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Total Prosthesis – Total Joint Replacement Explained

A total prosthesis replaces an entire joint with an artificial implant. It is used in cases of severe joint degeneration or arthritis to relieve pain and restore mobility.

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Things worth knowing about "Total prosthesis"

A total prosthesis replaces an entire joint with an artificial implant. It is used in cases of severe joint degeneration or arthritis to relieve pain and restore mobility.

What is a Total Prosthesis?

A total prosthesis – also known as a total endoprosthesis or total joint replacement – is a surgical implant that completely replaces a severely damaged or worn-out joint. Unlike a partial prosthesis, which replaces only part of a joint, a total prosthesis takes over the full function of the natural joint. The most common applications are in the hip and knee joints, although total prostheses are also used in the shoulder, elbow, and ankle.

Causes and Indications

A total prosthesis is typically recommended when conservative treatments such as physiotherapy, pain medications, or injections no longer provide sufficient relief. The most common reasons for total joint replacement include:

Osteoarthritis: Advanced joint degeneration where cartilage has been largely destroyed.
Rheumatoid arthritis: An inflammatory joint disease that progressively destroys cartilage and bone.
Hip fractures: Severe bone fractures, particularly in elderly patients.
Avascular necrosis: Death of bone tissue due to reduced blood supply.
Congenital joint deformities: Severe malformations that lead to early joint degeneration.

Types of Total Prostheses

Total Hip Replacement (THR)

The total hip replacement (THR) is one of the most commonly performed orthopaedic surgeries worldwide. It consists of an acetabular cup, a femoral head, and a stem anchored in the thighbone. Materials include metal alloys, ceramics, and highly cross-linked polyethylene.

Total Knee Replacement (TKR)

The total knee replacement (TKR) resurfaces the damaged joint surfaces of the knee. It consists of a femoral component, a tibial component, and a polyethylene insert that acts as a bearing surface. In some cases, the back of the kneecap (patella) is also replaced.

Total Shoulder Replacement

A total shoulder replacement is used for severe joint destruction or arthritis of the shoulder. A specialised variant, the reverse total shoulder replacement, is used when the rotator cuff tendons are also significantly damaged, reversing the ball-and-socket configuration.

The Surgical Procedure

Implantation of a total prosthesis is performed under general or spinal anaesthesia. The surgeon removes the damaged joint surfaces and anchors the artificial components to the bone – either using bone cement (cemented prosthesis), without cement allowing bone to grow into the porous implant surface (cementless prosthesis), or a combination of both techniques (hybrid fixation). Depending on the joint involved, surgery typically lasts between one and three hours.

Postoperative Care and Rehabilitation

Rehabilitation after a total joint replacement is critical for a successful outcome. Physiotherapy usually begins on the first day after surgery. Full recovery can take several months. Key elements of rehabilitation include:

Physiotherapy to restore strength and range of motion
Pain management with appropriate medication
Thrombosis prevention (anticoagulant medication)
Use of walking aids (crutches or walker) in the early phase
Home adaptations and assistive devices as needed

Risks and Complications

As with any surgical procedure, total joint replacement carries certain risks, including:

Infection: Superficial or deep wound infection, and in severe cases, periprosthetic joint infection
Thrombosis and pulmonary embolism: Blood clot formation in the leg veins
Dislocation: The prosthesis slipping out of position, particularly with hip replacements
Implant loosening: Long-term loss of secure fixation in the bone
Nerve injury: Numbness or weakness due to nerve irritation during surgery
Implant material allergy: Particularly reactions to metal alloys

Lifespan and Revision Surgery

Modern total prostheses have an average lifespan of 15 to 25 years. As the implant ages or if complications arise, a revision surgery may be necessary to replace the old prosthesis with a new one. These procedures are technically more demanding than the initial implantation.

References

Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-1519.
National Institute for Health and Care Excellence (NICE): Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157 (2020).
Kurtz S et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. Journal of Bone and Joint Surgery. 2007;89(4):780-785.

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