Knee and Hip Joint Replacement

Most of us take for granted the thousands of motions that use our joints each day – unless you suffer from joint pain. Because when a knee, hip, shoulder or other joint becomes damaged from injury, arthritis or wear and tear, even the slightest movement can become excruciating. At JointONE, we work together as a team to ensure the best possible course of treatment and outcome for each patient. Whether you need surgery, non-surgical interventions or a referral to a different sub-specialist, you can count on JointONE to do what’s right for you.

Our board-certified surgeons have a long history of providing orthopedic care and pioneering surgical techniques. We’ve developed an innovative hip preservation program designed to delay or avoid total hip replacement surgery, while effectively treating pain. When total joint replacement is needed, our surgeons are the leaders in the area because they are active in the development and research of new artificial joints designed for extended longevity, and they participate in national clinical research on joint replacements. This gives JointONE patients access to the most up-to-date implants and technology available for quicker recovery and longer prosthetic life.

Through our partnership with the state-of-the-art Parkview Ortho Hospital, joint replacement patients receive a total care experience – from diagnosis and treatment through rehab and recovery. Plus, they have access to the Club Ortho program with its innovative approach to education and rehabilitation.

Since 1962, JointONE has established an impressive record of patient care. And today, JointONE is ranked among the 40 top hip replacement, knee replacement and shoulder replacement teams in the nation. Don’t let joint pain slow you down.

Common Joint Conditions

JointONE is recognized as a regional and national leader in joint care. Our board-certified orthopedic surgeons specialize in the diagnosis and treatment of all types of joint disorders and advanced joint replacement procedures for hips, knees and shoulders. Conditions commonly treated at JointONE include:

  • Degenerative osteoarthritis
  • Rheumatoid arthritis
  • Gouty arthritis
  • Arthritis from fractures
  • Infectious Joint Disease
  • Tumors
  • Hip fractures

Arthritis

The most frequent source of debilitating pain and joint destruction is arthritis. It is estimated that 36 million people in the United States have some form of arthritis. Of the more than 100 types of arthritis, the following three are the most common sources of joint damage

It is sometimes called degenerative arthritis, is a disease which involves the breakdown of the tissue (cartilage) that normally allows the joint to move smoothly. When the gliding surface of the cartilage is gone, the bones grind against each other, creating popping sounds, pain and loss of normal movement. Although this condition occurs primarily in people over 50, it can begin at a younger age as a result of injury or overuse. Osteoarthritis commonly affects the hip, knee and shoulder.
It is considered a systemic disease because it can attack any or all joints of the body. It affects women more often than men, and can strike both young and old, but usually occurs in adults over 30 years of age. Rheumatoid arthritis causes the body’s immune system to produce a chemical that attacks and destroys the protective cartilage that covers the joint surface. The joint linings swell and pain and stiffness are usually present even when the joint is not in use. This usually occurs in the hands and feet, but larger joints such as the hips, knees and elbows may be involved.
This happens when the joint is injured, either by fracture, dislocation or damage to the ligaments surrounding the joint causing instability or damage to the joint surfaces.
Today, most types of arthritis cannot be cured. Anti-inflammatory drugs, exercise and physical therapy may be helpful in reducing stiffness and pain. The use of proper body mechanics as well as canes, walkers or crutches may also lessen stress on affected joints and help to improve function.

When conservative methods of treatment fail to provide adequate relief, a cartilage restoration procedure or total joint replacement may be considered. Use the information on this site to learn more.

Treatment

At JointONE, you’ll find a comprehensive array of medical specialists — anesthesiologists, surgeons, physiatrists, physical therapists and certified athletic trainers — all working together to ensure the best possible course of treatment and outcome for each patient. Most recently, our specialists have developed an innovative hip preservation program designed to delay or avoid total hip replacement surgery, while effectively treating pain.

From non-surgical treatments to advanced Cartilage Restoration procedures to the latest minimally invasive joint replacements, you can count on JointONE to be there every step of the way on your road to recovery.

