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Total Knee or Hip Replacement at Our Los Angeles Center

Doctors recommend joint replacement surgery when pain and loss of function become severe and when medicines and other treatments no longer relieve pain. Your doctor will use x-rays to look at the bones and cartilage to see whether they are damaged and to make sure that the pain isn't coming from somewhere else.

Total joint replacement involves outpatient surgery to replace the ends of both bones in a damaged joint to create new joint surfaces. Doctors may attach replacement joints to the bones with or without cement.

Cemented joints are attached to the existing bone with cement, which acts as glue and attaches the artificial joint to the bone.

Uncemented joints are attached using a porous coating that is designed to allow the bone to adhere to the artificial joint. Over time, new bone grows and fills up the openings in the porous coating, attaching the joint to the bone.

Doctors often use general anesthesia for joint replacement surgeries, which means you'll be unconscious during surgery. But sometimes they use regional anesthesia, which means you can't feel the area of the surgery and you are sleepy, but you are awake. The choice depends on your doctor, on your overall health, and, to some degree, on what you prefer.

The younger you are when you have the surgery and the more stress you put on the joint, the more likely it is that you will eventually need a second surgery to replace the first artificial joint. Over time, the components wear down or may loosen and need to be replaced.

Your artificial joint should last longer if you are not overweight and if you do not do hard physical work or play sports that stress the joint. If you are older than 60 when you have joint replacement surgery, the artificial joint probably will last the rest of your life.

Knee replacement

More than 500,000 knee replacements are done in the U.S. each year, mostly due to severe arthritis. A healthy knee has four ligaments that hold the leg bones in place, but when a knee is arthritic or damaged, the ligaments can be scarred and need to be replaced along with other parts of the joint.

In knee replacement surgery, the ends of the damaged thigh and lower leg (shin) bones and usually the kneecap are capped with artificial surfaces lined with metal and plastic. Usually, doctors replace the entire surface at the ends of the thigh and lower leg bones. Doctors usually secure knee joint components to the bones with cement, though there are cementless designs that instead rely on the bone growing into the implant.

Generally, the metal alloy components of a replacement rarely break, but they can come loose from the bone sometimes. There are two reasons for loosening:

1. The knee handles significant stresses during everyday activity. When the harder shinbone is removed during a knee replacement, this means that the load is transferred to the softer bones underneath. If this is too heavy, over time the prosthesis will start to sink or loosen from its attachment. This wear can also create debris of polyethylene that adds to the loosening of the implant and occasionally bone loss around the implant.

2. The polyethylene debris causes the area around the knee to become inflamed as the body tries to get rid of the particles, which results in a condition called osteolysis, where small parts of bone around the implant are removed. The bone loss continues with regular wear, leading to weakening and ultimately loosening of the implant. However, despite these recognized failure mechanisms, the bond between cement and bone is generally very durable and reliable.

Knee replacement operations, whether they use cemented or cementless fixation, are highly successful in relieving pain and restoring movement. However, the ongoing problems with wear and particulate debris may eventually necessitate further surgery, including replacing one or more parts of the knee replacement (revision surgery).

Hip Replacement

Total hip replacement surgery replaces the upper end of the thighbone (femur) with a metal ball, resurfaces the hip socket in the pelvic bone with a metal shell and plastic liner and replaces damaged cartilage with new joint material in a step-by-step process.

Rehabilitation (rehab) after hip replacement surgery may vary depending on whether the surgeon used cement or cementless methods to attach the joint replacement surfaces. Whether your surgeon used cement also determines how much weight you can put on your leg. Your surgeon will let you and your rehab team know what limitations you have. Usually, you cannot put any weight on an uncemented hip for about 6 weeks. With a cemented or hybrid (one piece cemented and one piece uncemented) hip, you can usually put some weight on your leg right away. But you'll still need a walker, a cane or crutches for several weeks.

Because of the way the hip is structured, every added pound of body weight adds 3 pounds of stress to the hip. Controlling your weight will help your new hip joint last longer.

People who have outpatient hip replacement surgery have much less pain than before the surgery and are usually able to resume daily activities. You will probably be able to do your daily activities more easily because the joint moves better.

It probably will be easier for you to do things such as climb stairs, get in and out of a car, walk without tiring, walk without a limp or with less of a limp, and take care of your feet.

You probably will be able to resume activities, such as golfing, biking, swimming, or dancing, that you did before surgery. Continued exercise (such as swimming and walking) is important for your general well-being and muscle strength. Discuss with your doctor what type of exercise is best for you.

Your doctor may discourage you from running, playing tennis, and doing other things that put a lot of stress on the joint.

Most artificial hip joints will last for 10 to 20 years or longer without loosening, depending on such factors as:

  • Your lifestyle and how much stress you put on a joint.
  • How much you weigh (being very overweight puts extra stress on the joint).
  • How well your new joint and bones mend.
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