Joint Replacement

Joint replacement is a designation for one of the most common orthopedic surgeries - replacing sick or damaged joint by artificial one. Hip and knee replacement surgery belong to the most common.


Joint replacement is used when a joint is severely injured or damaged by certain disease. Very often, joint replacement is the ultimate solution of osteoarthritis. This degenerative joint disease restricts mobility and its advanced forms are associated with significant joint pain. Joint replacement of the hip is commonly chosen in injuries associated with fractures of the femoral neck in the elderly people.


The surgery is usually performed under general anesthesia. If this is not possible, the patient may also be operated while conscious with anesthesia of the entire lower half of the patient's body (epidural anesthesia). The surgery includes removal of the original joint and its replacement with artificial one. This very simply described procedure is in fact a very complicated operation that places great demand on both manual dexterity and strength of the surgeons.


The majority of joint replacements are made ​​of metal. The adjacent bone is fixed to the metallic joint with a special cement (cemented replacement), or it has a special surface, which allows the ingrowth of the bone (non-cemented replacement).


Rehabilitation usually begins the next day after the surgery, because it is very important in the proper healing process. Quick surgery followed by subsequent rehabilitation may be lifesaving for elderly patients with a fractured femoral neck, because it protects them from infectious complications such as pneumonia.


Artificial hip joint


Scheme of a typical artificial hip joint


One of the most unpleasant complications is bacterial infection of the artificial joint and its surroundings, including the bone. The symptoms include local pain, impaired wound healing, fever and inability to stand on the affected limb. It is virtually impossible to cure these infections by antibiotic therapy alone. It is usually inevitable to combine the antibiotics with removal of the infected foreign material, i.e. artificial joint. Of course, when the joint replacement affects the lower limb, the joint removal immobilizes the patient who has to lie. A very dangerous infection is caused by antibiotic resistant strains of bacteria such as the so-called MRSA.


Orthopedic surgeries of the extremities are also associated with an increased risk of deep vein thrombosis and therefore, the patients should be administered anticoagulant drugs in preventive dosage in perioperative period.


Joint replacement is the last and ultimate option to replace the function of a damaged joint by some degenerative process or injury. When it is a planned procedure, it should be indicated cautiously because of its possible complications. Successfully performed and right indicated joint replacement is a great procedure, which significantly improves the life quality of the patient and in some cases; it may be even life-saving.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources