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The Right Angle: Breaking Down Joint Replacement

Wednesday, October 18, 2017 7:55 AM

Alexander Tauchen, MD, Orthopaedics at NorthShore, has one goal for his patients: to help them understand the nature of their problem as well as all of the treatment options available to them.


To help us further understand what is joint replacement and when it is needed, Dr. Tauchen answers some common questions:

What is the difference between joint replacement and total joint replacement? What are they typically used for?

People tend to use these terms interchangeably. A joint can be thought of as an articulation between at least two bones. A total joint replacement would mean that all parts of the joint have been replaced whereas a partial joint replacement – a hemiarthroplasty – would mean that only part of the joint has been replaced. All of these procedures are grouped together as “joint replacement.”

Joint replacements are most commonly used to treat chronic pain and limited function that may result from a number of different conditions, most commonly arthritis. The primary goal of the operation is to improve pain and increase function. Joint replacement can also be used to reconstruct a joint after a fracture. Joint replacement for a fracture is most common in the hip and the shoulder.

What kind of joints can be replaced?

Many different joints in the body can be replaced. Going from head to toe, these include intervertebral joints (joints between two bones in the spine), shoulder, elbow, wrist, metacarpophalangeal (the knuckle), hip, knee, ankle, and the joint at the base of the great toe. While all of these types of joint replacements can be performed, certainly some have a better track record than others. Also, arthritis tends to be more common in some of these joints than others. As a result, the hip, knee, and shoulder tend to be the most common joint replacements that people hear about.

How do I know if I need a joint replaced? What happens during surgery?

The most common reason people have a joint replaced is because of chronic pain that is limiting their quality of life along with x-ray evidence that the joint is worn out. If you try non-operative treatment and continue to have pain, your surgeon may recommend total or partial joint replacement surgery in order to improve your pain and level of function. During surgery, a number of specialized instruments will be used to remove the arthritic or damaged part of the joint and replace it with a prosthesis. Depending on what joint is being addressed, the prosthetic portion may consist of multiple different parts that work together to reconstruct the joint. Some of the materials that may be used to reconstruct the joint include metal (titanium or different alloys), ceramic, and specially prepared plastics. Your surgeon will discuss these details with you prior to surgery.

Is there a particular age range joint replacement is typically used for?

Joint replacement is typically performed in patients over the age of 50 or 55 years old. However, this is by no means a strict rule. There are a number of different conditions that may damage a patient’s joint much earlier than this. If this is the case, joint replacement may be the best treatment option regardless of age. The materials used for joint replacement today last longer than materials that were used 20-30 years ago. Sometimes different materials are selected for younger patients in an attempt to maximize how long the joint will last. Your surgeon can discuss these details with you.

What is it like for patients after they get it? Do they need additional therapies, follow-up appointments, etc.?

The post-operative course varies widely depending on what joint is replaced. For larger joints such as the hip and the knee, patients typically have a short hospital stay prior to being discharged to home or a rehabilitation facility depending on their individual needs. Patients will then have further physical therapy for a number of weeks. This may be done through home therapy early on followed by outpatient therapy. The patient will have follow-up appointments with the surgeon for the first few months and then these become less frequent. Each surgeon has a preferred protocol. By about 3-4 months after surgery, most people are back to their normal daily activities without many significant limitations. It is important to remember that everyone recovers at a different pace. It can take up to a year after knee or hip replacement for a patient to fully recover.

Are there common conditions this is used as treatment for?

The most common reason people have a joint replaced is arthritis. Osteoarthritis, rheumatoid arthritis, and psoriatic arthritis are some examples. Avascular necrosis, or AVN, is another reason people may have a joint replaced – particularly the shoulder or the hip. This is a condition that can be thought of as impaired blood supply to the joint so the bone can actually “collapse.” This can be extremely painful and it can progress quickly. This condition has been associated with heavy alcohol intake and certain medications (steroids, chemotherapy) among others, but often times we do not know the cause.

What innovative things are happening with joint replacement at NorthShore?

NorthShore is at the forefront of joint replacement surgery. With specific regard to hip and knee replacement, surgeons here may elect to use computer-navigated surgery, patient-specific instrumentation based on a CT scan or MRI, or robotic-assisted surgery. The aim of these techniques is to reconstruct the joint as closely as possible to the patient’s native anatomy. The goal is a quick recovery and ultimately a well-functioning joint replacement.