When the articular cartilage surrounding the ball and socket of your shoulder joint (where the humerus meets the scapula) is damaged beyond repair, most often due to osteoarthritis (or degenerative joint disease), shoulder replacement surgery seeks to remove the damaged portion of the shoulder and replace it with an artificial component to increase range of motion and alleviate shoulder pain.

A total shoulder replacement (or total shoulder arthroplasty) is used for patients with severe arthritis in the shoulder joint, but with a functioning rotator cuff. Total shoulder replacement involves 5 main steps:

• Preparation of the Glenoid – The damaged cartilage, as well as a small amount of the bone, is removed from the socket (glenoid) in the scapula (shoulder blade) and the new surface is shaped to fit the designated implant.
• Preparation of the Humerus – The ball at the end of the humerus, along with the damaged cartilage, is removed and the center of the humerus is reamed to fit the designated humeral stem implant.
• Positioning of Glenoid Implant – A cup-shaped plastic implant is positioned in the glenoid. It can be cemented or press fit into place. This plastic implant provides a smooth gliding surface, acting in place of cartilage for the artificial shoulder.
• Positioning of Humeral Stem Implant – A metal stem is inserted into the humerus bone. It can be cemented or press fit into place.
• Positioning of Humeral Head – A metal ball is positioned on top of the humeral stem, taking the place of the damaged end of the humerus, which was removed.

A reverse shoulder replacement (reverse shoulder arthroplasty) is used for patients with severe arthritis in the shoulder joint, but without a functioning rotator cuff (rotator cuff arthropathy). Reverse shoulder replacement gets its name from the fact that it reverses the position of the ball and socket in the shoulder joint. It involves 5 main steps:

• Preparation of the Glenoid – The damaged cartilage, as well as a small amount of the bone, is removed from the socket (glenoid) in the scapula (shoulder blade) and the new surface is shaped to fit the designated implant.
• Preparation of the Humerus – The ball at the end of the humerus, along with the damaged cartilage, is removed and the center of the humerus is reamed to fit the designated humeral stem implant.
• Positioning of Glenoid Implant – A metal base plate is positioned in the glenoid cavity and affixed directly to the bone with screws. A metal ball (glenosphere) is then affixed to the base plate
• Positioning of Humeral Stem Implant – A metal stem is inserted into the humerus bone. It can be cemented or press fit into place.
• Positioning of Humeral Socket – A plastic cup-shaped implant is positioned on top of the humeral stem. This plastic implant provides a smooth gliding surface for the ball now on the scapula, acting in place of cartilage for the artificial shoulder. 

Reverse shoulder replacement offers the same benefits of total shoulder replacement, but changes the biomechanics of the shoulder joint to maximize the efficiency of the larger deltoid muscle and allow patients without an intact rotator cuff to regain some of their lost function.

In addition to helping patients with rotator cuff arthropathy, reverse shoulder replacement has allowed surgeons to address very difficult shoulder problems like arthritis with bone loss, fracture non-union or malunion, and failed shoulder replacements.

Speak with your surgeon to learn more about the two types of shoulder replacement and which might be most appropriate for you.

• Most patients will stay 1-2 days in the hospital, where they will work on gentle, passive stretching with a therapist to reduce swelling. Once out of the hospital, patients begin physical therapy (either with a physical therapist coming to their home or in outpatient physical therapy sessions). 
• Physical therapy starts with gentle and passive exercises for the first 4-6 weeks, then progresses to full stretching and active exercises. The duration of physical therapy for a shoulder replacement will depend on the rate of tissue recovery.
• After recovering from shoulder replacement, you can expect to live a normal lifestyle, including activities like fishing, golfing, and tennis.  Most shoulder replacement patients experience a significant reduction in pain as well as a vastly increased range of motion and ability to perform daily activities.

• The medial compartment – the inner joint where the femur meets the tibia
• The lateral compartment – the outer joint where the femur meets the tibia
• The patellofemoral joint – where the kneecap meets the femur

If only one compartment of your knee is damaged, you may be a good candidate for partial knee replacement (or unicompartmental knee replacement), in which only one compartment of the knee joint surface is removed and replaced. Partial knee replacement is less invasive than total knee replacement and offers the following advantages:

• Faster recovery time
• Less pain following surgery
• Less blood loss

Partial knee replacement can also be significantly less expensive than total knee replacement as, in many cases, it can be performed in an outpatient surgery center, avoiding the expense of a hospital stay.

• Preparation – The damaged cartilage, as well as a small amount of the bone, is removed from the ends of the femur and tibia and the new surfaces are shaped to fit the designated implants.
• Positioning – Metal implants are positioned in place of the removed bone and cartilage to recreate the joint surface. The implants are then cemented in place.
• Patellar Resurfacing – The damaged underside of the kneecap is removed and replaced with a plastic implant. This step my be omitted, depending on the individual patient’s case.
• Spacing – A plastic spacer is inserted between the newly resurfaced ends of the femur and tibia, creating a smooth surface for gliding (acting in place of cartilage for the artificial knee).

