Joint Replacement, or Total Joint Arthroplasty

When a degenerative joint condition becomes disabling and impacts a patient's quality of life, joint replacement, also called total joint arthroplasty, may be indicated. Joint replacement relieves the pain and disability most often caused by severe osteoarthritis or rheumatoid arthritis - resulting in a breakdown of cartilage and generally found in the hips, spine, knees, toes and fingers.

Joint replacement is an alternative to joint fusion, or arthrodesis, and relieves pain while providing range of motion and natural movement required in many daily tasks - particularly important for the hand and fingers.

Salvaging joint function in the upper extremity has been a longtime challenge for those in the field of orthopedics, though today is more promising than ever before.

Total joint replacement, replaces the patient's degenerating joint with an artificial joint, also called a prosthesis, in order to prevent bones once joined by articular cartilage from rubbing directly against one another.

While a broader selection of effective prostheses have long existed for the elbow and shoulder, improved joint prostheses for small articular surfaces with complex curvatures have been only recently developed and are proving effective for the hand and wrist as well.

The type of joint undergoing replacement will determine the technique and type of prosthesis used. This will vary for the fingers, thumb, wrist and elbow.

The Procedure
Before the procedure a complete physical examination is performed and a meeting with a physical or occupational therapist is scheduled, in order to prepare patients for the postoperative rehabilitation.

Total joint replacement can be performed under general (whole body sedation) or regional anesthesia (local sedation). An incision is made, carefully avoiding damage to surrounding tissue and nerves. Access to the joint is gained and the prosthesis is securely placed. The joint is then tested through its range of motion to ensure a correct fit. Once the appropriate fit is confirmed, the prosthesis is tightly secured in place and tissue removed to gain access to the joint is replaced. The skin is then closed.

Complications
The types of complications associated with total joint replacement of the upper extremity include infection, loosening in the joint, and nerve and blood vessel injury. The risk of such complications is minimized with careful presurgical preparation and planning.

Following surgery, a splint and bandage may be used. The limb of the affected joint is kept in a natural position during healing.

Rehabilitation is key to successfully obtaining range of motion.