ONE is on the Leading Edge of Bio-Orthopaedics

As the region’s largest Orthopedic practice, Ortho NorthEast is committed to providing the most comprehensive treatment options. The new Cartilage Restoration Center (CRC) is an exclusive Center of Excellence that provides alternatives to joint replacement surgery. ONE physicians are skilled in a wide range of procedures that offer relief to those who have an injury or joint deterioration that causes pain, swelling, loss of motion and other symptoms. Cartilage restoration therapy is considered ideal for patients under the age of 50 who are seeking to delay or avoid joint replacement and maintain active lifestyles.
The Cartilage Restoration Center combines leading cartilage repair techniques in a subspecialty that includes all major joints: knee, hip, shoulder, elbow and ankle.

Procedures currently offered include:

  • Microfracture surgery — a minimally invasive procedure that encourages the growth of new cartilage
  • OATS (Osteoarticular autograft transfer system) — a transfer of healthy hyaline cartilage to the site of damaged articular cartilage (Patient’s own cartilage)
  • Osteoarticular allograft — replaces damaged cartilage and encourages new cartilage growth (donor cartilage)
  • Cartilage transplant — replaces cartilage defects with new cartilage cells to help restore normal joint function
  • Meniscus transplant — replaces the damaged meniscus “cushion” of cartilage with donor cartilage
  • Viscosupplementation — an injection of a thick fluid to help cushion the joint, provide lubrication and encourage cartilage growth

To learn more about the Cartilage Restoration Center or to consult with an ONE physician, contact us to arrange an appointment.

What you can do today to preserve your hips for tomorrow.

Total joint replacement surgery is a modern medical miracle, offering relief to people whose hips have deteriorated to the point to no return. However, as helpful as the surgery is, it is a major undertaking and should only be considered as a last resort for pain and progressive degenerative diseases. That’s why Ortho NorthEast has developed an innovative hip preservation program designed to delay or avoid total hip replacement surgery, while effectively treating pain.

Team ONE

ONE takes a team approach to hip preservation, with doctors from different specialties working together to create individualized treatment plans for each patient. The final goal is always the same, preserving the natural joint by delaying the need for total joint replacement surgery. Each plan begins with an initial assessment and diagnosis, which rules out other causes of the pain, such as underlying vascular or spinal issues. A unique treatment strategy specific to your needs is then developed that may include medications, physical therapy, injections or a combination of these. ONE’s individualized hip preservation plans often provide effective pain relief while also helping to preserve the natural joint.

Sign of Possible Problems

If you experience any of the following issues with your hip, now is the time for action, before these conditions get any worse.

  • Pain
  • Catching or locking sensation
  • Clicking or popping
  • Pinching
  • A feeling like the joint is “giving way”

Questions to Consider

When seeking treatment for hip pain, the answers to the following questions will help the ONE hip preservation team decide how to most effectively treat your individual case.

  • Was there an injury?
  • How long has the pain been present?
  • Where is the pain located?
  • Are there specific movements that recreate the pain?
  • What actions make the pain worse?

Hip Issues

ONE’s hip preservation program treats a variety of issues ranging from minor aches caused by wear and tear on joints to more serious pain caused by progressive degenerative diseases. Our hip preservation program treats the issues before there’s a need for hip replacement surgery. Some of the more serious, yet common, issues we treat are:

  • Arthritis – In the hip, arthritis is a leading indicator of the need for eventual hip replacement surgery. The ONE hip preservation team has a variety of treatments for the pain and damage caused by arthritis.
  • FAI – Femoroacetabular Impingement is a common hip condition where the ball and socket of the hip joint rub abnormally, creating friction, pain and damage to the joint. ONE is the only orthopedic team in the area to specifically treat FAI.

Take the Next Step

Regardless of your age, if you are having any symptoms of hip problems, now is the time to treat them. Don’t wait any longer; find out what you can do today to preserve your hips for tomorrow. Call ONE at 484-8551 or toll free at 1-800-589-8551 and ask about ONE’s hip preservation program.

Knee Replacement

When pain, stiffness, knee swelling and limitation of motion in your knee keep you from your daily activities, you may need total knee replacement. (The most frequent source of debilitating pain is arthritis.) The development of total knee replacement began more than 30 years ago. Today, more than 200,000 people in the United States annually undergo knee replacement surgery as a means of diminishing pain and stiffness and restoring mobility.

