A total hip or knee replacement is an operation to replace worn or damaged parts of a hip or knee joint. The surfaces of the diseased joint are removed and replaced with a mechanical, artificial joint that is called a prosthesis. This surgery can relieve the pain and stiffness patients with damaged hip or knee joints often experience. When more conservative treatments like medication can no longer relieve the pain and disability, orthopedic doctors will typically encourage the patient to consider having a total hip or knee replacement.

Hip and knee replacement surgery has evolved in recent years to become a much less invasive procedure. Blood management and bloodless medicine techniques have made it possible for patients to receive a total hip or knee replacement without the need for a blood transfusion. Eliminating the need for a blood transfusion during any surgery reduces the risk for contracting diseases and infections while also providing a speedier recovery time.

The Normal Knee Joint -

The knee is a hinge joint where the end of the thigh bone (femur) meets the beginning of the large bone in the lower leg (tibia). A healthy knee has smooth cartilage that covers the ends of the femur and tibia. The smooth cartilage between the knee joint serves as a cushion, permitting the bones to glide smoothly as the knee bends. The muscles and ligaments around the knee joint support a person's weight and help move the joint smoothly so that running, walking, sitting, standing and other movements involving the knees are possible without pain.

The Degenerated Knee Joint -

The smooth cartilage layers can wear down on the ends of the femur and tibial side of the knee. This degeneration can happen because of arthritis, an injury, or as a side effect from medicines, such as steroids. When the joint wears down, the smooth surfaces become rough and irritated like sandpaper. Instead of the joint gliding when the leg moves, the bones grind causing pain and/or stiffness. When pain in the knee or leg prevents a person from performing normal activities and an x-ray shows irregular surfaces at the knee, a doctor might suggest a knee replacement.

The Normal Hip Joint -

The hip is a ball and socket joint where the thigh bone (femur) meets the pelvis (hip bone). A healthy hip has layers of smooth cartilage that cover the ball shaped end of the femur and socket part of the pelvis. The cartilage acts as a cushion and allows the ball of the femur to glide easily within the socket of the pelvis. The muscles around the joint support a person's weight and help move the joint smoothly so that walking, running and other movements are possible without pain.

The Degenerated Hip Joint -

The smooth cartilage layers can wear down on the ball of the femur and within the pelvic socket. This is called degeneration. It can happen because of arthritis, injury, or as a side effect from medicines, such as steroids. When the joint wears down, the smooth surfaces become rough and irritated like sandpaper. Instead of gliding smoothly with leg movement, the ball grinds in the socket causing pain and stiffness, which causes decreased movement.

With a new knee replacement (also called arthroplasty) and the help of a skilled orthopedic team, patients may be able to resume some of the activities they once enjoyed. Due to modern medical advances, including arthroscopic surgical techniques and blood management programs, patients will often stand and begin walking the day after surgery. Patients initially walk with a walker, or crutches then a cane. Most patients have some temporary pain after joint replacement, as the tissues heal and muscles regain strength. This pain should go away in a few weeks or months. Eventually, patients may be able to go on long walks, dance, play golf, garden and ride a bicycle. Total joint replacement has an excellent track record for improving quality of life, allowing greater independence and reducing pain. Nationally, more than half a million total joint replacements are performed each year.

The Role of Blood Management -

Blood management techniques, including bloodless surgery methods, can play a large role in deciding to have a knee replacement surgery. Many modern hip and knee replacements involve the use of arthroscopic surgery techniques. These techniques are minimally invasive and involve many of the principles of bloodless medicine.

Another advantage of blood management and the field of bloodless medicine is the ability for a patient to decline having a blood transfusion. A blood transfusion is the infusion of blood or blood parts/components into a vein.

Like any surgery, a hip or knee replacement may require a blood transfusion. However, a blood transfusion is only necessary when a patient's body does not have enough blood cells to work properly. By applying blood management and conservation techniques during surgery, an orthopedic surgeon can eliminate the need for a transfusion.

Patients may wish to avoid having blood transfusions for a number of reasons. Below are a few benefits of having a hip or knee replacement with bloodless surgery:

• Quicker recovery times

• Reduced risk of disease or infection

• Reduced risk of allergic reaction during surgery

Some patients also request a bloodless surgery without the use of a blood transfusion for religious beliefs.

For more information about hip and knee replacements, including bloodless surgery and blood management options for these procedures, contact your local healthcare system. Blood medicine programs are becoming available at more hospitals every year.