Osteoarthritis, Degenerative Joint Disease, Arthroplasty

Joint Replacement Surgery

Osteoarthritis or degenerative joint disease manifests as stabbing pain that worsens when moving and is relieved while at rest. When joint pain makes normal moving about and everyday chores difficult to accomplish or the joint exhibits rest pain and medication is no longer of any avail, a doctor should be consulted. Coxa Hospital for Joint Replacement is responsible for the treatment of hip replacement patients in the Pirkanmaa region and provides 24/7 on-call service. Coxa’s orthopaedic surgeons perform joint replacement surgeries on patients from all over Finland.

Osteoarthritis is the most common of all joint diseases as it manifests in nearly all people along with ageing. Other risk factors include genetic disposition, obesity, joint injury or subsequent joint instability, malpositions and too intense exercise and work. The ultimate cause of the disease, however, remains unknown.

Osteoarthritis usually occurs in the knees, hips, finger joints and joints between spinal vertebrae, and it may induce changes not only in the joint cartilage, but also in the bone and in the joint capsule. The changes normally advance slowly over several years.

When the disease advances, osteoarthritis pain may become constant and a source of discomfort even during the night. Other typical symptoms are stiffness in the morning and when starting to move. Osteoarthritis in a lower extremity makes walking increasingly cumbersome, making it difficult to stand up and sit down. In advanced osteoarthritis, even putting on socks and shoes may become difficult.

Examinations and a referral to Coxa

A doctor should be consulted if the joint pain makes normal moving about and everyday chores difficult to accomplish, the joint exhibits rest pain or paracetamol medication is no longer of any avail. Of the examinations, the doctor's clinical examination is the most important one. As to imaging studies, x-ray examination is usually sufficient and examinations such as MRI are usually not needed.

A doctor may refer the patient to Coxa for joint replacement surgery if the patient exhibits:

• an x-ray finding consistent with osteoarthritis along with joint pain that cannot be managed by non-surgical means; or
• clinically observable reduction in the range of joint motion or joint malposition that has an essential impact on functional ability.

At the pre-operative assessment at Coxa will be determined if it´s time for the joint replacement. If the surgical intervention is required, the surgical planning will be made and the personal of Coxa will ensure that the patient will be provided with the pre-operative instructions and support in preparing for surgery.

Surgery decision and individual treatment plan

The decision to go ahead with a joint replacement operation is usually made during your first consultation by one of Coxa’s orthopaedists.

If the decision is to go through with the surgery, you will then be provided with an individual treatment plan, selecting the most suitable replacement components. During your first visit you will also meet with a nurse who will discuss with you any issues you may have and provide written instructions on how to prepare for your operation.

You will receive an invitation to the first visit at Coxa by post. It is advisable to bring with you to the clinic a family member or friend who is able to assist you in the postoperative recovery stage.

Proper preparation for the operation is essential

While waiting for your surgery, it is a good idea to familiarize yourself with information regarding joint replacement surgery and what you can expect from it. It is important that your general health is good when arriving for the operation, because good general health and muscular strength will speed up recovery. The patients are provided with all the necessary pre-operative information and instructions at Coxa.

Preoperative assessment at Coxa

Patients who are to undergo joint replacement operation are called for a preoperative assessment, during which they will meet with the nurse anaesthetist or anaesthesiologist and nurse.

You will receive an invitation to preoperative assessment at Coxa by post. It is advisable to bring with you to this visit as well a family member or friend who is able to assist you in the postoperative recovery stage.

The anaesthetist will make sure during the meeting that the patient’s medical conditions are under control and decide whether there is need to discontinue any medication. The anaesthetist will also explain what happens during regional or general anaesthesia and how your pain will be managed.

What happens during a joint replacement operation at Coxa

When you arrive for surgery, a nurse will accompany you from the waiting room to the Coxa admissions ward on the morning of the operation. If you travel from a further distance, you may arrive to the ward the night before if so as agreed, or sleep at the Patient Hotel.

An operating room nurse will walk you to the operating room. The most common form of anaesthesia is the spinal anaesthesia. In addition to the regional anaesthetic, you may also be administered sedative drugs. A joint replacement surgery lasts 1 – 2 hours and a re-operation 2 – 6 hours.

In joint replacement surgery, the damaged joint surface is removed and replaced with artificial material. In some cases it is possible to remove the joint surface only partially and use a partial prosthetic joint.

The majority of joint replacement operations conducted at Coxa are performed on knee and hip joints, but we also carry out shoulder, elbow, wrist and ankle replacement surgeries. We also perform the demanding replacement re-operations, which require specialized expertise.

After the surgery, patients will be taken to the Coxa recovery room that is located on the same floor as the inpatient ward to recover from the operation. Nurse anaesthetists assume responsibility for the care provided in the recovery room. The aim is to have postoperative pain under control and restore the patient’s general condition to a satisfactory level. This will allow for recovery to begin on the day of the surgery.

Recovery on the inpatient ward

The patients will move from the recovery room to the inpatient ward for rehabilitation. Rising to upright position and mobilisation at an early stage speed up the rehabilitation process and reduce complications associated with the surgery. The inpatient ward nurses will assist the patient to sit up and, depending on the patient’s condition, to stand up and walk already on the day of surgery.

The nursing team on the inpatient ward will take care of monitoring the condition of the patients under their care, perform care procedures and assist in daily activities. Doctors’ rounds take place daily. The patients will receive guidance for the rehabilitation stage motion exercises from a physiotherapist, along with advice on coping at home and on the rehabilitation process in general.

From Coxa to home or further treatment

Professional ward staff is the key to a speedy recovery, which is why the majority of patients can be discharged directly home from Coxa. This will be discussed before the operation during the outpatient visit together with a doctor and a nurse.

Patients undergoing their first surgery will be recovering on the inpatient ward for 2–3 days. If longer inpatient treatment is necessary, the patient will be transferred to their local health centre hospital on the second day following surgery. The place of further treatment depends on the agreement made with the patient’s home municipality.

Postoperative check-up

The postoperative check-up at Coxa takes place 2 to 3 months after the operation. The patient will receive an invitation to the Coxa outpatient clinic by post.

Before the postoperative check-up, patients should undergo all the tests they have been referred to. During the postoperative check-up, the patient’s mobility and functional capacity are assessed and x-ray images are analysed. Usually the postoperative check-up is carried out by a physiotherapist.

Joint replacement patients are followed up with periodic examinations.

Recovery from a joint replacement operation is teamwork

Rehabilitation starts already on the day of surgery. The purpose of multiprofessional cooperation and the physiotherapists and nurses working together is to help and guide the patient at the recovery stage. Shared goals help to attain results faster.

The patients will receive guidance for the rehabilitation stage motion exercises from a physiotherapist, along with advice on coping at home and on the rehabilitation process in general. A patient recovering from a joint replacement operation will meet a physiotherapist on the inpatient ward every day.

Persons in charge

Chief Medical Director Teemu Moilanen
Nursing Director Minna-Riikka Rantala