The Knee Joint

The knee is the largest joint in the body. It is commonly referred to as a “hinge” joint because it allows the knee to flex and extend. While hinges can only bend and straighten, the knee has the additional ability to rotate (turn) the femur (thigh bone) and the patella (knee cap). Each bone end is covered with a layer of smooth shiny cartilage that cushions and protects while allowing near frictionless movement. Cartilage, which contains no nerve endings or blood supply, receives nutrients from the fluid contained within the joint. Surrounding the knee structure is the synovial lining, which produces this moisturizing lubricant. If damaged, the cartilage is not capable of repairing itself.

Tough fibers, called ligaments, link the bones of the knee joint and hold them in place; adding stability and elasticity for movement. Muscles and tendons also play an important role in keeping the knee joint stable and mobile.

Your Knee Evaluation

An orthopedic surgeon specializes in problems affecting bones and joints. Your knee evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary and medically safe. It helps the surgeon understand your pain, limitations in activity and the progression of your knee problem.

After your history is taken, a physical exam is performed. The range of motion of your knee is measured, your legs are evaluated for variances such as bowlegs or knock-knees, and your muscle strength is analyzed. The surgeon will observe how you walk, sit, bend and move.

X-rays are taken of your knee joint. Bring any X-rays that may have been taken of your knee in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new knee prosthesis.

A small amount of fluid may be taken from your knee joint to check for infection.

After your initial orthopedic evaluation, the surgeon will discuss all possible alternatives to surgery. If the X-rays show severe joint damage and no other means of treatment has provided relief, total knee replacement may be recommended.

Total Knee Replacement

Total knee replacement or “arthroplasty” is the relining of the joint (bone end surfaces) with artificial parts called prostheses.

There are three components used in the artificial knee. The femoral (thigh) component is made of metal and covers the end of the thigh bone. It may be cemented to the bone or, for some prostheses, inserted without cement for tissues to grow into the porous coating of the device (biological fixation). The tibial (shin bone) component, made of metal and polyethylene (medical-grade plastic), covers the top end of the tibia.

The metal forms the base of this component, while the polyethylene is attached to the top of the metal to serve as a cushion and smooth gliding surface between the metal of the femoral and tibial components. The tibial component may be secured to the bone with bone cement or, for some porous coated prostheses, biologically fixed by tissue ingrowth.

The third component, the patella or knee cap, may be all polyethylene or a combination of metal and polyethylene. Depending on the prosthesis used, this part may be fixed with or without cement.

The total knee replacement is inserted through an incision that runs three or four inches above the knee down along the inside of the kneecap to several inches below the knee. The new components are stabilized by your ligaments and muscles, just as your natural knee was.

Before Surgery

You may be asked to see your family physician or an internal medicine doctor for a more thorough medical evaluation. To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you take estrogen (i.e. Premarin), your surgeon will probably advise you to stop taking it one month prior to surgery. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery.

You will probably be admitted to the hospital the morning of surgery. You cannot eat or drink anything after midnight the day of surgery.

In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. The anesthesiologist will speak to you before surgery and discuss the type of anesthetic to be used.

What To Expect After Surgery

You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You may feel as though you only left your room for a few minutes. If you experience pain, medication will be available.

You may have a tube or drain coming through the surgical dressing that is attached to a drainage apparatus. This system provides gentle, continuous suction to remove any blood that accumulates in the surgical area. The drain will probably be removed several days after surgery. The dressing will also be changed and a smaller one applied.

An “immobilizer” (a cloth support with stays) will fit around this dressing and will hold your leg straight. An alternative to immobilization after surgery is the use of a “Continuous Passive Motion” (CPM) machine. Your leg is held softly in a cradle. The knee is then gently and slowly bent and straightened.

Your leg will be supported and elevated on one or two pillows to help your circulation and stretch the muscles behind your leg. You will be asked to move your ankle to promote circulation and prevent stiffness in your ankle joint. The immobilizer may be used the first 48 hours after surgery, then removed. The CPM machine may be used the next 48 hours or longer, if needed, even after you leave the hospital.

The nurse will assist you in turning on your side, if you wish. You may adjust the head of the bed to any level you desire. The knee adjustment on the bed should not be used. Your knee should remain straight unless you are performing knee exercises.

An IV may remain in your arm for several days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon.

To prevent problems in your lungs, you may receive an incentive spirometer after surgery to encourage you to cough and breathe deeply. This is used every hour while you are awake.

It is normal to feel pain and discomfort after surgery. Inform the nurse of your pain, and medication will be ordered.

