Joint surgery is very serious and is typically used as a last resort to solve issues related to pain and lack of mobility. Joint surgery can range from minimally invasive arthroscopic surgery to total joint replacement. Even with minimally invasive surgery there is a potential for risks and complications. In general, a patient will be encouraged to try mobility aids or medications to relieve symptoms before resorting to joint surgery.
In the event that pain and mobility cannot be controlled or improved with other strategies a doctor may recommend a patient undergo surgery to repair damage to a joint, to replace part of the joint, or to replace the joint in its entirety. Damage caused by wear-and-tear, athletics, trauma, or arthritis may all lead to significant joint damage over time that requires some type of surgery.
Who Needs Joint Surgery?
There are two main factors to consider when deciding if a patient needs some type of joint surgery: pain and mobility. Joint surgery can help a patient get pain relief by correcting damage to a joint or by replacing it with an artificial joint. When pain is severe enough, and other strategies have not worked to reduce the pain to a reasonable level, surgery may be the next best option.
Mobility is another consideration, especially with knees and hips. If the joint is damaged enough it can make walking, let alone more vigorous activities, painful, difficult, or even impossible. A patient may first try mobility aids, like canes or walkers, pain medications, physical therapy, and other strategies, but if these do not improve mobility, surgery is likely the next step. When surgery can restore a better quality of life, and other, less-invasive treatments cannot, surgery is often the right choice.
The pain and lack of mobility that many people experience in their joints is a result of damage to the joint. The most common cause of this damage is arthritis. Osteoarthritis, which occurs as most people age, and rheumatoid arthritis, an autoimmune condition, are the most likely types of arthritis to cause significant damage to joints. Trauma, such as a fall, and repetitive use of a joint, may also cause significant damage.
Total Joint Replacement
When damage to a joint is extensive, and symptoms are severe, a total joint replacement may be done to remove an entire hip or knee and replace it with an artificial system. There are several medical device companies that make these joint systems and for many patients, getting a new joint means less pain and restored mobility. The choice of artificial joint type depends on the age, health, and needs of the patients. A younger, more active patient may need a more flexible and durable joint, for instance.
A total joint replacement is serious surgery, but experienced orthopedic surgeons conduct these surgeries on a regular basis. The surgery takes a few hours to complete in most cases. The surgeon has to remove all damaged tissue, which may include bone and connective tissues like tendons and cartilage. The surgeon then secures the new joint where the damaged tissue was removed. The joint may be made of plastic, ceramic, metal, or a combination of these materials.
Alternatives to Total Joint Replacement
For some patients, the damage in a knee, hip, or shoulder joint can be addressed without completely replacing it. For instance, a partial joint replacement may involve removing and replacing just one component of a joint, like the socket in the hip instead of both the ball and the socket. There are other types of joint surgeries as well and these may help some patients avoid a complete replacement:
- Arthroscopic surgery. This is minimally invasive surgery and involves a small incision and cameras and small tools used to repair damaged tissues in a joint.
- Joint resurfacing. This is common for knee surgery and is used to replace just one or two components of a joint instead of the entire joint. It may also be used in hip surgery and involves resurfacing and capping the ball rather than replacing it.
- Osteotomy. An osteotomy is a surgery that either removes some bone or adds in wedges of bone to help repair damage to a joint.
- Synovectomy. The synovium is the tissue lining joints and when it gets inflamed by arthritis it can be removed.
- Revision surgery. Revision surgery is done to replace or fix artificial joint components. This may be done when a joint reaches the end of its lifespan of 10 or 15 years, or it may be done when the joint fails in some way.
Joint Surgery Complications
Any kind of surgery is risky, but both patients and doctors have to weigh the benefits against the risks when deciding on any type of joint surgery. The health and age of the patient must also be considered before choosing surgery. Poor health or advanced age may disqualify some patients from this kind of surgery because the risks of complications may be too great.
Complications that anyone might face after joint surgery include infections, the formation of blood clots, bleeding, and damage to the tissue or blood vessels around the joint. These complications have the potential to be serious, and even fatal in the case of a blood clot, but most are treatable and manageable.
There are also more specific potential complications that can occur with joint replacements. These include loosening of the joint after surgery, which can cause pain, dislocation of the joint, and wear on the joint that may cause it to loosen, dislocate, or fail entirely.
Metal-on-Metal Hip Systems
The U.S. Food and Drug Administration approved metal-on-metal hips to help provide better, more durable joints. Medical device makers designed these hips to be made entirely of metal and to be more durable and longer lasting for younger and more active recipients of artificial hips. Unfortunately, since that time there have been many problems with the hips, made by companies like DePuy, Biomet, Stryker, and Zimmer.
The metal components are more durable than plastic or ceramic, but they can also cause serious complications. One of the biggest problems is that when the metal components rub against each other as the joint moves, small fragments of metal break off and enter the tissue around the joint. This can cause local tissue damage, but also metal poisoning if the metal gets into the bloodstream. Some of the hips have also started to corrode, or even break, inside patients, causing serious pain and damage.
Anyone with any type of replacement joint may face the need for a revision surgery. This may be the result of natural wear and tear over years of use, or it can be necessary if the joint is damaged or fails in some way. Metal-on-metal hips have higher than usual revision rates. Additional surgery means more potential complications, pain, and extended recovery time.
Some people who have had to have revision surgery because joints failed have successfully sued the manufacturers for making faulty devices. Johnson & Johnson, for instance, has been forced to pay over $2 billion over faulty DePuy and Zimmer hips that led to painful revision surgeries, joint damage, and metal poisoning.
Joint surgery may be necessary for many people to enjoy a better quality of life, to be able to be active, and to live without pain. Many of these patients have successful surgery and enjoy their new hips. Some, though, suffer serious complications, aggravated by the fact that some artificial hips may be faulty and have high failure rates. Make sure you understand all the risks and benefits before you decide on joint surgery.