Joint replacement
Joint replacement may be considered when damage to a joint causes persistent pain, limits everyday activities and is no longer adequately controlled by conservative treatment.
Clinical principle
An X-ray may show the degree of joint wear, but it cannot by itself determine the need for a replacement. Symptoms, clinical examination findings, investigations, previous treatments, general health and the patient's goals all need to be considered together.
The consultation aims to confirm the source of the pain, compare conservative and surgical options, and determine whether the scale of the procedure is proportionate to the functional limitation.
Areas of expertise
Assessment may concern primary or secondary hip osteoarthritis, osteonecrosis of the femoral head, post-traumatic osteoarthritis, the consequences of fractures or dislocations, and deformities associated with hip dysplasia.
Joint replacement may be considered for primary or post-traumatic knee osteoarthritis, varus or valg deformity, loss of extension or flexion, and instability associated with osteoarthritis.
Assessment may cover glenohumeral osteoarthritis, rotator cuff tear arthropathy, osteonecrosis of the humeral head, the consequences of proximal humeral fractures and problems affecting an existing shoulder replacement.
Surgical procedures
This list explains procedures that are commonly performed, but it is not a recommendation for surgery. The choice is made only after the symptoms, clinical examination findings and investigations have been considered together.
Book an assessmentThis procedure replaces the femoral head and the surface of the acetabulum. It is most commonly used for advanced hip osteoarthritis, but may also be appropriate for osteonecrosis, dysplasia or post-traumatic osteoarthritis.
The components may be fixed without cement, with cement or using a hybrid method, depending on the anatomy, bone quality and clinical context.
Revision replaces one or more components of an existing hip replacement when implant loosening, wear, instability, infection or a periprosthetic fracture occurs.
Planning may require CT, assessment of bone loss and specialised reconstruction implants.
This procedure replaces the damaged joint surfaces of the femur and tibia and, selectively, the surface of the kneecap. It is appropriate for advanced symptomatic knee osteoarthritis when the pain and functional limitation are consistent with the clinical examination and weight-bearing X-rays.
The procedure aims to restore alignment, stability and a useful range of movement.
This procedure replaces only the affected compartment of the knee and preserves the rest of the joint. It is suitable for a carefully selected group of patients with limited wear, functioning ligaments and a correctable deformity.
It is not a suitable option when osteoarthritis extends across several compartments.
Revision may be needed when a knee replacement becomes painful or unstable because of loosening, wear, infection, alignment problems or bone loss.
Identifying the cause is essential before surgery; more constrained implants and bone augments are sometimes required.
An anatomical shoulder replacement recreates the normal joint anatomy by replacing the humeral head and, usually, the glenoid surface. It is considered mainly for glenohumeral osteoarthritis when the rotator cuff is functioning.
Glenoid bone quality, movement and tendon integrity influence whether it is appropriate.
A reverse shoulder replacement reverses the geometry of the joint and allows the deltoid muscle to contribute more to raising the arm. It is commonly used for rotator cuff tear arthropathy, selected complex fractures and certain revision procedures.
Suitability depends on deltoid function, the available bone stock and the patient's goal.
This procedure replaces only the humeral side of the joint. It may be used in selected situations, including certain fractures or cases in which the glenoid surface is preserved.
It is less common than total anatomical or reverse shoulder replacement, and the choice is strictly individualised.
Consultation and diagnosis
The consultation begins with the activities that have become difficult and how the symptoms have progressed. Movement, strength, stability and alignment are examined and then considered alongside the available X-rays and other investigations.
It is helpful to bring the actual images from previous investigations, relevant medical records and an up-to-date list of your medication.
Choosing treatment
The presence of osteoarthritis does not automatically mean that surgery is needed. Depending on the joint and severity, options may include activity modification, weight loss, rehabilitation, medication, walking aids or injections.
Conservative options are chosen according to the diagnosis and the realistic benefit they may offer the patient.
If joint replacement is chosen, the plan is tailored to the anatomy, bone quality, other medical conditions and functional goal. Preparation may include blood tests, medical assessments, management of chronic conditions and a review of medication.
Medication, including anticoagulants, must not be stopped on your own initiative. The plan is determined by the doctors involved in preparing for the operation.
After treatment
Recovery differs for the hip, knee and shoulder and depends on the preoperative condition, the type of procedure and individual progress. The plan includes wound care, mobilisation, tailored exercises and clinical and radiological follow-up.
The aim is to reduce pain and achieve function consistent with the clinical situation. The pace of recovery and possible limitations are discussed individually, without promising the same result for every patient.
Further information
No. The decision depends on the severity of the symptoms, functional limitation, clinical examination, imaging findings and response to previous treatments.
There is no single implant that is right for everyone. The choice depends on the joint, anatomy, bone quality, stability, other medical conditions and activity level.
Bring previous X-rays and other investigations, including the actual images, together with medical letters and a list of your current medication. Further investigations are recommended after examination if needed.
The duration varies between joints and between patients. Recovery is assessed by functional milestones—movement, independence and return to activities—not simply by a fixed deadline.
The main aim is to reduce pain and improve function. Outcomes vary between individuals, and the limitations and risks are discussed before the procedure.
Appointment
The consultation clarifies the diagnosis, the available alternatives and whether joint replacement is an appropriate option for your functional goal.
This website does not provide emergency care. In an acute or life-threatening situation, call 112 or go to the nearest emergency department.