Physical Therapy

A knee rehabilitation program, which begins 24 hours after surgery, will be ordered and supervised by your surgeon. Isometric exercises (tightening muscles without moving the joint) will begin while you are still in bed.

You will be instructed to do these exercises a number of times per day while awake. You will be encouraged by the physical therapist to move your ankle and other joints so that you will remain strong. These exercises will help you regain strength and mobility.

The day after surgery, you will probably begin walking and exercising your knee joint. The exercises will probably be done twice daily. Initially, the physical therapist will assist you in getting out of bed and standing at the bedside with a walker. For your entire hospital stay, you will walk with a walker or crutches under the supervision of a therapist. Your walking distance will gradually increase. When you are strong enough, you will be able to walk without the support of the immobilizer.

Through progressive daily exercises, you may achieve about a 90-degree bend in the knee joint by the time you leave the hospital. Bending your knee during the exercises may be painful. Pain medication taken before therapy will make the exercises more comfortable. Ice packs, hot packs and other treatments may be used to assist you in bending your knee.

Preparing To Go Home

The usual hospital stay for knee joint replacement is usually one to two days. Depending on your progress, you will probably gain independence within one week after surgery. To accommodate sitting, there will be an elevated chair and commode available for your use. An elevated toilet seat will be ordered for you to take home. At home, you will need a firm chair with arms.

Just prior to your discharge, you will receive instructions for your at-home recovery. Until you see the surgeon for your follow-up visit, you must take certain activity precautions. It is important for you to adhere to your surgeon’s directions and follow proper positioning techniques throughout your rehabilitation. Arrangements will be made for someone to remove the sutures or skin clips about 10 days after surgery.

It is normal for you to have some discomfort. You will probably receive a prescription for pain medication before you go home. If a refill is needed, please call your surgeon’s nurse at least five days before you run out of pills.

Look for any changes around your incision. Contact your surgeon if you develop any of the following:

  • Drainage and/or foul odor coming from the incision.
  • Fever (temperature about 101 degrees F or 38 degrees C) for two days.
  • Increased swelling, tenderness, redness and/or pain.

Take time to adjust to your home environment. It is normal to feel frustrated, but these frustrations will soon pass. It is okay to take it easy.

Resuming Activities

Depending upon the physical demands of your job, you normally can resume work when authorized by your surgeon.

You usually may begin driving once you are able to bear full weight on your knee. Be sure you are comfortable with your strength. Be sure to practice driving in a safe area. Once you are comfortable with your mobility, you generally may drive anywhere.

Sexual intercourse may be resumed at any time as long as all knee precautions are kept in mind.

We encourage you to be active in order to control your weight and muscle tone. It is generally three to four months before you can resume low-impact aerobic activity such as walking, golfing, bowling and swimming. Jogging, high-impact aerobics and contact sports are never allowed. Your new knee is artificial and although it is made of very durable materials, it is subject to wear and tear.

Since your rehabilitation is an individual one, please seek advice on future activities from your surgeon.

Special Instructions

You may be seen six weeks, five months and twelve months after your surgery. It may be requested that you see your surgeon once a year after the first year, even if you are not having any problems.

Any infection must be promptly treated with proper antibiotics because infection can spread from one area of the body to another through the blood stream. Every effort must be made to prevent infection in your artificial joint. You should always tell your dentist or physician that you have an artificial joint. If you are to have dental work performed, please call your surgeon prior to having this work done. Your surgeon will most likely prescribe an antibiotic for you. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.

Hip Replacement

When pain and stiffness in your hip keep you from your daily activities, you may need total hip replacement. (The most frequent source of debilitating pain is arthritis.) The development of total hip replacement began over 40 years ago. Today, more than 180,000 people in the United States annually undergo hip replacement surgery to diminish pain and stiffness and restore mobility.

The Hip Joint

A joint is a junction where two or more bones meet. The hip joint forms where the top of the femur (thigh bone) meets the acetabulum (the socket of the pelvic bone). The top of the femur is ball-shaped and fits snugly in the socket formed by the acetabulum. The bones of the hip joint are covered by a layer of smooth, shiny cartilage that cushions and protects the bones while allowing easy motion. Surrounding the hip joint is the synovial lining, which produces a moisturizing lubricant. Tough fibers, called ligaments, connect the bones of the joint and hold them in place, while adding strength and elasticity for movement. Muscles and tendons also play an important role in keeping the joint stable.

