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Questions and answers about joint replacement
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Are there special centres for joint replacement surgery or can I go to any hospital?
Nobody is an expert at everything. This is also true in medicine. Which is
why there are special centres for joint replacement. Furthermore not every
hospital performs joint replacement surgery every day. Since it is a very
specialized operation, only extensive experience and a thorough knowledge of the
field can produce an optimal result. You should therefore find out in good time
whether the hospital you are considering carries out this type of operation
frequently and thus with the requisite know-how. Go to top
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Should I have my operation early or wait as long as I can? When is the best time for surgery?
When x-rays prove joint damage, two factors are crucial for deciding on the
right time for surgery: quality of life and degree of suffering. Regardless of
age one should contemplate an operation if medication to stop pain no longer
helps or if it is leading to pronounced side effects. One should also take into
account the damage caused to other joints and structures such as the spine by
walking in the wrong way or poor posture. An operation postponed for too long
can result in permanent injury to the spine,even after surgery.Go to top
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What are the risks of a hip or knee replacement operation?
Joint replacement surgery of the hip or knee is among the most successful
orthopaedic operations with a vast body of experience: in Europe alone some
400,000 hips and 200,000 knees are replaced every year. As with every other
surgical intervention there are certain risks. On the one hand these are the
general risks that can arise from any operation, on the other the special risks
relating to the specific operation.
General risks include:
Deep vein thrombosis in the legs with risk of a pulmonary
embolism
Infection of the wound
Injury to the nerves
Blood loss and the necessity for blood transfusions
Special risks include:
- Instability and dislocation of the joint after surgery
- Unequal leg length
- Ossification around the hip joint, reducing range of movement
To safeguard against these risks we can implement a number of
measures:
- You will receive blood thinning medication (Heparin) regularly
to guard against thrombosis
- The operating time is short
- The surgical team is very experienced and specially trained
- The operating theatres are free of bacteria, so the risk of
infection is greatly reduced
- Precise planning before the operation, partly augmented by computers,
minimizes the danger of dislocating the joint or unwanted leg lengthening
- Short-term medication and/or radiation therapy also virtually eliminate
any possible ossification where there is a tendency for this to happen in
the area of the joint.
As you can see, surgery is not completely risk free, but risks remain very
small if the right measures are implemented. Go to top
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What ist MIS (minimally invasive surgery)?
The less tissue is damaged by surgery the better. So called "minimally
invasive" surgical interventions allow skin, muscle and bone to be spared by
special techniques. Optimized surgical approaches, specially designed surgical
instruments, new patient positioning methods and bone sparing implants are
combined to enable you to quickly return to your activities of daily living and
regain your quality of life after surgery. It also is an important prerequisite
for a possible revision operation after many years of painfree use. A
well-trained, experienced and coordinated surgical team is essential for these
demanding techniques. Go to top
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Which prosthesis is right for me? Which material is better: Metal, ceramics or plastic?
This question can only be answered in a discussion between you and your
surgeon. However the final decision has to be made during surgery.
In
principle younger people's bone reacts faster and more pronouncedly to an
implant. Therefore implants can be used that are are stabilized by direct
contact with the surrounding bone (cementless implant).
For bones altered by
osteoporosis or rheumatic diseases a fixation of the implant with a so-called
bone cement (a two-component epoxy glue) can make sense. This ensures high
stability. A combination of the two techniques is also possible and is often
used. The material for cemented implants is usually a chrome-cobalt alloy,
cementless implants are usually made of titanium alloys.
The two parts of the
implant that form the surface of the joint and interact with each other are also
of great importance. They are called "articulating" or "bearing" surfaces: after
years of use, wear of these surfaces is inevitable and sets limits on the
durability of the implant. The combination of metal/polyethylene and
ceramics/polyethylene have proved themselves in this respect.
A further
reduction in wear is expected of metal/metal bearing surfaces (e.g. Metasul™),
ceramic/ceramic bearings (Biolox forte™) and new highly crosslinked
polyethylenes (e.g. Durasul™, Marathon™), which should significantly lengthen
the durability of implants. If one of the bearing surfaces is to be preferred is
yet to be determined, since long-term results over a ten-year period are not yet
available in sufficient volume.Go to top
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Will my legs be of equal length after surgery?
