Total Joint Owner's Manual - Maintaining Your Total Hip and Total Knee
Will my total hip or total knee need to be redone? This is a common question and is understandable given the history of joint replacement failures a generation ago. Yet, greater than 75% of total hips and knees done 25 years ago have not had to be re-operated on! Amazing when you consider these used radical surgical techniques, early implant designs, and were made of poor plastic and metal materials; a far cry from today’s standards! The current generation of implants and bearing surfaces should give excellent results in most patients for 20 years or more, before any maintenance needs to be done on them. The common perception that total joints have to be redone every 10 years is totally wrong!
TWO IMPORTANT CHANGES HAVE IMPROVED THE LIFESPAN OF MODERN TOTAL JOINTS:
- STANDARDIZED IMPLANTS WITH IMPROVED MATERIALS
- REGULARLY SCHEDULED FOLLOW-UP APPOINTMENTS FOR LIFE TO MONITOR THE DEVICE
Total joints are mechanical devices placed in an unforgiving biologic environment. In 30 years of use, the average active person will take more than 45 million steps, and each step puts stress on the implant. We do not have immortal total joint materials and with time the plastic surface of the joint (the bearing surface) will begin to wear down. As this occurs microscopic plastic particles are released into the joint. If a large amount of particles are released, the body may respond to them by causing a reaction that can loosen the metal pieces that are fixed to bone. That’s the undesirable consequence we all want to avoid!
Patients usually will not notice any symptoms of the plastic wearing out until there is a major problem with the joint, such as the metal implant becoming loose from bone causing pain and a limp. However, a regular examination of your total joint by your Orthopaedic team with x-rays will reveal signs of early wear. Even if a plastic bearing surface wears out after 15 or more years this is NOT a failure of the operation but the expectation of a successful operation that permitted the patient to function at a normal high level of activity for years! The plastic alone can be replaced, and this is considered normal joint maintenance. Replacing the plastic alone is not the same major operation as the original surgery and can be likened to changing the brakes to keep your car going versus buying a new vehicle. Yes it’s an operation, but minor compared with having to replace the whole total joint! Therefore, regularly scheduled follow-up evaluations are very important to identify a minor problem and correct it to keep it from becoming a major issue!
Stronger materials and improved surgical techniques have allowed younger patients with arthritic hips and knees to return to moderate physical activity such as tennis, skiing and even softball after hip and knee replacement. However, physical fitness and body weight does have an effect on one’s ability to return to these activities, as well as the longevity of the total joint.
Having a total joint is a chronic condition that needs regular follow-up like any other medical condition, be it high blood pressure, diabetes or a heart valve. A typical post-operative course involves an examination and x-rays at 6 weeks, 3 months and 1 year from surgery. After that, a follow-up appointment interval of about every 2-3 years is reasonable. Please help us, help you maintain your total hip or knee by coming back for your long term follow-up appointments, and with that, you can expect a lifetime of great function from your total joint!