Your Hip Evaluation

Your hip evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary. It helps the surgeon understand your pain, limitations in activity and the progression of your hip problem.

After your history is taken, a physical exam is performed. The range of motion of your hips and knees are measured and your muscle strength is evaluated. The surgeon will observe how you walk, sit, bend and move.

X-rays are taken of your hip joint. Bring any X-rays that may have been taken of your hip in the past. These X-rays will help your surgeon plan the surgery and evaluate the fit of your new hip prosthesis.

A small amount of fluid may be taken from your hip joint to check for infection.

After your initial orthopaedic evaluation, the surgeon will discuss possible alternatives to surgery. Ortho NorthEast has developed an innovative hip preservation program designed to delay total hip replacement surgery, while effectively treating pain. If the X-rays show severe joint damage and no other means of treatment has provided relief, total hip replacement may be recommended.

Total Hip Replacement

Total hip replacement or “arthroplasty” is the replacement of the ball and socket of the hip joint with artificial parts called prostheses. There are two main components used in total hip replacement. The femoral component is made of metal and replaces the ball. The acetabular component replaces the socket and may be made entirely of a very hard medical-grade plastic called polyethylene. It may also be made of a metal and polyethylene combination in which the polyethylene cup is placed inside a metal shell. The acetabular component is then secured inside the natural pelvic socket.

The natural ball portion of the femur (thigh bone) is removed during surgery and the inside of the femur (the canal) is drilled and enlarged to fit the femoral component of the hip prosthesis. The socket portion of the pelvis is also enlarged with a special surgical instrument to make room for the new artificial socket component. The femoral component is inserted down the enlarged shaft of the thigh bone. The acetabular component is inserted into the enlarged socket. The ball and socket are then fitted together and stabilized with the surrounding ligaments and muscles, just as your original hip had been.

Before Surgery

You may be asked to see your family physician or an internal medicine doctor for a more thorough medical evaluation. To prepare yourself for surgery, you may be asked to do a number of things. You may be asked to lose weight if you are overweight. If you smoke, it is important for you to stop two weeks prior to surgery. If you are taking aspirin or certain arthritis medications, inform your surgeon; you may need to stop taking these two weeks before surgery. If you take estrogen (i.e. Premarin), your surgeon will probably advise you to stop taking it one month prior to surgery. Your doctor may want you to donate your own blood ahead of time for a possible transfusion during surgery.

You will probably be admitted to the hospital the morning of surgery. You cannot eat or drink anything after midnight the day of surgery.

In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. The anesthesiologist will speak to you before surgery and discuss the type of anesthetic to be used.

What To Expect After Surgery

You will awaken after your surgery in the Post-Anesthesia Recovery Room. You will remain there until you have recovered from the anesthesia, are breathing well, and your blood pressure and pulse are stable. You may feel as though you only left your room for a few minutes. If you experience pain, medication will be available.

You may have a tube or drain coming through the surgical dressing that is attached to a drainage apparatus. This system provides gentle, continuous suction to remove any blood that may accumulate in the surgical area. The drain will probably be removed several days after surgery. Your dressing will be changed and a smaller one applied.

You may move the leg that was not operated on as soon as you awaken. As you lie on your back, flexing the non-operative hip will reduce aching in your lower back. The nurse will help you find comfortable positions. You may turn with a pillow between your legs. The nurse will encourage you to do ankle pumping exercises every hour to protect against blood clots.

An IV may remain in your arm for several days to administer antibiotics or other medications you may need. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. You will begin regular fluid and food intake under the direction and advice of your surgeon.

To prevent problems in your lungs, you may receive an incentive spirometer after surgery to encourage you to cough and breathe deeply. This is used every hour while you are awake.

It is normal to feel discomfort after surgery. Inform the nurse of your pain, and medication will be ordered.

Physical Therapy

A hip rehabilitation program begins right after surgery and is ordered by your surgeon. Isometric exercises (tightening muscles without moving the joint) will begin while you are still in bed. You will be instructed to do these exercises a number of times per day while awake. You will be encouraged by the physical therapist to move your ankle and other joints so that you will remain strong. These exercises will help you regain strength and mobility. The day after surgery, you will probably begin walking and performing exercises that move your hip joint. Initially, the physical therapist will assist you in getting out of bed and standing at the bedside with a walker. For your entire hospital stay, you will probably walk, with a walker or crutches, two times per day under the supervision of the therapist. Your walking distance will gradually increase.

