Joint Replacement 101: An Introduction to Total Joint Replacement for Patients and Their Families.

In this article, we will cover the basics of total joint replacement as I would explain them to a patient in the office or attendees at a community lecture. Let’s start with some questions.

What is arthritis?

What causes arthritis?

How do you diagnose arthritis? How do you treat arthritis?

When, why, and how do we perform surgery for arthritis?

What is arthritis?

Arthritis simply refers to joint pain. There are three main kinds: osteoarthritis, inflammatory arthritis, and post-traumatic arthritis.

Most patients are familiar with osteoarthritis. Osteoarthritis, or “wear and tear” arthritis is caused by damage of articular cartilage. Think of the end of a chicken bone. The glossy white end-cap (cartilage) along with synovial fluid (lubricant) normally allows bones to move on each other under normal body weight and activity, without friction and without pain. Bone is alive like other tissues in the body and it has nerve endings. We believe friction from uncapped bones that have lost their protective cartilage is the source of pain. This pain along with stiffness and deformity lead to trouble walking and overall mobility.

Patients with rheumatoid arthritis, gout, and lupus know another type of arthritis, inflammatory arthritis. In inflammatory arthritis, the membrane lining the inside of a joint is inflamed as part of an autoimmune response. Autoimmune disease occurs when the body’s immune system attacks the body. To understand inflammation, think of a bad injury where there is redness, swelling, warmth, and pain. In med school, we learned the latin terms rubor (redness), tumor (swelling), calor (heat), and dolor (pain). Inflammation is our body’s injury response and it promotes healing. But, sometimes this response happens without injury and it just causes destruction. Eventually the joint destruction can spread from the synovial lining to the nearby connective tissues that hold the joints together (ligaments) and cartilage.

Finally, post-traumatic arthritis happens when a joint is irreversibly damaged by trauma. Sources of trauma, or severe injury, include fractures that end into the joint surface of the bone, joint dislocation, and ACL injuries. In most cases, post-traumatic arthritis is a unique form of osteoarthritis that occurs after trauma and in younger patients. One study showed that about 12% of surgeries for osteoarthritis were from post-traumatic arthritis.

How is arthritis diagnosed?

In short, we listen to patient symptoms, perform a physical exam, look at Xrays and sometimes other imaging and see if a patient fits the normal clinical picture or arthritis. I have covered this topic extensively in another blog article. Check it out. "Arthritis is like a duck."

How do we treat arthritis?

The orthopedic playbook is actually a very short read short. We try anti-inflammatory medication, bracing, a cane, activity/lifestyle change, and/or exercise programs. On a side note, some patients say they prefer natural medicine, and I say ME TOO. I don’t push prescription medication, and I support the use of mustard, blueberries, and turmeric in your diet if it helps with joint pain. If these noninvasive treatments are not enough, injections can be helpful.[injection video link] Steroids are the classic medication of choice for injections. In recent years platelet rich plasma (PRP – concentrated blood cells) and viscosupplementation (lubricant) have come into use.

When and how do we perform surgery?

Joint replacement becomes an option when a patient becomes sidelined by joint pain. They stop rolling and greasing the wheels will no longer get you back in motion. In this situation, resurfacing the bony joint surfaces with medical grade metal and plastic has an excellent track record of success.

Here are some fun facts. Approximately 790,000 total knee replacements and over 450,000 hip replacements are performed annually in the U.S. This number continues to grow as our population ages. Total joint replacement is one of the safest and most reliable treatments in any area of medicine. A hip or knee replacement done today typically can be expected to last for 20 or more years.

I hope you have found this information helpful!

Best regards,

Dr. B

Orthopedic Surgeon

Bristol Health

Disclaimer: No content on this site should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.