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You probably have a friend or relative who’s gotten a new hip or knee replacement. Maybe you’ve even heard about someone who is getting their shoulder replaced. But advances in orthopedic surgery now make it possible to replace some of the body’s smaller and more complex joints, including ankles, elbows, thumbs and finger joints.
These procedures can help people with severe arthritis, whether due to chronic wear or an old injury, who have pain and limited motion that make everyday activities difficult. For some people, newer implants and surgical techniques can relieve pain while preserving more movement and function than older procedures.
Here’s what to know about the new wave of joint replacement surgeries.
What is joint replacement?
Joint replacement involves a surgeon replacing your damaged joint with an artificial one made of metal, silicone or ceramic. A joint can be totally or partially replaced with a prosthesis.
Doctors recommend starting with other treatments, like physical therapy, bracing, medications, injections or changes to daily activities, before considering joint replacement surgery.
X-rays also don’t tell the whole story. Some people have severe arthritis on an X-ray but only mild pain. Others have pain that affects sleep, work, hobbies or basic daily tasks, despite mild changes on an X-ray.
“We treat them based on pain level, not so much on how the X-ray looks,” says Jerry Huang, MD, an orthopedic surgeon at UW Medicine. “If the X-ray looks pretty awful, but they tell me they can do most activities they enjoy doing and the pain is tolerable, we recommend continued conservative management.”
If nothing else has helped, though, it might be time to consider joint replacement.
6 joints you didn’t realize could be replaced
Every year in the U.S., nearly 800,000 knees and more than 500,000 hips are replaced. But there are now many other joints that can be replaced as well. Here are some you might not have known about.
Shoulder replacement
Shoulder replacement may not surprise people as much as ankle or finger replacement. But two decades ago, it was not very common.
“When I was training as an orthopedic surgeon, we would get pretty excited when a shoulder replacement case was on the schedule,” says Huang. “Now, the shoulder is probably one of the biggest areas of growth in joint replacement. Last year, about 300,000 people in the United States had a shoulder replacement."
Shoulder replacement may help people with severe arthritis, rotator cuff problems, or fractures that cause pain that makes it hard to use the arm. Some people need a total shoulder replacement. Others may need a reverse shoulder replacement, which changes how the joint works so that other muscles can help move the arm.
Ankle replacement
Until recently, ankle fusion was the go-to surgery for people with severe ankle arthritis. Fusion can relieve pain, but it immobilizes the ankle joint. Today, total ankle replacement is an exciting alternative for people with advanced ankle arthritis who have tried braces, injections, medications or other treatments without enough relief.
“About 75% of the patients who end up getting an ankle replacement are patients who had a previous ankle injury that developed into arthritis over time,” says David Dalstrom, MD, a foot and ankle surgeon at UW Medicine.
Newer ankle replacement implants and surgical techniques have improved outcomes.
“Both ankle fusion and ankle replacement can relieve pain. But patients tend to be happier with ankle replacement because it preserves movement and helps them walk more naturally,” Dalstrom says.
Elbow replacement
Elbow replacement can relieve pain and improve movement, but surgeons recommend it carefully.
“This procedure provides pain relief and a good functional range of motion. But with an elbow replacement, patients have a 5-to-10-pound lifting restriction for life,” Huang says.
If people lift too much after elbow replacement, the implant can loosen over time. For that reason, elbow replacement often works best for people with a lower-demand lifestyle who can follow the lifting restriction.
Because of those limitations, younger and more active people should explore other options first. For example, the surgeon may be able to clean out bone spurs or loosen pieces in the joint. Some people may benefit from a procedure that places tissue in the elbow as a cushion instead of using metal implants.
Thumb replacement
Thumb arthritis can make everyday tasks painful. Turning a key, opening a jar, holding a fork, gripping a steering wheel or shaking someone’s hand can hurt when cartilage wears away at the base of the thumb.
The thumb base joint, called the carpometacarpal (CMC) joint, moves in several directions. That complex movement makes thumb replacement more challenging than some other joint replacements.
For years, many surgeons treated thumb arthritis by using a tendon to create a cushion in the joint. Last summer, the U.S. Food and Drug Administration approved a new thumb joint implant for arthritis at the base of the thumb.
Not many orthopedic hospitals or clinics offer it yet, but if you’re in the Pacific Northwest, UW Medicine became the first healthcare system in the region to perform it.
“We’re seeing good results so far,” Huang says. “At some point, I think joint replacement will become the standard of care for people with severe, symptomatic arthritis in the thumb CMC joint.”
Finger joint replacement
Finger joint replacement may surprise people the most.
“Finger replacement is the one that I wish more people knew about,” Huang says. “A lot of patients assume you have to live with finger arthritis, or that there aren’t a lot of options out there.”
Finger joint replacement may help people with severe pain, deformity and loss of movement from rheumatoid arthritis, osteoarthritis or an old traumatic injury. Surgeons can replace the knuckle joints and middle joints of the fingers. They don’t replace the joints near the fingertips because those joints are too small.
“If you look at the literature, pain relief is the number one benefit of finger joint replacement,” Huang says. “The person’s overall range of motion may not be full, but it’s much more functional.”
Unlike elbow or wrist replacement, finger joint replacement usually does not come with long-term lifting restrictions once the joint heals.
Wrist replacement
Surgeons can replace some wrist joints, though wrist replacement remains much less common than hip, knee or shoulder replacement. Last year, only about 700 people in the U.S. had a wrist replacement, although it is more common in Europe.
“Wrist replacement has the same lifting restrictions as elbow replacement. It’s often best for older, less active people,” Huang explains. “Implant designs are improving for wrist replacement, though, so we might see more of these procedures in the future.”
Is joint replacement surgery right for you?
If you have joint pain, it’s important to work with your doctor to make sure you’re getting the care that’s most appropriate for your situation.
“Not everybody is necessarily the best candidate for joint replacement,” Huang says. “But if severe pain keeps you up at night, or pain prevents you from doing basic activities like cooking and personal care, you might benefit from surgery.”
