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 Arthritis Publication Date: April 2009 Joint Replacement Surgery: Information for Multicultural Communities What Is Joint Replacement Surgery? Joint replacement surgery is removing a damaged joint and putting in a new 
one. A joint is where two or more bones come together, like the knee, hip, and 
shoulder. The surgery is usually done by a doctor called an orthopaedic 
(pronounced or-tho-PEE-dik) surgeon. Sometimes, the surgeon will not remove the 
whole joint, but will only replace or fix the damaged parts. The doctor may suggest a joint replacement to improve how you live. Replacing 
a joint can relieve pain and help you move and feel better. Hips and knees are 
replaced most often. Other joints that can be replaced include the shoulders, 
fingers, ankles, and elbows. Illustration of a doctor showing an X-ray to a patient and her daughter What 
  Can Happen to My Joints?What 
  Is a New Joint Like?Do 
  Many People Have Joints Replaced?Do 
  I Need to Have My Joint Replaced?What 
  Happens During Surgery?What 
  Happens After Surgery?Will 
  My Surgery Be Successful?What 
  Research Is Being Done?Where 
  Can I Learn More About Joint Replacement Surgery?AcknowledgmentsFor 
  Your Information What Can Happen to My Joints? Joints can be damaged by arthritis and other diseases, injuries, or other 
causes. Arthritis or simply years of use may cause the joint to wear away. This 
can cause pain, stiffness, and swelling. Bones are alive, and they need blood to 
be healthy, grow, and repair themselves. Diseases and damage inside a joint can 
limit blood flow, causing problems. What Is a New Joint Like? A new joint, called a prosthesis (pronounced praas-THEE-sis), can be made of 
plastic, metal, or both. It may be cemented into place or not cemented, so that 
your bone will grow into it. Both methods may be combined to keep the new joint 
in place. Illustration of an artificial hip joint A cemented joint is used more often in older people who do not move around as 
much and in people with �weak� bones. The cement holds the new joint to the 
bone. An uncemented joint is often recommended for younger, more active people 
and those with good bone quality. It may take longer to heal, because it takes 
longer for bone to grow and attach to it. New joints generally last at least 10 to 15 years. Therefore, younger 
patients may need to have the same damaged joint replaced more than once. Do Many People Have Joints Replaced? Joint replacement is becoming more common. About 773,000 Americans have a hip 
or knee replaced each year. Research has shown that even if you are older, joint 
replacement can help you move around and feel better. Any surgery has risks. Risks of joint surgery will depend on your health 
before surgery, how severe your arthritis is, and the type of surgery done. Many 
hospitals and doctors have been replacing joints for several decades, and this 
experience results in better patient outcomes. For answers to their questions, 
some people talk with their doctor or someone who has had the surgery. A doctor 
specializing in joints will probably work with you before, during, and after 
surgery to make sure you heal quickly and recover successfully. Do I Need to Have My Joint Replaced? Only a doctor can tell if you need a joint replaced. He or she will look at 
your joint with an x-ray machine or another machine. The doctor may put a small, 
lighted tube (arthroscope) into your joint to look for damage. A small sample of 
your tissue could also be tested. After looking at your joint, the doctor may say that you should consider 
exercise, walking aids such as braces or canes, physical therapy, or medicines 
and vitamin supplements. Medicines for arthritis include drugs that reduce 
inflammation. Depending on the type of arthritis, the doctor may prescribe 
corticosteroids or other drugs. Illustration of a surgeon operating on a patient's knee However, all drugs may cause side effects, including bone loss. If these treatments do not work, the doctor may suggest an operation called 
an osteotomy (pronounced aas-tee-AAHT-oh-me), where the surgeon �aligns� the 
joint. Here, the surgeon cuts the bone or bones around the joint to improve 
alignment. This may be simpler than replacing a joint, but it may take longer to 
recover. However, this operation is not commonly done today. Joint replacement is often the answer if you have constant pain and can�t 
move the joint well � for example, if you have trouble with things such as 
walking, climbing stairs, and taking a bath. Illustration of a man and a woman walking through a mall What Happens During Surgery? First, the surgical team will give you medicine so you won�t feel pain 
(anesthesia). The medicine may block the pain only in one part of the body 
(regional), or it may put your whole body to sleep (general). The team will then 
replace the damaged joint with a prosthesis. Each surgery is different. How long it takes depends on how badly the joint 
is damaged and how the surgery is done. To replace a knee or a hip takes about 2 
hours or less, unless there are complicating factors. After surgery, you will be 
moved to a recovery room for 1 to 2 hours until you are fully awake or the 
numbness goes away. Illustration of medical staff in an operating room performing a knee replacement What Happens After Surgery? With knee or hip surgery, you may be able to go home in 3 to 5 days. If you 
are elderly or have additional disabilities, you may then need to spend several 
weeks in an intermediate-care facility before going home. You and your team of 
doctors will determine how long you stay in the hospital. After hip or knee replacement, you will often stand or begin walking the day 
of surgery. At first, you will walk with a walker or crutches. You may have some 
temporary pain in the new joint because your muscles are weak from not being 
used. Also, your body is healing. The pain can be helped with medicines and 
should end in a few weeks or months. Illustration showing a nurse accompanying a man who is using a walker Physical therapy can begin the day after surgery to help strengthen the 
muscles around the new joint and help you regain motion in the joint. If you 
have your shoulder joint replaced, you can usually begin exercising the same day 
of your surgery! A physical therapist will help you with gentle, range-of-motion 
exercises. Before you leave the hospital (usually 2 or 3 days after surgery), 
your therapist will show you how to use a pulley device to help bend and extend 
your arm. Illustration showing a physical therapist helping a man exercise his knee Will My Surgery Be Successful? The success of your surgery depends a lot on what you do when you go home. 
