Arthroplasty Health Article

Diagnosis/Preparation

Significant disabling pain, deformity, and reduced quality of life are the primary indications for arthroscopic procedures. Patients at this stage of discomfort and disability will most likely have already been diagnosed with a form of arthritis. Pain and stiffness on weight-bearing joints are the major symptoms that patients report, though some people experience night pain as well. Other symptoms may include stiffness, swelling, and locking of the joint; and even the joint giving way, particularly when the knees or hips are affected. To determine the extent of disabling, the referring physician and/or the surgeon will likely ask about walking distance, sporting ability, the need for walking aids, and the ability to perform self-care tasks such as dressing and bathing. Besides evaluation of the joint itself and level of mobility, the clinical examination will include evaluation of the patient's general health, the condition of the ligaments and muscles around the affected joint, and also assessment of the patient's mental outlook and social circumstances to help develop the most effective postoperative rehabilitation plan. Diagnostic testing will typically include:

• x rays of the affected joint (and other joints as well)to determine loss of joint space and to differentiate between OA and RA
• imaging studies, such as computed tomography (Cat scans), magnetic resonance (MRI), and bone densitometry to assess bone loss or bone infection
• cardiac tests, such as electrocardiogram, to evaluate the heart and circulatory system
• blood tests to rule out infection and possibly to confirm arthritis

Prior to arthroplasty, standard preoperative blood and urine tests are performed to rule out such conditions as anemia and infection. If a patient has a history of bleeding, the surgeon may ask that clotting tests be performed. The patient will meet with the anesthesiologist to discuss any special conditions that may affect the administration of anesthesia. Surgery will not be performed if infection is present anywhere in the body or if the patient has certain heart or lung diseases. Smokers will be asked to stop smoking. Weight loss may also be recommended for overweight patients. If surgery involves deep tissue and muscle, such as total hip arthroplasty, the surgeon may order units of blood to be prepared in case transfusion is needed to replace blood lost during the surgery. Healthy patients may be asked to donate their own blood, which will be returned to them at the time of surgery (autologous transfusion). Certain pain medications may have to be discontinued in the weeks just prior to surgery.

Aftercare

Immediately after surgery, while still in the hospital, patients will be given pain medications for the recovery period and antibiotics to prevent infection. When patients are discharged after joint surgery, they must be careful not to overstress or destabilize the joint, requiring rest at home for a period of weeks. Physical therapy will begin immediately to improve strength and range of motion; it is the most important aid to recovery and may continue for several months. Activity may be resumed gradually, using devices if necessary, such as walkers or crutches, as recommended by the physical therapist. Lifestyle changes may include the use of special seating or sleeping surfaces, and employing home care assistance for help with shopping, cooking, and household tasks.

Risks

Joint resection and interpositional reconstruction do not always produce successful results, especially in patients with rheumatoid arthritis, a chronic inflammatory disease that may continue to narrow the joint space and accelerate the formation of scar tissue. Repeat surgery or total joint replacement may be necessary. As with any major surgery, there is always a risk of an allergic reaction to anesthesia, post-operative infection, or the formation of blood clots (thrombophlebitis) that may cause pain and swelling near the surgery site and travel through the veins to other parts of the body. A joint that has undergone surgery is less stable than a healthy joint and dislocation or loosening of the resected joint may occur, especially with inappropriate physical activity.

Normal results

Most patients enjoy an improved range of motion in the joint and relief from pain. Younger people may actually return to some form of low-impact sports activity. However, people who have degenerative or inflammatory diseases must understand that they will not suddenly have a normal joint, even while they will gain pain relief and improved function.

Morbidity and mortality rates

The number of deaths for all arthroplasty surgeries is less than 1%, with death more likely to occur among elderly patients and those with other serious medical conditions.