recommend joint replacement surgery if you have severe symptoms that don’t get better after trying nonsurgical treatments like activity modifications, physical therapy or medications. Symptoms that can cause you to need an arthroplasty can include:

• Joint pain.
• Stiffness or decreased range of motion (how far you can move a joint).
• Limited mobility (difficulty physically moving because of your affected joint).
• Swelling.
• Instability.

Arthritis is the most common reason people need an arthroplasty. Most people who choose to have a joint replacement have osteoarthritis, but some people with rheumatoid arthritis may need one, too.

A healthcare provider might suggest an arthroplasty if you’ve experienced a bone fracture (broken bone) in your joint or if you have post-traumatic arthritis. Trauma that causes fractures or post-traumatic arthritis can include:

• Falls or other serious injuries.
• Car accidents.
• Sports injuries.

How common is joint replacement surgery?

Arthroplasties are some of the most common surgeries. Surgeons perform more than 850,000 knee replacements and more than 450,000 hip replacements every year in the U.S.

How should I prepare for an arthroplasty?

Your healthcare provider or surgeon will help you get ready for surgery. You might need:

• A physical exam to make sure you’re healthy enough for surgery.
• Blood tests.
• An electrocardiogram (EKG) to check your heart health.
• A dental exam to reduce your risk of developing an infection after surgery.
• Imaging tests, including X-rays. You might also need magnetic resonance imaging (MRI) or a computed tomography (CT) scan.

Tell your provider and surgeon about any medications and over-the-counter (OTC) supplements you take. You may have to stop taking them before your surgery.

Your surgeon will tell you when you should stop eating and drinking the day before your surgery. Most people need to avoid eating and drinking for eight hours before their surgery. Your surgeon will tell you which medications are safe to take with a sip of water the morning of your surgery.

What happens during an arthroplasty?

The day of your surgery you’ll receive anesthesia to numb your body and make sure you don’t feel any pain. An anesthesiologist will give you either general anesthesia to put you to sleep during your surgery or regional anesthesia to numb the area around your joint that needs replacing. They may give you other medications to make you sleep if you need regional anesthesia.

During a joint replacement, your surgeon will:

• Remove damaged cartilage and bone.
• Insert the prosthetic joint.
• Insert other prosthetic parts to recreate your natural tissue. They might use spacers to mimic natural cartilage, for example.
• Reshape the bones around your joint to fit the new prosthetic (if they need to).

Robotic-assisted joint replacement

Some types of arthroplasties can be done as robotic-assisted joint replacements. This doesn’t mean a robotic surgeon does the procedure automatically — it’s a special technique to help your surgeon. During a robotic-assisted arthroplasty, your surgeon will use a special computer that guides their surgical tools during the operation. Studies have found that robotic-assisted joint replacements can be more accurate and insert prosthetic implants more securely.

It’s most common for surgeons to use robotic assistance to replace bigger joints like hips and knees.

How long does an arthroplasty take?

Arthroplasties usually take a few hours from start to finish. It depends on which of your joints needs a replacement, and if you’re getting a total or partial joint replacement.

What happens after an arthroplasty?

After surgery, you’ll be moved to a recovery room. Your surgery team will keep an eye on you for a few hours to make sure you wake up from the anesthesia without complications. They’ll also monitor your vital signs and pain level.

Some people who have joint replacement surgery go home the same day. You might need to stay in the hospital overnight or for a few days. Your surgeon will tell you when it’s safe for you to go home.

What are the pros and cons of joint replacement?

For most people, the benefits of a joint replacement far outweigh the risks. An arthroplasty is a major surgery, and that means there’s always a chance you experience complications. However, many people who have a joint replacement experience a big, noticeable improvement in their daily routines — especially if they’ve been living in pain for a long time.

Certain health conditions can make recovery from an arthroplasty more difficult. Talk to your surgeon about your health history. Tell them if you have:

• Hemophilia.
• Diabetes.
• Other autoimmune diseases (like lupus).

Talk to your healthcare provider or surgeon about the risks of a joint replacement. They’ll help you decide if arthroplasty is right for you.

Benefits of arthroplasty

Arthroplasty is a safe, effective procedure that helps people regain their mobility and relieves long-term pain. Most people who have a joint replacement have an increased quality of life because they can move better with less pain.

