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Joint Replacement: Weighing Individual Goals, Risks and Benefits Key to Success

Kevin MacDonald, MD, Contributing writer | Apr 28, 2017, 6:03 p.m.
Virginia Mason orthopedic surgeon Kevin MacDonald, MD, interacting with a patient

As an orthopedic surgeon, I spend a fair amount of time working with an experienced team performing various types of hip and knee replacement surgery on appropriate patients.

Joint replacement is a surgical procedure where parts of an arthritic or damaged joint are removed and replaced with a metal, plastic or ceramic device called a “prosthesis.” The prosthesis is designed to replicate the movement of a normal, healthy joint.

When to consider surgery

You might be considering joint replacement surgery if a hip or knee has been painful and is restricting movement. Although immediate benefits of surgery include less pain and enhanced mobility, you should first exhaust non-surgical options for management.

I remind all my patients that joint replacement surgery is elective and should come down to a quality-of-life decision. My advice almost always includes recommending that they try non-surgical treatments first – whether that be ice, heat, anti-inflammatory medication, swimming or physical therapy.

However, if nothing works, people should ask themselves if pain and disability are destroying their quality of life. If the answer is yes, I advise them that it’s the appropriate time to discuss surgical options.

Risks

Like every type of surgery, joint replacement is not without risks, which include:

• Infection

• Damage to a blood vessel

or nerve

• Loosening or dislocation of

the new joint over time

• Medical complications, such as heart attacks or blood clots, due to the physical stress of undergoing surgery

Fortunately, these risks can be significantly reduced with good management before and after surgery, which most orthopedic surgery centers are very experienced at providing.

Benefits

Studies have consistently shown that hip and knee replacement are some of the most successful procedures in all of medicine when it comes to patient satisfaction and quality-of-life improvement. Most patients are able to resume activities that arthritis had made difficult, whether that be golfing, biking, caring for family members, or missing fewer work days due to pain.

Types of joint replacement

Thanks to advancements in surgical techniques, prostheses, imaging, post-operative care and rehabilitation, many orthopedic surgeons are able to offer patients in need of joint replacement a variety of surgical options – depending on their individual situation and other factors like overall health, chronic disease and anatomy.

Options often include:

Posterior total hip replacement – This proven hip replacement method has a long-term track record of success. During this one- to two-hour surgery, a three- to six-inch incision is made over the damaged hip to expose deeper tissue. The damaged “ball” or head of the thigh bone (femur) is dislocated and removed. Damaged bone and cartilage in the “socket” are removed and the socket is smoothed and enlarged to receive the metal implant. A highly polished socket liner, which is usually made of polyethylene plastic, is secured inside the socket. The surgeon then creates a narrow, five-inch channel on top of the thigh bone to receive the new implant’s stem and ball. Materials in the new ball-and-socket joint press against one another easily to help restore hip motion.

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