Joint replacement is serious surgery.  You need to know about the surgeon's skill, the facility's success rate and also about the hardware that is being put in your body.  All of these things greatly affect your outcome.

Joint replacement – called arthroplasty – is a surgical procedure in which diseased or damaged parts of a joint are removed and replaced with new artificial implants.  Its goals are to relieve pain, increase mobility and improve or restore normal joint functions. 

The most common reason that people have joint replacement surgery is the wearing down or disintegration of a joint caused by osteoarthritis.  Other conditions that can lead to deterioration of a joint and require arthroplasty include rheumatoid arthritis (chronic or severe inflammation), avascular necrosis (loss of bone due to insufficient blood supply), physical injury and bone tumors.

People who undergo arthroplasty can expect dramatic pain relief and improved ability to function normally.  But there is a cost.  Joint replacement is a very invasive operation.  It requires a lot of preparation, and a long and somewhat intense recuperation.  There are a lot of things the patient can do before and after surgery to make everyday tasks easier and speed their recovery

Before surgery

• Research the most experienced surgeons and the best hospitals for joint replacement surgery in as wide a geographic area as is reasonable for you.  You can evaluate a provider's competence by looking at:
• experience
• credentials
• whether they participate in continuing medical education
• quality reports
• how they are viewed by former patients, peers and staff
• how they monitor and improve their quality of care
• Request and read information written for patients from the doctor and support agencies to make sure you understand the risks as well as the rewards
• If you have any factors that would increase your risk factors (such as being overweight or a smoker), work with your doctor to correct them.
• Ask your doctor for pre-surgical exercises.
• Enlist someone to help around the house for a couple of weeks after you get home from the hospital
• Set up a "recovery station" at home where you'll spend most of your time – complete with TV remote, radio, telephone, medicine, tissues, waste basket, water pitcher and glass
• Arrange your house so you can get around easily, and place everyday items at arm level so you don't have to bend or stretch
• Stock up on kitchen staples, fill the cupboard with easy-to-make foods like canned soup, and prepare and freeze meals in advance
• Arrange for transportation to and from the hospital, and for things like errands

After surgery

• Take your medicines religiously and your physical therapy seriously – both will be integral parts of your recovery
• Follow all doctor instructions related to diet, movement and other critical matters
• Wear an apron with pockets to carry essentials around with you 
• Use a long-handled "reacher" to turn on lights or grab things that are beyond your reach
• Be active when you're supposed to be active (during physical therapy) and rest when you're supposed to rest.  Be committed to your rehabilitation program.

Complications are rare.  The most common problems are dislocation for hip replacement patients, inflammation caused by tiny particles wearing off the artificial joint surfaces, blood clots, infection and excessive bone growth.  Patient with knee replacements are more at risk for blood clots and usually take medication after surgery to prevent them. 

Implants can wear out or become loose with time.  Historically these types of problems might occure after 10 to 15 years.  Newer hip implants may now last much longer, but the long term function of knew implants is less clear.  Collectively, over 90 percent of replacement joints are fully functional after 25 years.  But especially for younger patients, whose artificial joints tend to get more wear and tear, revision surgery might be needed.

Doctors usually consider revision surgery for three reasons:  If accompanying medication and lifestyle changes do not relieve pain and dysfunction, if damage to or failure of the artificial joint must be corrected, or if there is ongoing bone loss.  Subsequent surgeries tend to be more difficult and not as successful as the original surgery.  So it's important to explore all available options before proceeding with additional surgery.

Once joint replacement is selected as the appropriate treatment, choices need to be made among the types and characteristics of implants available.  A variety of factors influence this selection process.

Most artificial joints and implant components are made out of some combination of specialty metals and plastics.  There are three main types of replacement parts used in joint replacement.  An osteopaedic surgeon will suggest one type or another based on a patient's particular situation.  Among them are age, weight, bone strength, activity level and the joint being replaced.  The types are:

Cemented

The surgeon uses a bone "cement" or glue to hold the artificial parts in place and connect them to healthy bone.  This surgery is recommended for older or less active people, because results are consistently good and recovery is relatively quick.

Cementless (or non-cemented)

Parts that come in contact with healthy bone are produced from a material and feature a design that encourages the bone to grow into and around them.  This type of implant generally lasts longer.  However, it requires healthy bones that will grow into the replacement joint, as well as a longer recovery time.  Most people who receive cementless joint implants are younger or more active.  Some newer designs are used for all ages. 

Hybrid

These replacement joints are made up of both cemented and cementless components.  The surgeon selects the parts after a determination of what will work best, given the condition of the patient's joint and surrounding bone and tissue.  The goal is to provide a solution that will best alleviate adverse symptoms and restore natural function and movement.

There are other pros and cons related to the various types of replacement joints.  For example, cement particles can break off the joint through use and movement, which can cause irritation.  Revision surgery is usually more difficult with a cemented joint.  On the other side, uncemented joints take an extremely long time to heal and stabilize – three months or more.  And the process of natural bone growth can cause pain for a number of months after surgery.

In the end, the doctor and patient together should weigh the advantages and disadvantages of each type.  They also must factor in the unique aspects of the patient's condition and circumstances.  The right replacement joint has the potential to relieve the patient's pain, restore normalcy to their movement and function – and greatly improve their quality of life.