Treatment Guide Joint Replacement

USING THIS GUIDE

Please use this guide as a resource as you learn

about joint pain causes and treatment options. As

a patient, you have the right to ask questions and

seek a second opinion.

CLEVELAND CLINIC 866.275.7496

Joint ReplacementTreatment Guide

Is It Time for a Joint Replacement? Are you and your doctor considering replacement of

your hip, knee, shoulder or ankle? You are not alone:

more than a million Americans will undergo a joint

replacement this year, and that number is expected to

grow rapidly in the future.

Choosing your care The good news is that there are more effective

treatment options available for joint pain today

than ever before. At Cleveland Clinic’s Orthopaedic

& Rheumatologic Institute, we have designed our

services so that all the specialists you need – including

orthopaedic physicians and surgeons, rheumatologists

and physical therapists – work together to help you

return to an active lifestyle.

Using state-of-the-art diagnostics and decades of

experience, we evaluate the cause of your joint pain

and then tailor the most appropriate treatment for

your individual needs. Cleveland Clinic’s Orthopaedic

and Rheumatology programs have a long history

of excellence and innovation, and are consistently

ranked among the top five programs in the nation by

U.S.News & World Report.

TABLE OF CONTENTS:

Hip........................................................................ 2

Knee...................................................................... 4

Shoulder................................................................. 7

Ankle.................................................................... 10

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CLEVELAND CLINIC | GUIDE FOR JOINT REPLACEMENT

CLEVELAND CLINIC866.275.7496

The hip jointThe hip joint is a ball-and-socket synovial joint formed between the hip bone and the femur. A round, cup-shaped structure, known as the acetabulum, forms the socket for the hip joint. The rounded head of the femur forms the ball of the joint. The hip joint’s primary function is to support the weight of the body in both static (standing) and dynamic (walking or running) postures. These joints are the most important in maintaining balance in the human body.

What causes hip pain?OSTEOARTHRITIS

Osteoarthritis is a wearing down of the cartilage that allows the bones to glide smoothly over one another in joints such as the hip. It is one of the most common causes of hip pain in people over 65. As the cartilage wears away, the head of the thigh bone rubs directly against the inner hip socket. Splinters of bone and car-tilage can interfere with normal hip movement. Pain in the groin and front of the thigh is the most common symptom of hip arthritis, especially when walking or during activities that require twisting, such as putting on socks or getting out of a car. The pain is caused by the bones rubbing against each other. The hip joint also may become swollen and stiff.

HIP FRACTURES

Older individuals are susceptible to breaking a hip during normal everyday activi-ties if their bones are weak due to osteoporosis. Although osteoporosis chiefly affects women, men over 65 are at risk as well. Hip fractures are medical emer-gencies and can require immediate surgery.

In addition, younger active individuals can develop stress fractures of the hip. When muscles become fatigued, they fail to absorb the shock of impact from jumping and other activities, and forces are transferred to the bone itself, causing tiny cracks. Stress fractures in the hip joint can cause pain.

OSTEONECROSIS

Insufficient blood flow to bone can destroy bone cells, a process called osteonecro-sis (also avascular or aseptic necrosis). There are many causes of this condition, but it is commonly caused by corticosteroid use to suppress the immune system for different medical conditions. The hip is the most common site affected by osteonecrosis. Treatment options are many and diverse. Early consultation with a hip expert is recommended.

Surgical optionsHIP RESURFACING

For some active younger patients with arthritis or osteonecrosis of the hip, “hip resurfacing” is an alternative to total hip replacement that can stabilize the hip and alleviate pain. Approved by the U.S. FDA in 2006, hip resurfacing involves shaving away a few millimeters of bone in the hip joint, then capping the joint surface with a metal implant. Hip resurfacing preserves more bone than hip replacement and allows for easy hip replacement down the road if needed.

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CLEVELANDCLINIC.ORG/ORTHO 866.275.7496

• Recovery – Patients can expect to be on crutches for six weeks afterward. Physical therapy begins in the hospital and most patients learn all the exercises they need to do before they go home. In about one year, resurfacing patients will be able to resume their routine exercise habits.

• Benefits – The advantages include keeping more of your own bone, which feels more natural. The approach also reduces the risk of inaccurate leg length and dislocation. Patients who have hip resurfacing are also still candidates for a total hip replacement, if needed, down the road.

• Who is a candidate? – Hip resurfacing is not for everyone. Candidates are active people under age 60 with strong bone health, good renal function and no allergies to nickel or any other metal. Resurfacing procedures are not appropriate for patients with osteoporosis or kidney disorders or for women of childbearing age.

