Hips, shoulders and knees. Between the major bones in your body lies a joint, a moveable connection that is made up of bones, cartilage, and a cavity. They bear your body’s weight and are covered with a layer of cartilage to protect the bones from rubbing against each other when moving. Cartilage ensures that your bone bears the majority of the weight when you move your body, rather than the joint itself. Within the joint lie blood vessels and nerves, which send signals to the brain when the joint is in pain or distress.
Joints can only move in certain directions (like how your knee cannot bend the opposite way), and how far a joint can extend depends on its shape, surrounding muscles and ligaments. The knee is considered a “hinge” joint because of its ability to bend like a hinged door. The hip and shoulder are considered ball and socket joints because of the way the bones fit in to one another (the round end of one bone fits in to the cup-shaped area of another bone.) While joints let our limbs move freely and distribute our weight evenly across our bones, when they misalign or break, it can cause us major pain.
In most cases, joint pain is caused by damage to the cartilage that lines the bone joints. This damage or loss of cartilage can be due to a variety of conditions, including fractures and breaks, arthritis, or other joint conditions. The decision to replace a joint is a large one. If physical therapy, lifestyle changes, medications and activity changes do not change or ease the joint pain, a joint replacement surgery may be a good option. For patients with hip problems, total joint replacements may be recommended to ease effects from or solve problems from osteoarthritis, rheumatoid arthritis, or post-traumatic arthritis.
Until fairly recently, total joint replacements in an outpatient setting were very rare. Surgery was difficult and recovery even more long and difficult. Some people who had total joint replacements never regained full use of their joint after their surgery. However, all that changed with the advances in medicine that allow for outpatient total joint replacements. Because of the changes on surgical techniques, anesthesia and pain control techniques, outpatient total joint replacements are becoming a reasonable options for patients who qualify. Outpatient total joint replacements offer the same surgical benefits as traditional joint replacement surgeries (anesthesia, joint implants), but take place in under 24 hours. For the right patient (not all patients will qualify) outpatient total joint replacements have less risk of complications and a quicker recovery process. Patients in an outpatient setting are home within 24 hours of their surgery. They have less postoperative pain and faster recovery times.
During a total joint replacement, the damaged cartilage and bone are removed from the joint and replaced with prosthetics. This may include components made of metal, plastic or ceramic. These pieces mimic the shape and movement of a normal joint. Screws are placed within these components to keep them in place, and sometimes the screws are also cemented into place. The damaged cartilage is removed and replaced with a prosthetic version, and sometimes spacers are used to ensure that the joint fits properly within the bones of your body. During outpatient joint replacement procedures, a nerve block is given by injection that numbs the leg from the hip down, blocking pain to the leg. Then, a general anesthetic is given for the surgery. Medications are then given for pain during the surgery and afterward. The nerve block allows the majority of the pain to pass before the hard work of recovery can begin, resulting in faster recovery times for patients.
Preparing for an outpatient total joint replacement is similar to preparing for any other major surgery. Eating or drinking after midnight on the day of the surgery is prohibited, and medications may be controlled in the days and weeks leading up to surgery. Your surgeon may also order blood tests or scans to prepare and plan for the surgery. Depending on the type of joint replacement surgery that is ordered, you may be asked to perform certain exercise to condition and strengthen the joint. For hip replacements, detailed instructions may be given for before and after surgery, including the best ways to position oneself while sleeping. Joint replacements are some of the most successful surgeries in the world of medicine, and performing them in an outpatient setting decreases pain and recovery time for patients.
Dr. Fred Speck III
OakBend Medical Group
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.

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