Replacement of the Hip, Knee and Shoulder
Total joint replacement relieves pain by replacing an arthitic or damaged joint with an artificial one called a prosthesis. The prosthesis is generally composed of a metal piece that fits closely into a matching sturdy plastic piece. A plastic bone cement may be used to anchor the prosthesis into the bone or it may be implanted without cement when the prosthesis and the bone are designed to fit and lock together directly.
The Comprehensive Joint Care Program at California Pacific Medical Center is the Bay Area leader in joint replacement with 1,149 procedures performed in 2007.
When to Replace a Joint
A joint is formed by the ends of two or more bones, which are connected by thick tissues. The bone ends are covered with a smooth layer called cartilage. Normal cartilage allows nearly frictionless and pain-free joint movement.
The process whereby cartilage becomes damaged or diseased is known as arthritis. The affected joint resultantly becomes stiff, swollen and painful. Joint pain may also be caused by trauma, such as a serious fracture or an injury that doesn't heal properly. The pain may be so severe a person will avoid using the joint, weakening the muscles around it and making movement even more difficult. When other treatment options such as medication, physical therapy and lifestyle adjustments do not relieve joint pain and disability, total joint replacement may be considered.
Joint replacement surgery can provide remarkable relief of pain from arthritic joints. In doing so, many patients are able to return to fully active lives. Surgical techniques and implants have improved dramatically in recent years, providing for faster recovery and functional return.
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Total Hip Replacement
Common conditions treated with hip replacement are osteoarthritis, rheumatoid arthritis, arthritis from a previous injury or fracture, arthritis from hip dysplasia and avascular necrosis of the hip.
A total hip replacement is indicated for people who have unrelenting pain from arthritis that has not been adequately controlled by medications or activity modifications. Although near complete relief of pain and improved function can be achieved, these are man-made devices and as such will wear out in time. Thus, younger, very active patients must be aware that future surgery may be necessary and that certain higher impact type activities should be avoided. This generally applies for all joint replacements.
Hip implants are of two basic designs: those fixed to bone by cement and those fixed to bone via bone ingrowth into the prosthesis itself. Both can achieve excellent results. In general, younger, more active patients will receive bone ingrowth type implants. This form of fixation is living and more dynamic, but does not rely on healthy bone to actively attach the prosthesis. Older patients with thinner bone will do better with cement fixation. Generally, the cup side of the hip replacement is fixed without cement in both age groups. Your doctor will recommend the type of fixation appropriate for you.
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about preparing for hip replacement surgery.
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Total Knee Replacement
Patients who have disabling pain in the knee as a result of arthritic involvement are, as a rule, candidates for replacement of the knee joint. Many measures are generally tried before deciding to perform the knee replacement. The use of exercises, anti-inflammatory medication and injections into the knee may be tried prior to surgery. In the patient who has advanced arthritic changes in the knee, function becomes impaired. Pain will be felt when walking and many times while at rest. Deformity of the knee and painful swelling of the joint also frequently occur, and the patient may notice that the knee is becoming bowed or knock-kneed. Stiffness of the knee as well as swelling often develop in patients with arthritic knees.
Just as a dentist removes the decayed area of a tooth, so also are the arthritic ends of a knee joint removed. In essence, the surfaces of the thigh bone (femur), leg bone (tibia) and kneecap (patella) are "resurfaced" with metal and plastic. These components are fit precisely to the ends of these bones and often cemented into place. The prosthesis will then be moved by the muscles and ligaments that normally move the knee. It will be lubricated by the same synovial fluid that lubricates the normal joint.
The materials used in these prostheses have over a 30-year track record for implantation in humans. Most studies suggest that between 92-94% of total knee replacements implanted are still doing well 20 years after their initial implantation.
Read
about preparing for knee replacement surgery.
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Total Shoulder Replacement
Shoulder replacement can be done for people who have a variety of shoulder problems. Most commonly, it is done for those who suffer from severe arthritis, a condition where cartilage in the shoulder has worn away. However, it can also be done for those who have destruction of the joint from other causes or pain and dysfunction from a rotator cuff teach which cannot be repaired. While most patients seeking a shoulder replacement are over 50 years old, shoulders in any skeletally mature adult can be candidates.
Shoulder replacement surgery replaces damaged surfaces with prostheses. Typically, prostheses have two components: the upper arm bone (humeral component), which is made of metal, and the socket (glenoid component), which is made of polyethylene. Most shoulder replacements are secured with bone cement or screw fixation.
Determining the type of replacement a patient needs depends on whether both sides of the joint are arthritic and whether there are adequate muscles to control the arm after surgery. If both sides of the joint are affected, replacing both sides gives the best pain relief and function. A newly approved prosthesis for patients suffering from arthritis secondary to loss of their rotator cuff is also now available. The shoulder surgeons at California Pacific Medical Center have extensive experience in the use of this revolutionary device.
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What Happens After Surgery?
Typically, a short hospital stay is required following total joint replacement. As part of the continuum of care provided at California Pacific Medical Center, patients of the Comprehensive Joint Care Program begin working with physical and occupational therapists shortly after their procedures.
Therapists design specific exercise programs that patients can perform independently to accelerate the recovery process. The muscle groups supporting the replaced joint are treated to achieve optimal strength and balance to the joint and limb, as well as restoring optimum joint motion. Treatment includes muscle balance and precautionary education along with pain management. Occupational therapists assist patients in resuming daily self-care tasks.
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Contact Us
For more information about the Comprehensive Joint Care Program and to find a physician, please call us at 888-637-2762.
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