• Risks – There are two main risks involved in hip resurfacing. In about one percent of cases, patients with weak bones who undergo the procedure subsequently suffer fractures of the femur. If this occurs, it usually happens within six months of a resurfacing operation, in which case the patient will usually have to move on to total joint replacement. The good news is that the socket doesn’t have to be changed. The other potential disadvantage is related to the metals – cobalt and chromium – that comprise the components of a resurfaced joint. Ions of these metals will inevitably leak into a patient’s bloodstream after resurfacing. In other non-joint replacement situations, high levels of these metals have been associated with cancer, heart disease and kidney dysfunction. However, in patients with metal-on-metal joint implants, no increased risk of cancer has been. To minimize the ion levels, hip resurfacing patients must have well-functioning kidneys that are capable of adequately cleansing the blood.

• Durability – Metal-on-metal hip resurfacing has only been performed for 15 years, so longer-term data is not available. However, we know that more than 95 percent are still functioning at 10 years, and in young, active patients the results are as good as or better than total hip replacement.

Hip replacementIn severe osteoarthritis, hip pain can become constant, and joint swelling and stiff-ness can cause limping and difficulty moving. This may cause individuals to restrict their normal daily activities. In these cases, hip replacement surgery can dramatically improve the quality of life.

Today, more than 200,000 total hip replacements are performed each year in the United States, with this number projected to rapidly increase over the next decade. Besides osteoarthritis, hip replacement may be indicated for hip injuries, bone tumors that break down the hip, and osteonecrosis – if the disease has gone untreat-ed for a long time and has progressed to a point where the joint cannot be saved.

During the procedure, the orthopaedic surgeon removes damaged cartilage and bone from the hip socket, as well as the ball and upper end of the thigh bone (femur). An artificial joint, or prosthesis, made of a combination of metal and plastic or ceramic, replaces the hip socket, and the head and upper end of the femur. The prosthesis parts must sometimes be cemented in place. Your surgeon will determine what type of implant is the most appropriate for you.

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• Recovery – Physical therapy is key to recovering mobility and can begin the day of surgery in some cases. Helping patients get out of bed and put weight on the new hip can help speed recovery. Recovery is individualized, but in general, the younger you are, the faster your rehabilitation and recovery are likely to be, and the less time you’ll spend in the hospital. Many patients can walk normally, without a cane, four to six weeks after surgery. After completing rehabilitation, most patients can perform daily activities easily and without pain. They can return to recreational pastimes such as walking, cycling, golf, skiing, tennis and horseback riding. The only things they need to avoid are jogging on hard surfaces and jumping from heights.

• Benefits – A hip replacement will help debilitating pain that is unrelieved by conservative approaches, such as rest or pain relievers. The procedure helps restore range of motion and return patients to their daily activities.

• Who is a candidate? – Your orthopaedic surgeon will determine if you are a candidate based on your level of pain, disability and overall health.

• Risks – The risk for complications after hip replacement surgery is low. Fewer than 2 percent of patients experience serious complications (for example, joint infection). Having a chronic health condition may increase your risk for complications that may prolong or limit your recovery. The most common complication of hip replacement surgery is blood clots in the legs or pelvis. Your orthopaedic surgeon may prescribe blood thinners to prevent them. Inaccurate leg length may occur or become more noticeable after surgery. Some patients also experience complications, including dislocation, nerve and blood vessel injury, bleeding, fracture, stiffness or pain.

• Durability – Hip replacement surgery has been performed all over the world for more than three decades, with many refinements in the operation and in the design of hip prostheses during this time. With newer materials, loosening or wearing out is now less common. Today’s artificial hips can last up to 30 years, important for middle- aged individuals facing hip replacement.

The knee jointThe knee is the largest joint in the body. It is a complex mechanism made of bone, car-tilage and ligaments. The cartilage in your knee acts as a cushion and gliding surface. When healthy, the cartilage keeps the bones in the joint from rubbing together. How-ever, when the joint is affected by arthritis, the bones make contact and cause pain. Injuries, aging and degenerative conditions such as arthritis can cause the cartilage to break down.

What causes knee pain?OSTEOARTHRITIS

Arthritis is a chronic condition that causes joint inflammation. Symptoms include red-ness, warmth, swelling, tenderness and pain. Up to 30 percent of the population may have knee osteoarthritis, or “wear and tear” arthritis. This is the gradual breakdown of the cartilage in the knee. Also called degenerative joint disease, osteoarthritis usually develops over years and often is found in patients who have had a knee infection or injury and those who are overweight.

