What is total joint replacement?

Also called arthroplasty, total joint replacement is a surgical procedure in which both sides of a joint are removed and replaced by artificial implants (prostheses) that are anchored to the bones.

How are joint pain and stiffness related to arthritis?

In osteoarthritis (OA), the soft, movement-easing cartilage at the ends of joint bones breaks down and wears away as the person grows older. Eventually the bones rub directly against each other whenever the joint moves, causing pain and stiffness. The rest of the body's joint surfaces is covered with a smooth tissue lining called the synovium: In rheumatoid arthritis (RA), chemical changes in the synovium cause it to destroy cartilage. In post-traumatic arthritis, joint pain and stiffness may develop after injury to the joint; the resulting failure of the bone and cartilage to heal properly causes the roughened joint surfaces to grind together. For more information on arthritis and knee, hip, or shoulder joint pain, go to:

How "bad" does my joint pain have to get before I should consider having joint replacement?

This is a very personal decision that only you can make, with the help of an orthopaedic surgeon's evaluation of your pain and its effects on your daily life.

If I decide to have joint replacement, what will I need to do before the surgery?

You'll need routine blood tests, urinalysis, a physical examination, and, if you're over 50 or your doctor thinks they're advisable, an electrocardiogram (EKG) and chest X-Ray as well. Your own doctor or the hospital where you'll have the surgery may perform these preoperative tests and evaluations. You may also be asked to donate blood preoperatively or to have a designated donor -- usually a family member or relative -- do this. Your doctor or orthopaedic surgeon will specify exactly which tests and evaluations you will need and when you should have them. He or she may also recommend that you take an iron supplement before your surgery, and you may be asked to stop taking certain medications -- for example, aspirin and other medications that thin the blood. Your doctor or orthopaedic surgeon will also specify how these and any other medication concerns apply to you. Finally, do not eat or drink after midnight on the day your surgery takes place.

What will I need to know about postoperative recovery in the hospital?

Following joint replacement surgery, hospital stays vary depending on insurance coverage and individual medical status; a total of 4 days (including the day of the surgery) is typical. The surgery may take from 2 to 3 hours; you'll spend about the same amount of time in the recovery room. On the first day after your surgery, expect to get out of bed and begin physical and occupational therapy, typically several brief sessions a day -- first steps on your way to getting back into your life and activities! Usually a case manager is assigned to work with you as you move through your rehabilitation routines. When you're ready for discharge, the decision will be made concerning whether you can best continue to recover at home (the usual procedure) or in another facility where you can receive specialized rehabilitation help. If you do go to another facility, the goal will be to return you to your home, able to move about with a safe level of independence, within 3 to 5 days.

What can I expect in the first days after I'm discharged?

You shouldn't be surprised if you feel a little shaky and uncertain for the first day or two after you're discharged. But soon you'll get a routine going and gain confidence in your new joint -- the start of a new life with less pain. (As with any surgery, you'll probably take pain medication for a few days while you are healing.) Be aware that you'll probably need a walker and/or crutches for about 6 weeks, then use a cane for another 6 weeks or so. You'll be in touch with your doctor or orthopaedic surgeon as well as your case manager, so you'll have plenty of opportunities to ask questions or discuss concerns as well as to report your progress.

When will I be able to go back to a normal daily routine, such as going to work or driving a car?

This is a decision that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines:

• You'll practice stair-climbing in the hospital and should be able to do this by the time you leave.
• You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don't tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.
• When to resume driving a car, going to work, and/or participating in sports activities are all highly individualized decisions. Be sure to follow your doctor's or orthopaedic surgeon's advice and recommendations.