Hip and Knee Joint Replacement
Joint replacement can be an effective treatment for severe refractory joint pain in select patients when indicated. Conditions such as osteoarthritis, inflammatory arthritis (such as rheumatoid, psoriatic, and others), and osteonecrosis (also called avascular necrosis) can lead to end stage joint destruction, and chronic pain, severely decreasing quality of life.
Hips, knees, shoulders, and elbows can be replaced but with various patient satisfaction and functional outcomes. It’s important to exhaust all non-operative treatment options before considering surgery. Discuss your options with your doctor. You may first benefit from lifestyle modifications and conservative treatments.
Oral over the counter pain medications, such as NSAIDs (non-steroidal anti-inflammatory medications) are the first line of symptom control. Physical therapy can be utilized to educate patients on the benefits of exercise and strengthen the muscle around the joint. Intra-articular joint injections can also provide effective symptom relief in cases when oral regimens are not enough.
Revision Joint Replacement
Most joint replacements become a solution to the chronic pain that can plague a patient for years but not everyone is an ideal candidate for joint replacement and complications of joint replacement can occur. Most of the time we can determine why a joint replacement is painful. All painful joint replacements warrant a complete workup by an orthopedic surgeon.
If you suffer from a painful joint replacement you may benefit from a consultation. We will first need to identify the cause of the pain. A detailed history, physical exam, x-rays, and blood work can usually narrow down the list of reasons for your joint pain. Sometimes it is also necessary to remove some fluid from the joint and have the lab analyze the fluid. This may be done in the office or an interventional radiologist may do this with image guidance.
Once the cause of the joint pain is understood a surgical solution can be discussed. Revision joint replacement can be fairly straight forward or much more complicated than the first-time joint replacement. This depends on multiple factors including what the problem or problems are. The rehab has similar goals but will be tailored to your new joint to get you where you need to be.
Prosthetic Joint Infection
Prosthetic joint infection is a complication of joint replacement that can occur at any time after surgery and can be a cause of a painful joint replacement. If your joint replacement is causing pain, infection will need to be ruled out by your doctor. Some patients are at higher risk for infection than others. You should ask your doctor about your risks and what you can do to minimize them.
Some prosthetic joint infections may present within the first few months of surgery and in these cases the joint replacement can typically be salvaged with a “clean-up” surgery and a course of IV antibiotics. Surgery is always required to eradicate a prosthetic joint infection but it is not always successful. The rate of success depends on many factors including patient factors, chronicity (how long has the infection been there?), and microbial pathogenicity (the strength of the bug causing the infection).
If the bacteria causing the infection has formed a biofilm on the prosthesis this can prove to be treatment resistant. In these cases, if a patient is a candidate, the surgeon may advise a “two-stage” exchange of the joint replacement. This involves two surgeries spaced out over several months.
The first surgery is to remove the entire prosthesis and clean up the involved tissues to reduce the bacterial contamination. Typically an antibiotic eluting spacer is placed in the joint temporarily. A course of IV antibiotics is given over the course of 6 to 8 weeks based on the information obtained at the time of surgery. The second surgery (a permanent joint replacement) is performed once the doctor has determined that the infection has been cleared.