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Osteoarthritis (pronounced ah-stee-oh-arth-rite-iss) is the most common form of arthritis. It is caused by the breakdown of cartilage. Cartilage is the tough elastic material that covers and protects the ends of bones. Bits of cartilage may break off and cause pain and swelling in the joint between bones. This pain and swelling is called inflammation. Over time the cartilage may wear away entirely, and the bones will rub together. Osteoarthritis can affect any joint but usually affects hips, knees, hands and spine.
When arthritis or other conditions cause chronic pain that inhibits activity and can’t be addressed through medications, physical therapy or other treatments, replacing the affected joint can help. Joint replacement is a surgical procedure in which a worn out or injured joint, most often the knee or hip, is replaced with a metal, ceramic or plastic joint. For many people, a new minimally invasive joint replacement technique requires a much smaller incision, shorter hospital stay, less time for recovery and less trauma on surrounding muscles and tissues. This surgery has been widely used for many years with excellent results, especially with knees and hips. Other joints, such as shoulders, elbows and knuckles, may also be replaced
Major surgery on a joint may take two or three hours in the operating room. Getting full range of motion, strength and flexibility back in that joint after surgery usually takes months. That’s where pre-operative exercise and education and post-operative physiotherapy programs come in – to ensure you’re physically and emotionally prepared for surgery, and to maximize your recovery after surgery. Together, such programs are among the most important determinants in the success of your surgery. We also do offer home physiotherapy facilities for better rehabilitation.
I try to take an individualized approach to my patients. For patients who haven’t had any other treatments, I want to see them try some of the simpler things first – anti-inflammatory injections, physical therapy, maybe even arthroscopic surgery. At the same time I will follow them closely, checking them every couple of months, maybe with X-rays, to see if they are losing bone, because I can’t in general make the bone come back. If a patient comes to me who has tried other options and still has problems – they can’t walk where they need to go and have a lot of trouble getting around and doing the things they want to do – then that’s when we start looking at a joint replacement. I try some of the simpler things first because even though joint replacements work very well for most people, they don’t work well for everybody.
While the new, minimally invasive procedures available through our Joint Replacement Centre require a smaller incision and less recovery time, some pain will accompany it as it does with any surgical procedure. Anesthesiologists and pain management specialists, also part of the Joint Replacement Centre team, work with each patient to control pain. Many factors, including your tolerance for pain, physical condition and level of activity prior to your surgery will impact the level of pain you may experience.
It’s impossible to predict how long a new joint will last, since factors such as age, weight, activity level and bone strength determine the final outcome. If your new joint loosens over time, it may be necessary to repeat the surgery. It’s likely that your new joint will bring you years of pain-free activity. With the new materials and components, most people have a 90 percent or greater success rate at 20 years after surgery.
If you look in the literature, generally around 95 percent of people do very well with hip or knee replacements. These are some of the more reliable procedures we do. Still, I like to try the conservative things first because there can be significant complications.