Arthritis - A Look At Joint Replacement

People whose joints are irreparably damaged by osteoarthritis may need joint replacement. In this procedure, which is also called arthroplasty, the surgeon removes the diseased or damaged pieces of bone and installs a synthetic substitute. Instead of bone, you'll have stainless steel; instead of cartilage, you'll have a durable plastic such as Teflon. The artificial joint is either attached with surgical cement or allowed to gradually attach itself as real bone grows into the joint.

While the surgery may sound somewhat drastic, it can make your life feel worth living again. To people who have been homebound, unable even to walk through the house without pain, it can seem like a miracle. About 150,000 people a year have joint replacements, most often due to arthritis, and hip replacements are the most common procedures. If you are substantially overweight, you may not be considered a good candidate, however, because the extra weight would put too much stress on the joint.

Hips and knees are both large joints and reasonably easy to replace. These surgeries are common, and the prognosis for recovery is excellent. One or two out of every 100 hip replacements "fail" because of infections or blood clots. Hips, a simple ball-and-socket arrangement, are the simplest to replace, while knees are a bit more complex. Look at your knee: It bends back, but side-to-side movement is limited. That makes it a fairly complicated hinge.

Although less common, artificial joints are also available for ankles, elbows, shoulders, and fingers. They aren't as advanced as artificial knees and hips, so they leave some thing to be desired. (In some cases, wrist or ankle joints may need to be fused rather than replaced; they will be inflexible, but because bone is no longer rubbing against bone, the pain will vanish.) Replacement of finger joints can relieve pain, improve appearance and some function, but the new fingers, of course, aren't nearly as good as the nonarthritic originals were. A relatively new implant for the wrist, which fuses an L shaped metal plate to the finger and wrist bones, has worked for some people. In one study, it took about two and a half months for the implant to fuse to the bones, but afterward people could grip normally, had less pain and swelling, and found that their wrists were more stable than before the surgery.

Much progress has been made in replacement joints since the 1960s. These older joints would last only 10 to 15 years, while today's can last much longer. How long, of course, depends on how much stress the new joint is subjected to. Vigorous activity will wear it out more quickly.

A Closer Look At Hips And Knees

Two people with the same amount of joint damage and similar lifestyles can both have joint replacements. But one may declare the operation a success, and the other may be bitterly disappointed.

Part of what determines the success of your new joint is what you expect of it. While great advances have been made with artificial limbs, futuristic replacements that look and work even better than the originals are still a long way off Your new joint may work well, but it won't be the same as your "real" joint was when it was healthy.

And replacement joints, just like the originals, don't last forever. How long they last, just like the originals, can depend on how you treat them. Jogging, for example, is a lot tougher on a joint than bicycling or swimming.

Here are some more things to mull over.

Consider the true costs. If you've been putting off a hip replacement in the interests of saving money, think again. When a study compared the costs of having a hip replaced with not having it replaced including such things as quality of life as well as life expectancy it found that a hip replacement could save money. With a hip replacement, a 60-year-old woman could theoretically live alone and take care of herself for 20 years before needing help during her last two years of life. Without the hip replacement, that woman would likely need daily help for 15 years and then be bedridden for about eight years. And the long-term care she would require would cost twice as much as the surgery.

Kneecap replacement. Doctors have disagreed about whether it's necessary to replace part of your kneecap, a process called resurfacing, during a knee joint replacement. When 50 people with osteoarthritis in the knee had the resurfacing and 50 did not, the group without the kneecap resurfacing had less pain and better knee flexibility. Yet the only two people who had to have their surgeries repeated did not have their kneecaps resurfaced in the first procedure.

When two is better than one. If both your knees need replacing, you may want to consider having both done at once. It's generally cheaper, and you'll go through just one recovery period and spend less time overall in the hospital. One study found that if you have severe arthritis symptoms in that second knee, there's a good chance it will need replacing within the next decade. Of 185 people in the study, almost all with severe symptoms in one knee to be replaced required a second new knee within the decade.

(On the other hand, only 38 percent of those with only moderate symptoms in their "good" knee needed it replaced before a decade had passed.)

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