What is Arthroplasty?
Arthroplasty is a surgical procedure that involves the reconstruction or replacement of a damaged joint with an artificial prosthesis to relieve pain and restore function. This is the only definitive therapy for moderate-to-severe symptomatic osteoarthritis and advanced osteonecrosis with secondary arthritis 1, 2.
Core Definition and Purpose
Arthroplasty encompasses joint replacement surgery performed to address end-stage joint disease. The procedure involves removing damaged cartilage and bone, then replacing the joint surfaces with prosthetic components made of metal, plastic, or ceramic materials 3. The primary goals are:
- Pain relief - the most consistent and predictable outcome
- Restoration of function - improving mobility and range of motion
- Enhanced quality of life - enabling patients to return to daily activities
Most Common Types
Total joint arthroplasty (TJA) refers to complete joint replacement and is most frequently performed on:
- Hip (Total Hip Arthroplasty/THA) - offers excellent pain relief and functional improvement with predictable outcomes 4, 5
- Knee (Total Knee Arthroplasty/TKA) - the most commonly performed joint replacement procedure, with over 670,000 performed annually in the United States as of 2012 6, 5
- Shoulder - demonstrates encouraging outcomes but with less robust data than hip and knee 5
- Elbow - provides good pain relief but limited functional improvement with significant complication risks 5
- Ankle - has not demonstrated outcomes comparable to other major joints; fusion remains the standard treatment 5
Primary Indications
The major indications for arthroplasty include 3:
- Degenerative joint disease (osteoarthritis) - accounts for >90% of cases 4
- Inflammatory arthropathy (rheumatoid arthritis)
- Avascular necrosis (osteonecrosis)
- Complicated fractures
Key Contraindications
Absolute contraindications that preclude arthroplasty 3:
- Active systemic infection
- Active joint infection
- Neuropathic (Charcot) joint
Clinical Effectiveness
Arthroplasty is considered one of the most successful orthopedic procedures 7. Total hip and knee arthroplasty demonstrate the best evidence for both pain relief and functional improvement 5. The procedure is cost-effective, with costs per disability-adjusted life year averted often lower than treatments for chronic medical conditions 8. Patient satisfaction rates for TKA range from 75-89%, with long-term failure rates <1% per year 6.
Important Distinction from Arthroscopy
Arthroplasty should not be confused with arthroscopy, which is a minimally invasive diagnostic and therapeutic procedure using a camera. For degenerative knee disease, arthroscopic surgery (including debridement and partial meniscectomy) is strongly recommended against, as it provides no benefit over conservative management 9.
When to Proceed with Arthroplasty
For patients with moderate-to-severe symptomatic osteoarthritis who have failed nonoperative treatment, proceeding directly to arthroplasty without delay for additional nonoperative therapies is conditionally recommended 1, 2, 1. Delaying surgery for mandatory physical therapy, NSAIDs, braces, or intra-articular injections in patients already indicated for TJA leads to prolonged pain, functional limitations, and increased disability risk 1, 2.
The decision should involve shared decision-making between patient and physician, considering individual goals, risk tolerance, and medical comorbidities 1, 2, 1.