Follow your doctor�s advice about what you eat, what medicines to take, and how 
to exercise. Talk with your doctor about any pain or trouble moving. Illustration showing a woman sitting on a stool exercising her knee Joint replacement is usually a success in more than 90 percent of people who 
have it. When problems do occur, most are treatable. Possible problems include: **Infection** � Areas in the wound or around the new joint 
  may get infected. It may happen while you�re still in the hospital or after 
  you go home. It may even occur years later. Minor infections in the wound are 
  usually treated with drugs. Deep infections may need a second operation to 
  treat the infection or replace the joint.**Blood clots** � If your blood moves too slowly, it may 
  begin to form lumps of blood parts called clots. If pain and swelling develop 
  in your legs after hip or knee surgery, blood clots may be the cause. The 
  doctor may suggest drugs to make your blood thin or special stockings, 
  exercises, or boots to help your blood move faster. If swelling, redness, or 
  pain occurs in your leg after you leave the hospital, contact your doctor 
  right away.**Loosening** � The new joint may loosen, causing pain. If 
  the loosening is bad, you may need another operation. New ways to attach the 
  joint to the bone should help.**Dislocation** � Sometimes after hip or other joint 
  replacement, the ball of the prosthesis can come out of its socket. In most 
  cases, the hip can be corrected without surgery. A brace may be worn for a 
  while if a dislocation occurs.**Wear** � Some wear can be found in all joint replacements. 
  Too much wear may help cause loosening. The doctor may need to operate again 
  if the prosthesis comes loose. Sometimes, the plastic can wear thin, and the 
  doctor may just replace the plastic and not the whole joint.**Nerve and blood vessel injury** � Nerves near the replaced 
  joint may be damaged during surgery, but this does not happen often. Over 
  time, the damage often improves and may disappear. Blood vessels may also be 
  injured. As you move your new joint and let your muscles grow strong again, pain will 
lessen, flexibility will increase, and movement will improve. Illustration showing 2 women walking through a mall What Research Is Being Done? Scientists are studying replacement joints to find out which are best to 
improve movement and flexibility. They are also looking at new joint materials 
and ways to improve surgery. Other researchers are working to find out what 
causes joint damage, how to prevent it, and how to treat it. Some scientists are studying a condition called osteolysis, a condition where 
bone is lost around the implant in response to inflammation. This can cause the 
prosthesis to loosen and may require a second surgery. In 2008, scientists found 
that cells called fibroblasts trigger the inflammation that results in 
osteolysis. This finding could help scientists develop new drugs that prevent 
osteolysis in joint replacements. Other scientists are also trying to find out why some people who need surgery 
don�t choose it. They want to know what things make a difference in choosing 
treatment, in recovery, and in well-being. There are numerous research studies underway across the country and abroad. 
