Joint replacement surgery

Joint replacement surgery is a procedure where the arthritic areas of the joint are removed and the bone ends capped with man-made implants.

Other joints, which can be replaced include the shoulder, elbow, wrist, fingers, toes and ankles. However, the most common joints replaced are the hip and knee, with nearly one million combined procedures performed annually in the United States alone.

More information on total joint replacements

Hip Implant Technologies

In the hip, these joints consist of a metal stem which is implanted into the thigh bone (femur), and an artificial socket which is placed in the pelvis (acetabulum). A metal ball is on top of the stem and it articulates with an artificial socket, which is often contained in a metal shell.

Hip replacements are ball and socket implants made of metal, ceramic and/or plastic. The metals used today include primarily Titanium or Chrome Cobalt alloys. Tantalum and Oxinium are now used in some implants. The implants are modular and composed of an acetabular cup, a cup liner, a femoral stem and a femoral head. The acetabular cup fits into the socket of the pelvis. The cup is then fitted with a liner that can be polyethylene, metal or ceramic. The femoral stem goes down into the canal of the femur (thigh bone) and is fitted with a metal or ceramic ball at the top. The ball is then seated into the acetabular cup liner. The ball sizes vary in diameter and depend on the liner type and patient size.

Traditional hip implants have a plastic (polyethylene) liner between the cup of the implant, which is in the pelvis or socket side of the hip, and the metal ball. The plastic liner is essentially the cushion between the metal cup and metal ball, and its presence ensures the smooth and painless range of motion of the artificial joint. However, as time passes, the plastic liner is the part of the hip replacement that is most likely to wear and may cause the implant to require additional surgery. This problem has primarily occurred in younger patients with high activity levels. Improvements in the manufacturing and sterilization of polyethylene have led to much more wear resistant material in today's total hips. An operation on a hip that has been previously replaced and now requires another surgery to replace the implant is called a bearing exchange of partial revision.

Knee Implant Technology

A partial knee replacement involves replacement of part of the knee for arthritis or other conditions that primarily involve only one part of the knee. This may include the inside (medial) part of the knee which is most common, the outside (lateral) part of the knee or the knee camp (patella-femoral) part of the knee. In this case, the majority of the knee is left alone, while the diseased portion is replaced with metal and polyethylene. This procedure is excellent for relieving pain and restoring alignment and function for knees with mild to moderate changes of arthritis. Usually performed with a smaller incision than a total knee, and with less surgery required, these procedures lead to a quicker recovery with fewer complications than total knee replacement. Of the knee patients that Dr. Fisher sees, approximately 25 percent are candidates for a partial knee replacement. While there are significant benefits to this procedure, the downfall is a slightly higher risk of repeat surgery within 15 years compared to total knee replacement.

Total knee implants consist of three components, which resurface the ends of the femur, the tibia (leg bone), and the undersurface of the kneecap (patella). They are made of metal and polyethylene materials. There are three parts of the knee that can be resurfaced with these implants including the femur, tibia and often times the patella. The femoral component is usually metal (although ceramic parts are being investigated) and made of Chrome Cobalt. When used, the patellar implant is polyethylene. The tibial implant can be all polyethylene or modular with a metal base and polyethylene liner. The modular tibial implants can have either fixed or mobile polyethylene bearings. The difference between the two is that in a fixed bearing the polyethylene is fixed to the metal base plate and motion only occurs between the bearing and the femoral implant. When properly aligned, this construct can be very durable and long lasting in either all polyethylene or metal-backed designs.

The mobile bearing implants allow rotation between the polyethylene bearing and the tibial base plate, as well as motion between the bearing and the femoral implant. In laboratory studies, mobile bearings have been shown to have theoretical advantages over the fixed bearings with regard to wear over a long period of time. This type of knee has been reserved for patients with greater than 30 years of life expectancy in the hopes that it may last longer than traditional knee implants.