To protect your hip, you will not be permitted to sit past a 90-degree angle. To accommodate sitting, there will be an elevated chair and an elevated toilet available for your use. This will allow your hip to be higher than or equal to your knee while sitting.

The therapist will teach you how to dress, get out of bed without help and use a walker or crutches. You will continue to work to strengthen yourself in preparation for your return home.

Preparing To Go Home

The usual hospital stay for hip joint replacement is one to two days. You will quickly gain independence after your surgery. Just prior to your discharge, you will receive instructions for your at-home recovery. Until you see the surgeon for your follow-up visit, you must take certain activity precautions. It is important for you to adhere to your doctor’s directions and follow proper positioning techniques throughout your rehabilitation. By the time you leave the hospital, you normally will be progressing well in regaining mobility and stability. If sutures or clips are not ready to be removed before discharge, you will be advised about who will remove them and where this will be done.

It is normal for you to have some discomfort. You will probably receive a prescription for pain medication before you go home. If a refill is needed, please call your surgeon’s nurse at least five days before you run out of pills.

Look for any changes around your incision. Contact your surgeon if you develop any of the following:

  • Drainage and/or foul odor coming from the incision.
  • Fever (temperature about 101 degrees F or 38 degrees C) for two days.
  • Increased swelling, tenderness, redness and/or pain.

Take time to adjust to your home environment. It is normal to feel frustrated, but these frustrations will soon pass. It is okay to take it easy.

Resuming Activities

Depending upon the physical demands of your job, you normally can resume work when authorized by your surgeon. You usually may begin driving once you are able to bear full weight on your hip. Be sure you are comfortable with your strength. Be sure to practice driving in a safe area. Once you are comfortable with your mobility, you generally may drive anywhere.

Sexual intercourse may be resumed at any time as long as all hip precautions are kept in mind.

We encourage you to be active in order to control your weight and muscle tone. It is generally three to four months before you can resume low-impact aerobic activities such as walking, bicycling and swimming. Jogging, high-impact aerobics and certain sports should be avoided. Your new hip is artificial, and although made of extremely durable materials, it is subject to wear and tear.

Since your rehabilitation is an individual one, please seek advice on future activities from your surgeon.

Special Instructions

You may be seen six weeks, five months and twelve months after your surgery. It may be requested that you see your surgeon once a year after the first year, even if you are not having any problems, to check out the condition of your new hip joint.

Any infection must be promptly treated with proper antibiotics because infection can spread from one area to another through the blood stream. Every effort must be made to prevent infection in your artificial joint. You should always tell your dentist or physician that you have an artificial joint. If you are to have dental work performed, please call your surgeon prior to having this work done. Your surgeon will most likely prescribe an antibiotic for you. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.

Shoulder Replacement

The shoulder is a very mobile and complex joint in which the muscles and ligaments work together to allow the free and easy movement found in a healthy shoulder. When pain and stiffness in your shoulder (most frequently caused by arthritis) keep you from your daily activities, you may need shoulder replacement. The development of total shoulder replacement began over 40 years ago, and over 15,000 people each year undergo this surgery to diminish pain and stiffness and restore mobility. If your X-rays show destruction of the joint, your surgeon will decide if your degree of pain and loss of use is severe enough to warrant the operation.

The primary purpose of the operation is to relieve your pain. The secondary purpose is to increase your range of motion. The extent of improvement in your range of motion will depend on the severity of your preoperative condition, the length of time you have had the problem, the range of motion of your shoulder before surgery and your commitment to the preoperative and postoperative rehabilitation programs. Total joint replacement is a remarkably successful operation that has transformed the lives of many people. Many of those who once suffered from severe pain and stiffness in a joint are again swimming, golfing, playing tennis and dancing.

The Shoulder Joint

A joint is a junction where two or more bones meet. The shoulder joint is considered one of the most complex joints in the body, with three bones meeting there — the scapula (shoulder blade socket), clavicle (collar bone) and humerus (upper arm bone). The shoulder joint is unique in that the ball of the upper arm bone is two times larger than the socket of the shoulder blade. This creates a very mobile joint, but demands an extensive array of ligaments and muscles to keep the joint together. The muscles and ligaments together allow the free and easy movement found in the healthy shoulder.

