Arthritis, the condition that most often leads to a joint replacement, is a painful inflammation of the joints common in seniors. The pain and disability resulting from arthritis can drastically affect quality of life. If knee or hip joints are involved, arthritis damage can make walking difficult. In recent years, joint replacement therapy has helped thousands regain their mobility.

Many different types of arthritis exist. The most common type, especially for seniors, is called osteoarthritis. Think of it as degeneration (wear and tear) of joint cartilage that caps the ends of bones. For example, you may have noticed the smooth white shiny cartilage at the end of a chicken drumstick bone. When a joint moves, the painless gliding of cartilage on cartilage reduces friction. Osteoarthritis gradually wears away cartilage, so that pain gradually increases as bone begins to rub against bone. Certain medical conditions, previous joint injury and being overweight can all encourage this condition. Genetics also play a role, as arthritis runs in some families.

Usually, arthritis pain increases with activity and improves with rest. It is often simple to diagnose, based on existing symptoms and x-rays showing thinned cartilage and distinct changes to the bone underneath.
Sadly, there is no cure. Once cartilage has been worn away, nothing can be done to regrow it. Thanks to ongoing research, there is hope that this may change in future.

However, before surgery is considered, more conservative treatments can be tried. Alternative treatments include:

painkillers (Tylenolª is usually considered the safest)
weight loss (to slow the loss of cartilage in the legs)
walking aids (such as a cane or a walker)
physiotherapy
braces (for example, knee braces for certain types of knee arthritis)
topical painkillers (such as anti-inflammatory ointments)
glucosamine
steroid injections into the affected joints
injection of artificial joint fluid for knee joints which have deteriorated.

Although these therapies can help greatly, sometimes relief is only temporary. Certain activities may become difficult and pain may be constant enough to disrupt sleep. Together, patient and family doctor can decide when it is time to see an orthopedic (bone) surgeon.

Joint replacement considerations

Age is a major factor that both the family doctor and orthopedic surgeon will consider before recommending arthroplasty. While nobody can predict with certainty how long a 'new' joint will last, replacements often work well for 15 or more years. Still, parts eventually loosen or wear out, especially in those who are overweight or athletically active. A future surgery, or 'revision,' may be necessary to replace the replacement.

Revisions are much more difficult to do than the original surgery, with more potential complications. Results are often poor and the replacement joint does not last as long. Surgeons hesitate before performing arthroplasty on a younger person, since a revision may eventually be needed. Arthroplasty may be delayed until the person is older. Alternative treatments, including steroid joint injections, will likely be tried first. Simpler surgeries may also be offered to buy the patient time.

When surgery is recommended, other specialists may be consulted before (and after) the operation. Other medical problems and possible risks are considered. Patients who have severe underlying medical problems (co-morbidities) take a greater risk during surgery. For some, the risks may be too high to have the operation. As joint replacement is elective, some people may be too ill with other diseases to safely tolerate an unnecessary surgery.

With any operation, risk is involved. After surgery, blood thinners help prevent the formation of a blood clot in the deep veins of the leg (called a deep vein thrombosis or DVT). If a clot does form, it can break off, travel through the veins, pass through the heart and become lodged in the lung arteries. This is called a pulmonary embolus, and if the clot is big enough it can be fatal. Although it is rare, this complication can develop even when blood thinners are used. Blood thinners themselves can have complications, including rare fatal hemorrhages in the brain.

Infection is another rare but serious complication of surgery. In spite of precautions (including antibiotics) taken to avoid infection during surgery, about one per cent of joint replacements become infected. Infection is a serious concern, requiring a long hospital stay and treatment with IV antibiotics. More operations may be needed to replace the infected parts. Healing time is greatly increased. Since possible complications from surgery are so serious, all patients should have a realistic understanding of possible risks before going into the operating room.

After the surgery, it takes many months for the joint to heal. Most patients are in hospital for at least five days, perhaps longer. Physiotherapy begins in hospital and continues after the patient has been sent home. Following recommended exercise and rehabilitation programs improves the chance of success. Although healing will be painful, many find it easier to tolerate than the pain level before surgery. Blood thinners will be used for many weeks following the operation.

Even once healing is complete, certain movements may be forbidden since the new joint parts can dislocate or pop out of place. Be realistic about what can be expected, and remember that the operation was done to help relieve pain. Even with a new hip joint, an 80-year-old still won't have the flexibility, mobility or strength that a teenager does.

The science of arthroplasty is an area of active research. Materials and technology used continue to improve. When successful, these surgeries have some of the highest ratings of patient satisfaction of any type of surgery, and years of pain-free function may be enjoyed.

Joint Replacement The pros and cons

The role of arthritis

Joint replacement considerations

Joint Replacement
The pros and cons