To learn more, go to the NIH Research Portfolio Online Reporting Tool � 
Expenditures and Results (RePORTER) Web site at http://projectreporter.nih.gov/reporter.cfm. Where Can I Learn More About Joint Replacement Surgery? National Institute of Arthritis and Musculoskeletal and Skin Diseases 
  (NIAMS)Information ClearinghouseNational Institutes of Health
  1 AMS CircleBethesda,  MD 20892-3675Phone: 
  301-495-4484Toll Free: 877-22-NIAMS (226-4267)TTY: 
  301�565�2966Fax: 301-718-6366Email: [email protected]Website: http://www.niams.nih.gov/ NIAMS provides information about various forms of arthritis and other 
rheumatic diseases, as well as other bone, muscle, joint, and skin diseases. It 
distributes patient and professional education materials and refers people to 
other sources of information. Additional information and updates can be found on 
the NIAMS Web site. MedlinePlus
  Website: http://medlineplus.gov/ MedlinePlus is the National Library of Medicine�s Web site for consumer 
health information. Office of Medical Applications of Research (OMAR)National Institutes 
  of Health
  Building 31, Room 1B03,31 Center Drive, MSC 2082Bethesda, 
   MD 20892-2082Phone: 301�496�5641Website: http://odp.od.nih.gov/omar OMAR is the focal point for assessing medical practice and state of the 
science on behalf of the medical community and the public. It works closely with 
NIH Institutes and Centers to assess, translate, and disseminate the results of 
biomedical research that can be used in the delivery of health services to the 
public. Several consensus statements on joint replacement surgery are available 
on its Web site. American Academy of Orthopaedic Surgeons (AAOS)
  6300 North River RoadRosemont,  IL 60018-4262Phone: 
  847-823-7186Toll Free: 800-824-BONE (2663) Fax: 847-823-8125Email: 
  [email protected]Website: 
  http://www.aaos.org The academy provides education and practice management services for 
orthopaedic surgeons and allied health professionals. It also serves as an 
advocate for improved patient care and informs the public about the science of 
orthopaedics. The orthopaedist�s scope of practice includes disorders of the 
body�s bones, joints, ligaments, muscles, and tendons. For a single copy of an 
AAOS brochure, send a self-addressed stamped envelope to the address above or 
visit the AAOS Web site. American College of Rheumatology (ACR)
  1800 Century Place, Suite 250Atlanta, 
   GA 30345-4300Phone: 404-633-3777Fax: 
  404-633-1870Website: http://www.rheumatology.org ACR is an organization of doctors and associated health professionals who 
specialize in arthritis and related diseases of the bones, joints, and muscles. 
The Association of Rheumatology Health Professionals, a division of ACR, aims to 
enhance the knowledge and skills of rheumatology health professionals and to 
promote their involvement in rheumatology research, education, and quality 
patient care. The association also works to advance and promote basic and 
continuing education in rheumatology for health professionals who provide care 
to people with rheumatic diseases. Arthritis Foundation
  P.O. Box 7669Atlanta,  GA 30357-0669Phone: 404-872-7100 
  Toll Free: 800-283-7800Website: http://www.arthritis.org The Arthritis Foundation is devoted to supporting arthritis research and 
providing educational and other services to individuals with arthritis. The 
foundation publishes a free pamphlet on rheumatoid arthritis and a magazine for 
members on all types of arthritis. It also provides up-to-date information on 
research, treatment, nutrition, alternative therapies, and self-management 
strategies. Chapters nationwide offer exercise programs, classes, support 
groups, doctor referral services, and free literature. The Web site offers free 
information about lupus, scleroderma, and other autoimmune and rheumatic 
conditions. Acknowledgements NIAMS gratefully acknowledges the assistance of Graciela S. Alarc�n, M.D., 
M.P.H., University of Alabama School of Medicine, Birmingham; Agustin Escalante, 
M.D., University of Texas Health Science Center, San Antonio; Kathleen Figaro, 
M.D., Vanderbilt University Medical Center, Nashville, TN; George Galante, M.D., 
Rush-Presbyterian-St. Luke�s Medical Center, Chicago, IL; Julia McClanahan, Oak 
Ridge, TN; and James Panagis, M.D., NIAMS/NIH, Bethesda, MD. Do You Have a Joint-Related Condition? You may be able to help scientists learn more about these conditions. For information about research projects near your home, call the **NIAMS****Information 
Clearinghouse**301-495-4484 You could make a difference! http://www.niams.nih.gov/
  The mission of the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human 
Services� National Institutes of Health (NIH), is to support research into the 
causes, treatment, and prevention of arthritis and musculoskeletal and skin 
diseases; the training of basic and clinical scientists to carry out this 
research; and the dissemination of information on research progress in these 
diseases. The NIAMS Information Clearinghouse is a public service sponsored by 
the Institute that provides health information and information sources. 
Additional information can be found on the NIAMS Web site at http://www.niams.nih.gov/. For Your Information This publication contains information about medications used to treat the 
health condition discussed here. When this booklet was printed, we included the 
most up-to-date (accurate) information available. Occasionally, new information 
on medication is released. For updates and for any questions about any medications you are taking, 
please contact U.S. Food and Drug Administration
  Toll Free: 888-INFO-FDA (888-463-6332)Website: http://www.fda.gov/ For updates and questions about statistics, please contact Centers for Disease Control and Prevention�s National Center for Health 
  Statistics
  Toll Free: 800�232�4636Website: http://www.cdc.gov/nchs This booklet is not copyrighted. You may make copies of it and give out as 
many as you want. For more copies, contact: National Institute of Arthritis and Musculoskeletal and Skin Diseases 
  (NIAMS)Information ClearinghouseNational Institutes of Health
  1 AMS CircleBethesda,  MD 20892-3675Phone: 
  301-495-4484Toll Free: 877-22-NIAMS (226-4267)TTY: 
  301�565�2966Fax: 301-718-6366Email: [email protected]Website: http://www.niams.nih.gov/ NIH Publication No. 09-5149 Visit 
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