The muscles around the shoulder include the powerful and large deltoid muscle which forms the bulk of the shoulder muscle mass; four smaller and deep muscles that comprise the rotator cuff; and multiple large muscles of the back and neck that help to stabilize the shoulder joint.

Your Shoulder Evaluation

Your shoulder evaluation will begin with a detailed questionnaire. Your medical history is very important in determining whether surgery is necessary. It helps the surgeon understand your pain and the progression of your shoulder problem.

After your history is taken, a physical exam is performed. The range of motion of your shoulder is measured and your muscle strength is evaluated. A small amount of fluid may be taken from your shoulder joint to check for infection.

X-rays are then taken of your shoulder joint. Bring any X-rays that may have been taken of your shoulder in the past. These X-rays will help your surgeon plan the surgery and identify the correct size shoulder prosthesis, if necessary.

After your initial orthopedic evaluation, the surgeon will discuss all possible alternatives to surgery. If the x-rays show severe joint damage and no other means of treatment has provided relief, total shoulder replacement may be recommended.

Total Shoulder Replacement

Total shoulder replacement or shoulder arthroplasty is the replacement of the ball of the upper arm and socket of the shoulder blade with specially-designed artificial parts, called prostheses, made of metal and polyethylene (a medical-grade plastic).

The humeral (upper arm) prosthesis consists of a metal ball that replaces the head of the humerus, and a body and stem that is secured into the upper arm bone. The glenoid (shoulder blade socket) prosthesis is made of a special polyethylene, and is designed to replace the socket part of the joint. The metal ball and stem units are selected by your surgeon from multiple sizes to fit the contour and shape of your humerus. This two-piece construction is known as a modular prosthesis. This allows fitting of the ball and socket to your shoulder, which enhances the proper repair and tension of the muscles around the joint.

There are two types of shoulder replacement procedures. If the surgeon only uses the metal humeral (upper arm bone) components, the procedure is called a hemi-arthroplasty. If the surgeon uses both the humeral components and the glenoid (shoulder blade socket) prosthesis, then the procedure is called a total shoulder arthroplasty. The surgeon decides which procedure to use based on the extent of damage to your shoulder.

Before Surgery

You may be asked to see your family physician or an internist for a thorough medical evaluation one to two weeks prior to hospital admission. You may be asked to lose extra weight. If you smoke, it is important to stop two weeks before surgery. If you are taking any anti-inflammatory medications, your surgeon will probably advise you to stop taking them one week prior to surgery. This helps to minimize bleeding during your operation.

If Estrogen (Premarin) is being used, your surgeon will probably advise you to stop taking it one month before surgery. Your doctor may want you to donate your own blood ahead of time in the event that transfusions are needed during surgery.

You will probably be admitted to the hospital the morning of surgery. You cannot eat or drink anything after midnight the day of surgery.

In order to receive medications and blood transfusions during surgery, an intravenous (IV) line will be started. The anesthesiologist will speak to you before surgery and discuss the type of anesthetic to be used.

What to Expect After Surgery

You may have a drainage tube coming out through your surgical dressing, which will be attached to a portable drainage apparatus. This system provides continuous, gentle suction to remove any blood that may be accumulating in the surgical area. It is usually removed on the first or second day after surgery. Your dressing will probably be changed on the first or second postoperative day, and cold compresses may be applied for up to two days.

On the first postoperative day, you may begin drinking fluids and eating meals under the direction of your surgeon.

The IV will remain in your arm for one to two days to administer fluids and antibiotics. This helps prevent infection and gives you proper nourishment until you are eating and drinking comfortably. It is normal to feel pain and discomfort after surgery. Be sure to inform your nurse of your pain, and medication will be ordered.

To prevent fluids from building up in your lungs, you will receive an incentive spirometer to encourage you to cough and breathe deeply. This will be used every hour while you are awake.

Your arm will be in a shoulder immobilizer, which protects and positions your shoulder, or it may be placed in a shoulder splint. Keeping a small pillow or folded blanket under your elbow while sitting or lying down will prevent the arm from falling back and straining the area of your operation.