Gender-specific knee replacement refers to implants crafted specifically to accommodate the female knee. For years, the same knee replacement implants were used for men and women. However, in the early 2000s, knee replacement implants were developed specifically for the female knee to take into account the facts that:

• Women tend to have smaller, narrower knees than men.
• Women have more of an angle between their hip and knee than men.
• Women’s kneecaps are positioned slightly differently than men’s.
• The prominence on the front of the femur is less pronounced in women than in men.

Choosing the correct knee replacement implant for your specific case ensures that your implant will fit better, function better, and last longer.

• Most patients will stay 3-4 days in the hospital and then begin physical therapy (either with a physical therapist coming to their home or in outpatient physical therapy sessions). Some patients will return to routine activities such as driving within 2-3 weeks.
• After recovering from knee replacement, you can expect to live a normal lifestyle, including activities like walking, hiking, biking, hunting, and fishing.  According to the American Academy of Orthopaedic Surgeons (AAOS), more than 90% of total knee replacement patients experience a significant reduction in pain as well as a vastly increased ability to perform daily activities.
• Low impact activities are the key to the long-term success of your knee implant, so you will want to avoid high impact activities like running, which would put increased stress on the metal and plastic implants. Your goal after knee replacement should be to live a “knee-friendly” low-impact lifestyle and keep the muscles surrounding the joint strong to maximize the effectiveness and longevity of your artificial knee.

When the articular cartilage surrounding the ball and socket of your hip joint (where the femur meets the pelvis) is damaged beyond repair, most often due to osteoarthritis (or degenerative joint disease), hip replacement surgery seeks to remove the damaged portion of the hip and replace it with an artificial component.

A total hip replacement (or total hip arthroplasty) involves six main steps:

1. Preparation of the Hip Socket – The damaged cartilage, as well as a small amount of the bone, is removed from the hip socket (acetabulum) and the new surface is shaped to fit the designated implant.
2. Preparation of the Femur – The ball at the end of the femur, along with the damaged cartilage, is removed and the hollow center of the femur is reamed to fit the designated femoral stem implant.
3. Positioning of Hip Socket Implant – A cup-shaped metal implant is positioned in the hip socket. It can be secured with screws or press-fit into place.
4. Positioning of Femoral Stem Implant – A metal stem is inserted into the femur bone to a depth of around 6 inches. It can be cemented or press-fit into place.
5. Positioning of Femoral Head – A metal or ceramic ball is positioned on top of the femoral stem, taking the place of the damaged end of the femur, which was removed. 
6. Spacing – A plastic spacer is inserted into the hip socket implant, creating a smooth surface for gliding (acting in place of cartilage for the artificial hip).

The 3 most common approaches are as follows:

• Posterior Approach – Posterior approach (also known as the Moore or Southern approach) is the most traditional approach to hip replacement. It involves an incision from the back of the hip joint.
• Anterolateral Approach – Anterolateral approach (also known as the Watson-Jones approach) involves accessing the hip from the side.
• Anterior Approach – Anterior approach (also known as the Smith-Petersen approach or Direct Anterior Approach (DAA)) involves accessing the hip from the front.

• Most patients will stay 2-4 days in the hospital and then begin physical therapy (either with a physical therapist coming to their home or in outpatient physical therapy sessions). Physical therapy progresses from walking with a walker to walking with a cane over the course of 2-3 weeks. Post-operative pain management will be provided through medication and/or injections, but most patients are pain free 2-3 weeks after surgery.
• After hip replacement surgery, you can reasonably expect to return to work in an office setting within 2-3 weeks, routine activities like driving within a month, work in an industrial setting involving heavy lifting within 2-3 months, and leisure activities such as golfing and swimming within 3 months.
• After recovering from hip replacement, you can expect to live a normal lifestyle, including activities like walking, hiking, biking, hunting, and fishing.  Most total hip replacement patients experience a significant reduction in pain as well as a vastly increased ability to perform daily activities.

When the articular cartilage surrounding your ankle joint (where the tibia meets the talus) is damaged beyond repair, most often due to arthritis that has occurred as a result of the previous injury to the ankle joint, ankle replacement surgery seeks to remove the damaged portion of the ankle joint and replace it with an artificial component to increase range of motion and alleviate ankle pain.

A total ankle replacement (or total ankle arthroplasty) involves 5 main steps:

1. Preparation of the Tibia – The damaged cartilage, as well as a small amount of the bone, is removed from the bottom of your shin bone (tibia) and the new surface is shaped to fit the designated implant.
2. Preparation of the Talus – The damaged cartilage, as well as a small amount of the bone, is removed from the top of your ankle bone (talus) and the new surface is shaped to fit the designated implant.
3. Positioning of Tibia Implant – A metal implant is positioned on the cut end of the tibia and cemented into place.
4. Positioning of Talus Implant – A metal implant is positioned on the cut end of the talus and cemented into place.
5. Spacing – A plastic spacer is inserted between the two metal implants to provide a smooth gliding surface, acting in place of cartilage for the artificial ankle.