Joint Replacement
When the joint is worn out: modern prostheses restore quality of life – at the right time, for the right patient, with evidence-based decision-making.
When is joint replacement appropriate?
Joint replacement (arthroplasty) is indicated when conservative treatment options have been exhausted and pain and functional limitation permanently reduce quality of life. The decision is based on the patient's symptoms and functional status – not on the X-ray alone. A patient with severe arthritis on imaging but minimal symptoms does not need surgery; a patient with severe pain and functional limitation despite optimal conservative management does.
Conservative options that should be tried before surgery include structured physiotherapy, weight management, activity modification, analgesics and anti-inflammatory medication, and intra-articular corticosteroid injections for short-term relief. Only when these measures fail to provide adequate relief over a sustained period is joint replacement the appropriate next step.
- Total hip replacement: one of the most successful operations in medicine – 15–25 year implant survival
- Total knee replacement: excellent long-term outcomes; 90% implant survival at 15 years
- Reverse shoulder prosthesis: revolutionised treatment of rotator-cuff-deficient arthritis
- Decision based on patient suffering, not X-ray grade alone
- Second opinions before planned joint replacement are expressly welcome
Hip replacement (total hip arthroplasty)
Total hip arthroplasty (THA) is one of the most successful operations in the history of medicine. Modern implants achieve 15–25 year survival rates exceeding 90% according to national joint registries (Swedish Hip Arthroplasty Register, Australian Orthopaedic Association National Joint Replacement Registry). The operation replaces the worn femoral head and acetabulum with metal, ceramic and polyethylene components. Minimally invasive approaches reduce soft tissue trauma and accelerate recovery.
The choice of bearing surface (ceramic-on-ceramic, ceramic-on-polyethylene, metal-on-polyethylene) is tailored to the patient's age, activity level and anatomy. Highly cross-linked polyethylene has dramatically reduced wear rates and implant failure over the past two decades. Enhanced recovery protocols allow most patients to walk on the day of surgery and go home within 1–3 days.
Knee replacement (total knee arthroplasty)
Total knee arthroplasty (TKA) reliably relieves pain and restores function in end-stage knee arthritis. Registry data show 90% implant survival at 15 years. For isolated medial or lateral compartment arthritis in younger, active patients, unicompartmental knee arthroplasty (UKA) is an alternative that preserves more bone and allows faster recovery, but requires careful patient selection.
Robotic-assisted and computer-navigated TKA improve implant alignment accuracy and may reduce outliers, though long-term superiority in clinical outcomes over conventional techniques is still being established in randomised trials.
Shoulder replacement
For glenohumeral arthritis with an intact rotator cuff, anatomical total shoulder arthroplasty (TSA) provides excellent pain relief and function. For arthritis combined with rotator cuff deficiency – the most common scenario in older patients – the reverse shoulder prosthesis has revolutionised treatment: by reversing the ball-and-socket geometry, it allows the deltoid muscle to compensate for the absent rotator cuff, restoring active elevation. Outcomes are excellent for pain relief and function, with 10-year survival rates exceeding 85%.
Rehabilitation and return to activity
Modern enhanced recovery protocols begin on the day of surgery. After hip replacement: walking with a frame on day 0–1, stairs before discharge, return to driving after 4–6 weeks, return to sport (cycling, swimming, golf) after 3 months. After knee replacement: physiotherapy from day 1, full weight-bearing immediately, return to low-impact sport after 3 months. After shoulder replacement: sling for 4–6 weeks, physiotherapy from week 1, return to sport after 4–6 months.
Joint-friendly sports (cycling, swimming, hiking, golf, cross-country skiing) are encouraged after all joint replacements. High-impact and contact sports are discussed individually based on implant type and patient-specific factors.
Frequently asked questions
How long does a prosthesis last?
Modern hip and knee implants commonly last 15–25 years, and registry data show continuous improvement. Shoulder prostheses have 10-year survival rates exceeding 85%. Implant longevity depends on patient activity, weight, implant design and surgical technique.
Can I do sport with a prosthesis?
Yes. Joint-friendly sports such as cycling, swimming, hiking, golf and cross-country skiing are encouraged. Stop-and-go and contact sports are discussed individually. Activity after joint replacement improves cardiovascular health, muscle strength and quality of life.
When should I consider a second opinion?
Before any planned joint replacement. A second opinion is always welcome and recommended – it confirms the indication, explores alternatives and ensures you are making an informed decision. Bring your imaging and reports.
What are the risks of joint replacement?
Serious complications (deep infection, pulmonary embolism, periprosthetic fracture) occur in 1–2% of cases. Modern thromboprophylaxis, antibiotic protocols and surgical technique have dramatically reduced these rates. Specific risks are discussed individually before surgery.
References & Evidence
- Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet 2007;370:1508–1519. PMID: 17964352
- Swedish Hip Arthroplasty Register. Annual Report 2023. Available at: www.shpr.se
- Australian Orthopaedic Association National Joint Replacement Registry. Annual Report 2023. Available at: www.aoanjrr.sahmri.com
- Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–14. PMID: 2805470
- Boileau P, Watkinson DJ, Hatzidakis AM, Balg F. Grammont reverse prosthesis: design, rationale, and biomechanics. J Shoulder Elbow Surg 2005;14(1 Suppl S):147S–161S. PMID: 15726075
- Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ. Do the indications, technique, and results of reverse shoulder arthroplasty change with surgeon's experience? J Shoulder Elbow Surg 2012;21:1470–1477. PMID: 22459192
- Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007;89:780–785. PMID: 17403800
- Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57–63. PMID: 19844772
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