A trapeze bar attached to the bed will help you move about more easily. It is important that you use only your non-operative arm with the trapeze. You do not want to turn on or move your postoperative shoulder until instructed that it is alright to do so by your surgeon. The nurse will help you find comfortable positions.

On the first or second day after surgery, you will be encouraged to use your involved arm for some gentle living activities such as feeding yourself, brushing your teeth, shaving and drinking.

Physical Therapy

The postoperative rehabilitation program normally begins the day of surgery. It consists of stretching exercises and normal, gentle daily activities. The postoperative rehabilitation program is critical, and it is important that you cooperate, follow your surgeon’s instructions and work hard.

Pain medication may be taken prior to your therapy as you request. The members of the surgical team or a physical therapist will gently move your arm and shoulder through various positions while you relax. These early movements and exercises will help prevent stiffness and will help you regain shoulder motion. You will also work on tightening the muscles of your hand and arm by flexing your hand, wrist and elbow.

Depending on your progress, you will gain independence about one week after surgery. You will continue strengthening yourself in preparation of your return home. It is important for you to adhere to precautions and proper positioning techniques throughout your rehabilitation. Your stitches will be removed seven to ten days after surgery.

Just before your discharge, you will receive instructions for your at-home recovery, including how and when to wear your shoulder sling, changing your bandage and bathing and showering. The surgical team will also give you directions and the necessary equipment to continue your rehabilitation program at home and a date for your return appointment.

It is normal for you to have some discomfort, but it will be unusual for you to use pain medication more than five to seven days after surgery. You will receive a prescription for pain medication before you leave the hospital. If a refill is needed, please call your surgeon’s nurse at least five days before you run out of pills.

Preparing to Go Home

Until you see your surgeon for your follow-up visit, you must take certain activity precautions. Look for any changes around your incision. Contact your surgeon if you develop any of the following:

  • Drainage and/or foul odor coming from the incision.
  • Fever (temperature about 101 degrees F or 38 degrees C) for two days.
  • Increased swelling, tenderness, redness and/or pain.

Resuming Activities

You may return to work when authorized by your surgeon. Your surgeon will tell you when you can begin driving a car.

Take time to adjust to your home environment — it is okay to take it easy. You may need help with your daily activities, so it is a good idea to have family and friends prepare to help you. It is normal to feel frustrated, but these frustrations will soon pass.

You are encouraged to return to your normal eating and sleeping patterns as soon as possible, and to be as active as possible in order to control your weight and muscle tone. But remember to increase your activity level or exercises only as your surgeon has directed. Increasing activity too quickly may cause injury and damage to the healing tissue. Avoid activities that could cause stress on your shoulder, especially those that may result in a collision or fall such as contact sports or skiing. During your follow-up visits, your surgeon will discuss your progress with you.

Special Instructions

You may be seen six weeks, five months and twelve months after your surgery. You may also see your surgeon once a year after the first year, even if you are not having any problems.

Any infection must be promptly treated with proper antibiotics because infection can spread from one area of the body to another through the blood stream. Every effort must be made to prevent infection in your artificial joint. You should always tell your dentist or physician that you have an artificial joint. If you are to have dental work performed, please call your surgeon prior to having this work done. Your surgeon will most likely prescribe an antibiotic for you. Antibiotics must be used before and after any medical or dental procedure. This precaution must be taken for the rest of your life.

Whether you have had surgical or non-surgical treatment, you will most likely participate in a JointONE rehabilitation program. We offer a full range of rehabilitation capabilities, including treatment for acute, subacute and chronic conditions, as well as work reconditioning.

Depending on your needs, your individualized rehabilitation program may involve hands-on treatment to improve mobility, instruction in flexibility and strengthening exercises, as well as posture and body mechanics training. If you are having joint replacement surgery, you’ll also be instructed in exercises and activities to help protect your new joint.

Throughout the rehabilitation process, your JointONE physician will work closely with physical therapists to monitor your progress and make sure you regain as much mobility and function as possible.

Patient Education Resources

At ONE, we strive to be your source for the latest information to help you fully understand your condition and treatment options. The links on this page connect you with the latest articles provided by the American Academy of Orthopaedic Surgeons.

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AAOS Knee Articles

AAOS Hip Articles

AAOS Shoulder, Arm & Elbow Articles

AAOS Joint Replacement Articles