Written By: Joe N. Jarrett, Jr., MD
Jack Nicklaus has had one. Hugh Downs has had two. Many of us have friends, neighbors or relatives who have had total joint replacements. You can even watch the surgery on The Learning Channel (if you can stomach the graphic nature of the procedure). But what exactly is a "total joint replacement", and who really needs such a surgical procedure?
A Short History of Joint Replacement: In the early 1960's a famous British surgeon, Sir John Charnley, began to perform total hip replacements in patients who had severe arthritis of the hip. Many people are unaware, however, that the original "father" of hip replacement surgery was a native of South Carolina. Dr. Austin T. Moore of Columbia, SC, performed the first known hip replacement in the late 1930's in a patient who had a tumor of the hip. Along with a colleague from Pennsylvania, Dr. Moore developed the "Moore Prosthesis" which was popular and very effective metallic device used by surgeons to replace certain types of broken hips. The procedure was further developed by Sir John Charnley and other prominent surgeons and over the past 3 decades has been refined by continuing research and development of new materials, designs and techniques. In the late 1960's and early 1970's, after seeing the success of the total hip replacement, surgeons began to treat other diseased joints with surgical implants. Total knee replacement has become a very effective and popular option for a number of severe disorders of the knee. In addition, total joint replacement can be performed for severe disorders of the shoulder, elbow, wrist, finger and ankle joints. With every new technology come a "learning curve" and joint replacement is no exception. There have been some devices and procedures which have not worked well. At the present time, however, there are extremely effective and satisfactory devices and procedures for the replacements of the joints mentioned above.
Materials: At the present time, most of the devices used for joint replacement are made of a metallic component (surgical stainless steel, surgical alloys, or titanium) and a heavy-duty plastic component (high density polyethylene). Usually the metallic component replaces the bone portion of the joint, while the plastic part replaces the cartilage, which should normally cover the ends of the bones where they articulate at a joint. In the hip, for example, the artificial socket is made of metal, while the lining of the socket is made of high density plastic. The ball of the hip joint is replaced with a metal ball on a stem, which fits down in the marrow cavity of the thighbone. Exciting new developments in the field of biological materials include ceramics and bone substitutes. The technology of robotics and computer customized components is also unfolding. Who can benefit from joint replacement surgery? Patients suffering from severe degenerative arthritis, from severe rheumatoid arthritis, or from severe injuries to a joint could be candidates for joint replacement. A typical patient would be unable to perform certain activities of daily living or recreation due to the severe pain and disability of an arthritic joint. Usually such patients have had failed treatment with most of the non-surgical options available, such as rest, heat or ice to the involved joint, gentle exercises, braces or elastic wraps, and various types of arthritic medications.