[arthro- + -plasty]
Surgery to reshape, reconstruct, or replace a diseased or damaged joint. This may be done to alleviate pain, to permit normal function, or to correct a developmental, accidental, or hereditary joint defect.
About 1,000,000 hip or knee arthroplasties are performed in the U.S. every year.
Preoperative: The patient is prepared physically and emotionally for the procedure. Baseline data are gathered (usually including CBC, serum chemistry screen, urinalysis, prothrombin time and partial thromboplastin time, and chest x-ray and ECG for those over 40). Anesthesia is usually general, epidural, or a combination of the two. The patient is taught about postoperative care, patient-controlled analgesia, and any orthopedic equipment that may be prescribed.
Postoperative: The surgeon may prescribe traction or other immobilization devices, such as splints, pillows, or casts, or a continuous passive motion device. Bedrest is maintained for the prescribed period, with assisted ambulation usually beginning by the evening of surgery or the following day. The patient is positioned as prescribed. The affected joint is maintained in proper alignment; immobilization devices are inspected for pressure, and frequent neurovascular and motor checks are made on the involved limb distal to the operative site. Prescribed analgesics are administered, often with a patient-controlled device, and the patient is taught about self-administration. When oral analgesics become appropriate (usually 24 to 48 hr after surgery), care is taken to ensure that dosing provides equal analgesic effects. Noninvasive measures are used to reduce pain and anxiety. Vital signs are monitored for hypovolemic shock due to blood loss, and the patient is assessed for other complications such as thromboembolism, fat embolism, and infection. Incentive spirometry helps the patient's deep breathing and coughing, mobilizing secretions. Frequent changes in position and adequate fluid intake are encouraged. Rehabilitation therapists help the patient with exercise and activity, with appropriate measures taken to prevent dislocation of the prosthesis and to reinforce prescribed activity restrictions. The patient is taught to report symptoms such as fever, pain, and increased joint stiffness, and is referred for home care and outpatient rehabilitation. Acute care and rehabilitation may require about 10 days for standard procedures. Patients with minimally invasive procedures may be discharged to home care within 24 to 48 hr. General patient care concerns apply throughout.
The incidence of postoperative infection after arthroplasty is between 1 and 2%.
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