Medical surgeries are continuously advancing and progressing in order to help as many people as possible get healthier. Joint replacement surgery is one of the procedures that has become very prevalent because of its simplicity and effective results.

Joints and their function in the body

Joints are the link between the bones in the body. They can be categorised in two ways:

According to the function: Synarthroses (they only provide structural support and don’t move at all), Amphiarthrosis (they have limited movement and give a combination of stability and motion), and Diarthrosis (they move freely).

According to the structure, joints are made of bones and the connective tissues that link them together, which include cartilage, tendons, ligaments, and nerves. Therefore, joints are structurally classified according to how much connective tissue they contain: Fibrous joints (these aren’t very flexible and some of them don’t move, such as the joints in the skull and between the teeth and the jaw bones), Cartilaginous joints (they have some movement but not in many directions, such as the joints between the ribs and the joints between the pelvic bones), and Synovial joints (they have the most freedom movement, such as the joints in knees, elbows, shoulders, hips, neck, wrists, toes, and spine).

Joint replacement surgery

• In arthroplasty, or joint replacement surgery, they replace the damaged joint (or part of it) with another synthetic one. This surgery is usually applied to the joints in your knees, hips, shoulders, ankles, elbows, wrists, fingers, and toes, and the more common condition that requires joint replacement surgery is arthritis, such as osteoarthritis and rheumatoid arthritis
• The synthetic joint is called a prosthesis joint, and it can be made of metal, plastic, or ceramic parts. The new joint may be cemented into place or not, according to your condition
• This surgery was first performed in 1919, and since then, it has gone through a lot of developments and has become one of the most prevalent surgeries¹

Patient criteria for having a joint replacement surgery

Although joint replacement surgery is very common, it’s a major procedure and can lead to some serious complications. Therefore, the patients should meet specific criteria to be selected for this surgery. Joint replacement surgery is usually considered in:²

• Patients with lameness and joint pain that are unresponsive to conservative management
• Patients whose joints have been irreparably deranged and are likely to experience chronic pain and disability
• Osteoarthritis that is causing chronic, intractable joint pain
• Articular fractures that can’t be reconstructed
• Joint (sub)luxation that can’t be satisfactorily managed by alternative methods

Contraindications of joint replacement surgery

There are some cases that can’t undergo joint replacement surgery:²

• Joint diseases that aren’t causing lameness or pain, regardless of radiographic images
• Mild joint pain or lameness that can be managed conservatively
• Pain or lameness that results from other conditions, like degenerative lumbosacral stenosis and brachial plexus neoplasia
• The existence of a neurological disorder, unless the prognosis is good
• Joint sepsis
• Other sepsis issues, such as dental disease, pyoderma, or otitis externa
• Articular or periarticular neoplasia
• The inability to appropriately manage the patient postoperatively

Preparing the patient for joint replacement surgery

1.) It’s critical and very important to educate the patients about the surgery that they will undergo and all the details and outcomes that they might expect after the surgery. Moreover, there has been some evidence that the outcomes of the surgery are better if the patients were educated before about all the concerning details, such as minimising hospital length of stay, decreasing readmission, and improving home discharge.³

2.)Preoperative education is necessary for improving the patients’ expectations about the results of the surgery and what might occur after it. It’s also important for preparing the patient psychologically and for the recovery phase.³

3.) Preoperative education is very useful in decreasing anxiety about the upcoming surgery and it has been estimated that reducing anxiety before the procedure actually improves postoperative recovery, reduces the levels of self-reported pain up to 1 year after the procedure, and results in higher levels of patients’ satisfaction with their surgery.³

4.) Health literacy, which means the degree of the patient’s ability to understand and learn basic health information and services. It has been estimated that patients with poor health literacy have worse health-related outcomes, lower treatment satisfaction, increased hospitalisation, and worse communication with healthcare providers. On the other hand, providing good health literacy to patients will improve their understanding of the surgery, minimise anxiety, and improve clinically significant outcomes.³

5.) Several studies have demonstrated the importance of social support in patients’ outcomes after surgery, and there is some evidence that it’s associated with low mortality, mental health, stress, and depression. Moreover, a lot of patients have reported that social support helped them be less anxious about the surgery, more likely to discharge home, and more confident about discharging. Furthermore, limited social support was observed to negatively affect the quality and rate of recovery after the surgery.³

6.) In addition to educating patients before the surgery, they also must undergo some physical tests to ensure that they are ready for the surgery, such as blood tests, an electrocardiogram (EKG) to check the heart’s condition, a dental exam to exclude any possible risk of infections, and some imaging tests like X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scan.

Undergoing joint replacement surgery

Before starting the joint replacement surgery, the surgical team will give regional or general anaesthesia to the patient. After that, the surgeon starts by removing the damaged cartilage and bone, then inserting the prosthetic joint in addition to inserting some other prosthetic parts to recreate the natural tissue. In the end, they reshape the bones around the joint. The surgery usually takes a few hours, depending on the type of joint that is replaced and whether it’s a partial or total replacement.

What happens after joint replacement surgery?

Discharging from the hospital after joint replacement surgery depends on the condition of the patient; some patients might be discharged on the same day, while others might need to stay at the hospital for a specific period of time. The patient might suffer from temporary pain in the new joint, which can be managed with painkillers and should disappear within a few weeks or months. The patients can also undergo physical therapy, which may help them strengthen the muscles around the new joint and regain motion.

There are some risk factors that are associated with possible bad outcomes:⁴

• Sex and age: Old people and people assigned male at birth are more prone to postoperative infection
• Obesity (BMI ≥ 32)
• Malnutrition
• Comorbidities, such as diabetes, rheumatoid arthritis, asymptomatic bacteriuria, peripheral vascular disease, and chronic skin disease (like atopic dermatitis and psoriasis)
• Living habits, such as smoking and alcohol abuse

Pros and cons of joint replacement surgery

Joint replacement surgery advantages

There are several benefits to having joint replacement surgery: it’s safe, effective, helps people regain their mobility, relieves chronic pain, and increases their quality of life.

Joint replacement surgery disadvantages

In some cases, the pain might not disappear after the surgery, and some rare complications could occur, such as blood clots, infections in the surgery area or the joint, nerve damage, blood vessel damage, problems with the prosthetic implant, scar tissue inside the joint, and reduced range of motion and stiffness.

Summary

Joint replacement surgery is one of the most common surgeries, and it involves replacing the damaged joint with another synthetic one, which helps the patient regain their motion and get rid of pain. However, not everyone can undergo this procedure because there are specific criteria that determine the eligible patients for it. It has been estimated that preparing patients and educating them about their health and the surgery is correlated with better postoperative outcomes.

Nevertheless, like any surgery, there might be some complications, but they are rare. It's also critical that the patients take care of themselves and follow the directions of their healthcare providers to obtain the optimum results from the surgery.