Arthroplasty complications

Some people who have joint replacement surgery still experience pain and other symptoms in their affected joint. Rare complications include:

• Blood clots.
• Infection inside your joint or at your surgery site.
• Nerve damage (including foot drop).
• Blood vessel damage.
• Problems with the prosthetic implant, including the device wearing down too soon or loosening.
• Scar tissue inside your joint.
• Reduced range of motion and stiffness.

Your surgeon will tell you what you can expect after your surgery and how you can reduce your chances of experiencing complications.

It’s important to follow your surgeon’s and physical therapist’s recovery instructions and to avoid limping after your surgery. Moving unusually or unnaturally can cause tendinitis or bursitis.

How long does a joint replacement last?

A joint replacement usually lasts a long time. Many people who have a joint replacement live with it for the rest of their lives.

It’s rare, but some people need additional surgeries on that same joint in the future. Your surgeon will tell you what to expect.

What is the recovery time after an arthroplasty?

It depends on which joint was replaced. It usually takes at least a few months to recover after an arthroplasty. Everyone’s body responds differently to joint replacement surgery.

Your recovery time will depend on several factors, including:

• Which joint was replaced.
• If you had a total or partial arthroplasty.
• Your activity level before surgery.
• Your age.
• Other health conditions you have.

Your surgeon will give you a customized recovery plan, but in general, you should:

• Ice your joint: Icing your joint a few times a day for 20 minutes at a time will help relieve pain and swelling.
• Elevate your joint: Keep your joint above the level of your heart as often as possible. You can prop it up on cushions or pillows while lying down.
• Keep your incision clean and covered: Follow your surgeon’s incision care instructions carefully to prevent infections. Ask your surgeon when you should change the dressing on your incision site and when it’s safe to take a shower or bathe.
• Home exercises: Your surgeon will give you exercises to do as soon as possible after your surgery. They’ll show you how to perform movements and exercises to strengthen the muscles around your joint and prevent stiffness. Do your exercises as often as your surgeon instructs. They’ll help your recovery and make sure your joint regains its function.
• Physical therapy: You’ll work with a physical therapist for up to a few months after your surgery. They’ll help you start moving safely. People who have knee replacements should start moving their joint as soon as possible after surgery. Your surgeon will give you instructions about how to move your joint safely before you go home after your arthroplasty.
• Avoid movements that may cause dislocations: All newly replaced joints have a temporarily increased dislocation risk (especially hips and shoulders). You may need to avoid certain body positions or movements that can cause dislocations for up to six months after your arthroplasty. Your surgeon or physical therapist will tell you what’s safe and which movements to avoid while you recover.

Pain management after arthroplasty

After surgery, you’ll feel pain, especially in the first few weeks of your recovery. You’ll feel pain from the surgery itself and pain as your body begins to heal.

Your surgeon will suggest a combination of prescription pain medication, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) — if it’s safe for you to take them — and acetaminophen to relieve your pain. Your surgeon will tell you how much of each kind of medication you can take each day or in a certain amount of time.

Talk to your surgeon if you feel like you’re experiencing too much pain or if you’re worried about any complications from taking pain medication.

What can I do to help my recovery at home?

Ask your surgeon or physical therapist for tips to move through your home safely after your surgery. They can show you how to safely:

• Walk and move.
• Sit down and stand up.
• Go to the bathroom.
• Bathe or shower.
• Get dressed.
• Use stairs.

When can I go back to work or school after an arthroplasty?

How long you’ll need to miss work or school depends on how much stress your job or other activities put on your affected joint. Most people need to rest at home for a few weeks. Your surgeon will tell you when it’s safe to return to work or school.

When should I call my healthcare provider?

Call your surgeon or healthcare provider right away if you experience any of the following symptoms:

• Chest pain.
• Shortness of breath (dyspnea).
• Fever higher than 101 degrees Fahrenheit (39 degrees Celsius).
• Bleeding.
• Signs of infection at your surgery site, including leaking, swelling, discoloration, odor or a feeling of warmth.
• New or worsening pain in your calf, ankle or foot.
• Severe pain that doesn’t get better after you take pain medication.