As cartilage wears away, the bones around it can grow thicker and develop bony spurs. This can lead to increased friction between the bones and disrupted movement in your knee. This also can lead to problems with the synovium, a membrane in your knee that produces a liquid to keep your cartilage slippery. This membrane can become

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inflamed and make too much fluid. This results in swelling, or “water on the knee.” In the most severe cases, the knee can become deformed as the continued friction wears away the bone. Common symptoms of osteoarthritis include pain, stiffness, tenderness, a limited range of motion and a grating sensation when you bend your knee. The pain is usually worse after activity.

RHEUMATOID ARTHRITIS

Rheumatoid arthritis can affect joints on both sides of the body (both knees, both hands and/or both wrists). In rheumatoid arthritis, your body’s cells attack your own tissues. While in most people symptoms develop gradually over years, they can appear rapidly. Rheumatoid arthritis affects three to five times more women than men and often presents between the ages of 20 and 50. Rheumatoid arthritis may be related to a combination of abnormal immunity and genetic, environmental and hormonal factors. Over time, rheumatoid arthritis can cause cartilage to wear away, swelling in the synovium, and excess fluid in the knee. In later stages, bones can rub against each other.

Surgical optionsFOCAL KNEE RESURFACING

• Recovery – Patients are encouraged to walk soon after surgery. Many are able to drive after a week or two. Physical therapy is an important part of getting back mobility in your knee.

• Benefits – Knee resurfacing may be the wave of the future in treating severe knee pain. It is less invasive than a knee replacement. Because less bone is cut away, patients are left with more of a “real knee.” It also can feel more natural than a knee replacement because the implant is custom-made to fit a patient’s knee. Recovery can be shorter than it is with a knee replacement.

• Who is a candidate? – Knee resurfacing may be ideal for younger, more active patients. It can be effective for patients with focal cartilage defects and early to mid-stage osteoarthritis.

• Risks – Possible (but rare) complications of surgery include blood clots, infection and nerve damage. Long-term complications may include continued pain, infection or a loosening of the implant.

• Durability – Knee resurfacing is a new procedure and is predicted to last 10 to 15 years.

PARTIAL KNEE REPLACEMENT

Partial knee replacement may be an option for you if parts of your knee are free of disease or injury. This minimally invasive procedure may be possible when just one or two of the three compartments of your knee are damaged. In a partial knee replacement, cartilage and bone is shaved away and replaced with an implant in the affected compartment(s). This means a smaller incision and a shorter recovery time than with a total knee replacement.

• Recovery – Patients usually can start moving the knee the day after surgery. Physical therapy is key to recovery and regaining mobility. Patients can be back to full activity in about a month. However, high-impact exercises, jogging and running are discouraged because implants have a surface that can wear.

• Benefits – Compared to a full knee replacement, a partial knee replacement has a shorter recovery time, less postoperative pain, less blood loss during surgery

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and a smaller incision. In addition, more of the patient’s healthy bone and soft tissues are preserved, which means you could a have better range of motion and knee function than you would with a full knee replacement. Patients who have partial knee replacements also are still candidates for a full knee replacement, if needed, down the road.

• Who is a candidate? – The ideal candidate has osteoarthritis that is severe (but not advanced) and whose pain can no longer be managed with conservative treatments. This is not a procedure for patients with significant deformity.

• Risks – Possible (but rare) complications of surgery include blood clots, infection, nerve damage and other risks. Long-term complications may include continued pain, infection, and a failure, loosening or dislocation of the prosthesis.

• Durability – Approximately 85 percent of knee implants will last 20 years.

TOTAL KNEE REPLACEMENT

When all the parts of a knee need repair, total knee replacement may be the best option. This involves removing broken-down cartilage and bone and replacing it with the right artificial joint for you. This prosthesis is made of plastic and metal and provides fluid and free movement. It is attached to the bone with acrylic cement or can be press-fit, allowing bone to grow into the implant. Surgeons also perform any needed ligament repair. To work properly, the new joint needs support from the patient’s muscles and ligaments. Total knee replacement in our aging and active culture is increasingly common. By 2030, it is estimated that more than 3 million total knee replacements will be performed each year.

• Recovery – Following a total knee replacement, most patients spend only two to four days in the hospital. Patients can stand and move the joint the day after surgery and use a cane, walker or similar aid for several weeks. Physical therapy is crucial to restore motion to your joint. After six weeks, most patients are able to put full weight on their knee with the use of a cane. Full recovery and rehabilitation typically takes about six months. Patients are able to return to an active lifestyle, except for high-impact activities, such as running and jumping.

• Benefits – Most patients experience dramatic improvement and relief from pain within weeks of surgery.

• Who is a candidate? – Total knee replacement can be a good option for people with painful knee deformities, severe degenerative changes, or advanced or end- stage arthritis.

