Total Joint Replacement

Arthroplasty is the generic term for corrective surgery on a joint. Arthroplasty is derived from the Greek word “Arthros”-meaning joint and the Greek word “Plasty”-meaning to form, mold, or shape-literally translating into “shaping of the joint”. In modern terms, this most commonly means a “total joint arthroplasty” or “total joint replacement”. While hip joints had been replaced for many years with various designs of metal balls, “modern” total joint replacement was first performed in the hip by Dr. John Charnley in England in the 1960s. Dr. Charnley revolutionized orthopedics by being the first to use both metal and plastic to replace the hip joint. Since then, almost every joint has been successfully replaced with an artificial prosthesis. Hip and knee total joint arthroplasties are still the most commonly performed but shoulders, elbows, wrists, fingers, and even ankles are available.

Artificial joints vary in design but most commonly have included metal on one side of the joint and polyethylene (plastic) on the other side. This combination has proven tremendously successful. More recently, modern manufacturing techniques have solved some of the technical problems of the designs from the 1940s and 1950s and metal on metal and ceramic on metal prostheses have become more common.

Total joint replacement is different from arthroscopy in that it involves “standard” long incisions and typically involves 2 or perhaps 3 days in the hospital. Rehabilitation most commonly requires 2 or 3 weeks in an extended care center for aggressive physical therapy. Maximum improvement typically requires 3 or 4 months.

The risk of complications is, however, much higher in total joint replacement compared to arthroscopy. The risk of infection is approximately 1% (compared to approximately 0.0001% in arthroscopy) overall and there is a small but permanent increased risk of infection. There is a significant risk of blood clots, and multiple measures to prevent blood clots and pulmonary embolus are routinely performed. Total joints are mechanical devices and no mechanical device lasts forever, as loosening, wear, and polyethylene failure occur over time.

Overall, while it is a little simplistic, the chances of requiring another total joint arthroplasty (called a revision arthroplasty) are approximately 1% per year. In other words, after 20 years, you have approximately a 20% chance of having to have another total joint replacement because the first one has failed or become infected. This is major surgery and there is always the risk of heart attack, stroke, pneumonias, or other complications that can occur with any major surgery. However, with modern surgical techniques and prostheses, 90 or 95% of people who have had total joint replacement have little, if any, pain for many, many years.