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Joint replacement surgery

In this article, Dr Nelligan discusses the benefits and risks of joint replacement surgery for people with hip or knee osteoarthritis.
Xray of a knee joint replacement

Joint replacement surgery is a technique that removes the surface of a joint and replaces it with an artificial joint (prosthesis). This surgery aims to corrects the shape of the joint and how the joint moves.

When is joint replacement surgery recommended? It is only recommended as a last resort. Joint replacement surgery should only be considered for people who have severe joint symptoms and who have genuinely tried non-surgical treatments for an appropriate length of time, and still not achieved satisfactory control of their joint symptoms. For example, joint replacement surgery is not appropriate for someone who has not trialled a period of suitable exercise, weight management and medication under the guidance of healthcare professionals.

The reason joint replacement surgery is only recommended as a last resort is because:

  • of the risks associated with having surgery. For example, infection. Surgical risks are higher for people who have other medical conditions, smoke or are above a healthy weight.
  • of the potential need for future revision surgeries. For example, people with overweight or people who are younger or highly active are at greater risk of the artificial joint loosening or wearing out more quickly.
  • most people with osteoarthritis can effectively manage their symptoms through changes to their lifestyle, making surgery unnecessary. For example, participating in muscle strengthening exercise, physical activity and strategies to maintain a healthy weight.

Here is some information about the benefits and risks of joint replacement surgery, so you can be better informed about this type of surgery for hip and knee osteoarthritis.

Joint replacement surgery: What are the benefits? Around 90 out of 100 people report improvements in their knee following knee joint replacement surgery, while 4 out of 100 report no change and 6 out of 100 report worse joint symptoms. Around 95 out of 100 people report improvements in their hip following hip joint replacement surgery. While 2 out of 100 report no change and 3 out of 100 report worse joint symptoms. On average, a knee replacement can last for 10-25 years and a hip replacement 15-25 years. Are there any risks? Risks associated with having joint replacement surgery include joint infections and blood clots in the legs during the post-operative recovery phase. Around 30% of people report some type of post-surgical problem (e.g. urinary problems, allergies to drugs, bleeding or wound issues) while 7-9% require follow-up surgery. Also, not everyone benefits from joint replacement surgery. Around 30% of people are dissatisfied with the outcomes of their joint replacement because they continue to experience joint pain and difficulties with daily activities. How long will it take me to feel better after the treatment? The recovery time from joint replacement surgery varies from person to person and most people require rehabilitation/physiotherapy for around 3 months or more after surgery to assist with recovery. People can experience joint symptom improvements 3 to 6 months following surgery. But it can take up to 12 months to feel the full benefits on function and disability. Table modified from the Australian Commission on Safety and Quality in Health Care Osteoarthritis of the knee a decision support tool. Data sourced from NHS Digital.

Public waiting times for joint replacement surgery can vary widely. Typically, joint replacement surgeries have the longest wait time of any type of elective surgery.

For people with private health insurance, waiting times for joint replacement surgery is dependent on the surgeon’s availability. But wait times are typically far less in a private hospital compared to a public hospital.

It’s important to talk with your doctor about the possible risks of having surgery and let them know any concerns or questions you may have.

If you do choose to have surgery, a couple of points to remember:

  • If you are above a healthy weight you are at a greater risk of surgical complications. Also, if your BMI is greater than 40 you may experience less improvement in your joint symptoms after surgery. This is why weight loss is recommended before surgery.
  • Recovery after a joint replacement can be improved by being physically active and maintaining a healthy weight before surgery and after surgery.
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Taking Control of Your Hip and Knee Osteoarthritis

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