This article is more than 5 years old. Information may no longer be current.
What is arthroplasty?
Click Here to Manage Email Alerts
Arthroplasty is a surgical procedure that alters or completely replaces a joint in the body, usually to relieve pain in a malformed or diseased joint, such as the hip, knee, shoulder, elbow or ankle, and restores normal motion. The kind of physician who performs arthroplasty procedures is an orthopedic surgeon.
The joints are two-sided, with each side covered with slippery cartilage and smoothly contacting or articulating with the other. Arthroplasty may be required due to cartilage that wears out, limb/joint malalignment, joint space narrowing, a stiff joint, a disease, such as arthritis, or other degenerative or traumatic conditions.
Depending on the severity of the problem with the joint and other factors, resectional arthroplasty, interpositional arthroplasty or total joint arthroplasty may be performed.
In resection arthroplasty, the orthopedic surgeon removes a minimal amount of tissue surrounding the joint to restore joint function. This may be successful as a first surgical treatment, or interpositional arthroplasty can be performed. During interpositional arthroplasty, the joint is surgically reshaped and, to provide better contact between both sides of the joint, some kind of material (metal, plastic, ceramic or some of the patient’s own soft tissue) is positioned at the site where the joint articulates to relieve pain and provide a better functioning joint.
If that fails, total joint arthroplasty (total joint replacement) is performed. It is a surgical procedure that replaces or treats both sides of the joint articulation, or the total joint, when they are both problematic. Hemi-arthroplasty is performed to treat a problem with just one side of a joint.
Total joint arthroplasty or replacement is typically only indicated after a conservative, nonoperative course of therapy has failed.
During total joint arthroplasty, the orthopedic surgeon removes the damaged portions of the joint with special instruments and replaces them with artificial components. Stems or pegs on the artificial joint components are fitted into the healthy, remaining part of the bone and kept in place and stabilized with either bone cement or a special coating on the implant that fosters new bone growth in the area. The fixation method of a joint replacement device is selected based on the patient’s age, bone quality and activity level.
A newer type of arthroplasty, called resurfacing arthroplasty, replaces or “resurfaces” only the damaged, very extreme end of a joint. In the shoulder, for example, this involves “capping” the top, diseased part of the humerus, the long bone that connects the shoulder with the elbow. A goal of resurfacing arthroplasty is to maintain the remainder of the joint and preserve more of a person’s own anatomy for as long as possible.
Orthopedic surgeons have several types of arthroplasty implants or prostheses to choose from to replace or resurface the joint. Each of these implants and the materials they are made of (metal, a type of plastic called polyethylene, ceramic or a combination of these and other materials) has distinct success rates in clinical use (in patients).
When considering the best arthroplasty treatment and implant for a patient, the surgeon takes into account the success rates, including the number of years it has been used, in how many patients, those patients’ characteristics, the material the implant is made of, the arthroplasty technique used to implant the device, whether it was fixed with cement or bone in-growth methods, and what the results afterward (outcomes) have been in the short term and long term.
After arthroplasty surgery, patients should expect to undergo a rest, healing and rehabilitation period, usually at home. Then, under their doctor’s direction, they will gradually begin to regain strength and flexibility in the area surrounding the replaced joint, and re-learn how to use the joint, such as how to walk after total knee arthroplasty or dress themselves after shoulder hemi-arthroplasty surgery.
The orthopedic surgeon will continue to follow up his arthroplasty patients at regular intervals after surgery with a physical examination and usually X-rays or other type of imaging. This process helps ensure the arthroplasty procedure and device used are performing as expected.
Occasionally, when the patient develops a problem or complication after total joint arthroplasty surgery, such as an infection or a loose implant, the arthroplasty prosthesis or device must be removed, along with the damaged or infected tissue surrounding it. The procedure to implant a new arthroplasty device in place of the original or primary component is called revision arthroplasty surgery.
Additional information about arthroplasty may be found at these websites: