When joint replacement should be considered
Total hip or knee replacement is a well-established treatment for severe osteoarthritis, rheumatoid arthritis, avascular necrosis, and certain post-traumatic conditions. The decision to proceed with replacement is based on the severity of symptoms, the degree of functional limitation, the failure of conservative measures, and the patient's overall health and goals.
Joint replacement is not a decision to make lightly, and it is not appropriate for everyone. Younger, very active patients may need to consider alternatives or delayed replacement due to implant longevity concerns. Conversely, patients with severe arthritis who are otherwise healthy should not delay replacement unnecessarily if it would improve their quality of life.
- Persistent pain at rest or night pain despite medication
- Significant limitation of daily activities (walking, climbing stairs, dressing)
- Failure of conservative measures (physiotherapy, weight loss, injections)
- Joint stiffness limiting range of motion
- Joint deformity visible on examination
- X-ray showing severe joint space narrowing and bone-on-bone contact
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Preparation and recovery
Pre-operative assessment includes medical optimization (blood sugar control for diabetics, medication review, anaemia screening), infection screening, and pre-habilitation (exercises to strengthen the limb before surgery). Evidence shows that patients who are fitter before surgery recover faster afterwards.
After surgery, structured rehabilitation is essential for a good outcome. This typically begins on the day of surgery or the following day, with physiotherapy-led mobilization. Most hip replacement patients walk within hours of surgery; knee replacement patients typically take longer. Full recovery takes 3–6 months depending on the joint, the patient's age and overall health.
| Aspect | Hip replacement | Knee replacement |
|---|---|---|
| Surgery duration | 1–2 hours | 1–2 hours |
| Walking after surgery | Same day or next day | 1–2 days |
| Hospital stay | 2–5 days | 3–5 days |
| Full recovery | 3–6 months | 3–6 months |
| Implant lifespan | 15–25+ years | 15–20+ years |