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Is It Time for a New Joint?

Millions of us struggle with pain and loss of motion because of joint damage caused by arthritis. If other treatments fail to offer relief, you may wonder about turning in your worn-out joints for new ones.

Although surgery may not be a first treatment option, if you are a candidate for total joint replacement or arthroplasty, the results of the surgery are good to excellent for more than 90 percent of people, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). They get relief from pain and can resume normal daily activities.

Joint replacement surgery is fairly common for people with osteoarthritis. In this most common form of arthritis, cartilage - the tissue that protects bones in a joint - breaks down and wears away. Bones rub together, causing pain and loss of motion.

Should you have surgery?

Joint replacement should be a final step in treatment. More conservative treatments are generally recommended prior to joint replacement.

Those other treatments include using pain medication, losing weight to ease stress on the joint, and reducing physical activities that cause pain. Doctors also may suggest exercises to keep muscles and joints flexible, promote fitness, and strengthen muscles that support damaged joints.

While most people undergoing joint replacement surgery are in their 60s or older, younger people may undergo a joint replacement procedure when their condition warrants it. However, younger people may have other options available to them, such as changing to a less physically-demanding job, or having a different type of procedure that realigns or only partially replaces a joint.

The younger you are when you get a new joint, the more likely you are to need corrective surgery later. Surgery to fix or replace artificial joints has a risk of infection and other complications about four times greater than the initial surgery. Because doctors shape and remove bone to accept the new joint, repeated surgery also leaves less bone to attach to each new joint.

When do you need surgery?

X-ray evidence of joint damage is one of the criteria used to decide who should have this surgery. It is not the only one, though. Your symptoms--mainly pain--are the most important consideration. This is predominantly a quality of life decision.

Candidates for joint replacement surgery should have one of the following: severe pain during activity, such as walking or getting up from a chair; pain that prevents them from doing activities; or pain at night that prevents them from sleeping.

What can you expect?

To get ready, you should work with your doctor to be sure you can tolerate anesthesia. If you have dental problems, have them corrected before surgery to reduce the risk for infection. Bacteria from the mouth can get into the bloodstream and cause an infection at the surgical site. Heart problems should be stabilized before surgery.

Total joint replacement involves a two- or three-day hospital stay. You'll receive an anesthetic for the duration of the surgical procedure. The surgeon will reshape the ends of the bones to accept the artificial parts.

Artificial joints are usually made of metal and hard plastic. Depending on the type of replacement joint used, cement may be used to attach some of the parts. Metal parts may be anchored by inserting a rod into the bone or with cement. Typical hip and knee patients can walk the next day using a walker. You'll likely be discharged on the third or fourth day, but you'll need time to rehabilitate.

At first, you may need assistive devices, such as crutches or a walker after hip replacement, for example. Within a few months, you should resume most of your normal daily activities unaided. You may still need physical therapy.

After shoulder replacement surgery, you can start passive shoulder exercises, in which someone else moves the joint for you, soon after surgery. Three to six weeks after surgery, you'll perform exercises a therapist gives you. Eventually, you'll begin to stretch and strengthen your shoulder so you can regain normal use with far less pain than you had before the surgery.

Recovery from joint replacement surgery generally involves some pain for two to three months. However, it's usually a different type of pain and will go away as the recovery period continues.

Will a new joint last?

Experts caution against unrealistic expectations for a new joint. You shouldn't expect it to tolerate activities that involve jumping or the kind of stress that would be hard on a natural joint. Your doctor will advise you to avoid certain activities after surgery and may even recommend that certain joint positions be avoided in order to prevent dislocation of the joint. The restrictions given will depend on the joint that is replaced, as well as your individual situation.

An artificial joint will eventually develop changes from wear and tear, even under normal use and activity conditions. It may eventually need to be replaced. Artificial joints generally last 10 to 15 years; thus, a person who is younger at the time of the joint replacement surgery may eventually need to have the new joint replaced. However, new materials being developed for joint replacement are giving artificial joints a longer life span.