One of the goals of joint replacement surgery is to ensure that the legs will
be the same length. Experience and careful pre-operative planning ensure that
this goal is reached in most cases. Under special circumstances however it might
be necessary to lengthen the operated leg in order to gain the necessary
stability for optimal function and to prevent dislocation. Under these
circumstances there will be a difference in length. Either the spine takes care
of this difference or a shoe raise provides help. As a rule however both legs
are of equal leg length after the operation.Go to top
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Will I need a blood transfusion?
Since joint replacement surgery is not an emergency, it can be planned well
in advance. You can therefore donate your own blood for the operation.
Furthermore the blood you lose during surgery can be collected, cleaned and
given back to you (mechanical auto transfusion). In rare cases blood
transfusions cannot be avoided but careful screening of blood donors and strict
controls over blood products has led to a major reduction in the risk of disease
transfer through blood transfusion.Go to top
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How long do I have to stay in the hospital after surgery and when can I go back to work?
You should reckon on being in hospital for 14 days after a joint replacement
operation, followed by 14 to 21 days in a recuperation centre. After joint
replacement surgery, dependent on the type of operation, we would normally
certify you as unfit to return to work for between six weeks and four months. Go to top
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How soon after surgery can I walk without crutches?
You will usually get up out of bed for the first time two days after surgery
and will learn to walk with the aid of crutches under the guidance of a
physiotherapist. Depending on the type of surgery it will normally be four to
six weeks before you can walk without crutches.Go to top
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How important are check-ups after surgery?
Do I have to have a check-up even if I feel fine? About three months after
surgery you will return to our hospital for an out-patient check-up. Further
appointments should be planned for 12 months later and for every second year
thereafter. The continuing regular check-ups by your surgeon will ensure the
longest possible and trouble-free functioning of your joint since he can see
possible changes at an early stage and if necessary can treat them. Even if you
feel well you should schedule a check-up every two years. The reason: some
changes begin without any pain and can only be felt relatively late. You can
therefore help prevent major damage to your joint by regular visits for a
check-up.Go to top
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What impact will the artificial joint have on my life?
Once you have an artificial joint your lifestyle will not actually change
very much. The real difference will be the major improvement in your quality of
life, since the pain and discomfort coming from your hip or knee will either no
longer be there or be hardly noticeable. Changes in the neighbouring joints and
other structures such as the spine, do not of course vanish immediately after
surgery but can improve during the following months. In general you should avoid
overtaxing yourself physically, not pushing your body beyond its limits of
fatigue and planning your activities accordingly. Heavy lifting and continuous,
substantial bodily exertion are not recommended. When choosing the type of sport
you should consider low impact activities like swimming, cycling, hiking and
cross-country skiing. Other suitable sports are golf and - with restrictions -
alpine skiing. Sports unsuitable after joint replacement include tennis, squash,
martial arts and team sports like football, basketball or volleyball. In general
only sports you have mastered before surgery should be taken up again
afterwards.
In your job you should also avoid heavy manual work wherever
possible, if necessary considering a change in the type of job you do.
With
the fixtures and furniture in your house or apartment you can also implement
changes to protect your joint, especially for the time immediately after your
operation: raised toilet seats, higher beds or sofas, the removal of dangers
like cables running across on the floor. Handles in the bath, next to the toilet
or in the shower are also helpful.Go to top
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How long can I expect my artificial joint to last?
An artificial joint will last on average for 12 to 15 years - a long time if
you take into account the enormous stresses it is continuously subjected to. The
main reason for possible problems is the loosening of implants due to the wear
of the bearing materials involved. But other factors like height, body weight,
activity level and quality of bone substance also play an important role in the
longevity of the implant.
Newly developments in materials like metals,
ceramics and special plastics give cause for high hopes that the implants used
today will last much longer than the ones used in the past. This is confirmed by
laboratory tests which show excellent results. These developments are however in
part only a few years old. Therefore clinical proof is restricted to a limited
period but so far fully confirms our predictions.
If, after many years of
unhampered use, the implant needs to be replaced (the experts call this
"revision surgery"), special implants are available for this purpose. Thanks to
new and improved techniques, revision surgery today is much less invasive and no
longer restricted to one or two operations. It can, if necessary, be repeated
several times. Go to top
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