• Risks – The risk of complications is rare in total knee replacement surgeries, occurring in less than 2 percent of patients. Your surgeon may prescribe blood thinners to prevent blood clots after surgery. Some patients notice some loss of motion, stiffness or pain. For a very small percentage of patients, the joint may fail. Studies have shown this is more common in obese patients.

• Durability – Doctors have been performing total knee replacements since the early 1970s, and it is one of the most successful surgeries for knee arthritis. New data suggest that contemporary knee replacements may last more than 30 years. Approximately 85 percent of knee replacements done 20 years ago are still functioning well.

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The shoulder jointThe shoulder is a large ball-and-socket joint. It is made up of bones, tendons, muscles and ligaments that hold the shoulder in place and allow movement. The shoulder joint consists of the clavicle (collar bone), scapula (shoulder blade) and humerus (arm bone). A group of muscles and tendons, known as the rotator cuff, stabilize the shoulder and hold the humerus within its shallow socket (the gle-noid). Because of the complexity of muscles and ligaments and the lack of bony constraints, the shoulder is capable of extensive motion.

What causes shoulder pain?ARTHRITIS

Osteoarthritis is the wearing down of cartilage that allows bones to glide smoothly within the joints, and can occur with aging, trauma or overuse injury. The bones in the shoulder begin to rub against each other, and growths called bone spurs can develop. Stiffness, swelling, pain and reduced range of motion can occur, along with a “catching” sensation in the joint. Rheumatoid arthritis, a disorder of the immune system, produces chronic, painful inflammation of the joint’s lining, and eventual joint deterioration. Severe osteoarthritis or rheumatoid arthritis in the shoulder may require joint replacement in the later stages.

ROTATOR CUFF

The rotator cuff consists of four muscles and cord-like tendons, tightly enclosed within the shoulder joint. Rotator cuff injuries are the most common causes of shoulder pain and activity restriction at all ages, and include:

• Tendonitis – The mildest rotator cuff injury is tendonitis (tendon inflammation). Tendonitis can develop with repetitive overhead activities, such as playing tennis, pitching, raking, shoveling or painting. Tendonitis also can arise secondarily from joint degeneration due to osteoarthritis. It produces pain like a toothache radiating through the upper arm that can awaken you from sleep. Reaching overhead or behind your back is painful.

• Tear – A torn rotator cuff, sometimes called “pitcher’s shoulder” or “tennis shoulder,” is the most common cause of shoulder pain. The rotator cuff tendons can split or tear suddenly with injury, or slowly by rubbing against bone spurs. Untreated tears can weaken the arm, make it difficult to raise it and visibly shrink muscles. Pain occurs during motion and at night.

BURSITIS

Bursitis, which typically accompanies rotator cuff tendonitis, involves painful inflammation of the bursa (the fluid-filled sac that surrounds the rotator cuff and provides lubrication and protection from the overlying bony shoulder tip, called the scapular acromion). Bursitis is most often caused by repetitive motions (overuse), or repeatedly bumping or putting pressure on the area. Less often, bursitis is caused by a sudden, more serious injury.

IMPINGEMENT SYNDROME

Swelling and inflammation of tendons and/or bursa can place undue pressure on tendons as they pass between the upper arm bone and the shoulder tip. In its cramped space, blood flow to the swollen tendon is reduced, and it begins to fray.

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This syndrome is characterized by bursitis, inflammation, sometimes tearing of the rotator cuff, and bone spur formation on the acromion, producing pain and limiting range of motion. Symptoms include discomfort and, sometimes, acute shoulder pain when raising the arms above the head, reaching into a back pocket or while sleeping on the affected shoulder. People who frequently work with their arms above their heads may be more likely to get shoulder impingement syndrome.

INSTABILITY

When one of the shoulder bones moves or is pushed out of place due to injury, the shoulder becomes unstable and is at risk for partial or complete dislocation. Recurrent dislocations cause pain and unsteadiness when raising the arm or moving it away from the body, and a feeling that the shoulder is “slipping out of place” when reaching overhead.

LABRAL TEARS

Your labrum is a cartilage cuff around the socket that encircles the head of the upper arm bone to hold it within its shallow bony socket. This cartilage can tear with injury to the shoulder. It also becomes more brittle with age and thus susceptible to fraying. Aching in the shoulder, “catches” in the shoulder when moved, and pain with some activities may signal a torn labrum.

FROZEN SHOULDER

Between ages 40 and 60, the joint capsule surrounding the shoulder can shrink, making movement painful and stiff. Reluctance to use the shoulder brings increasing stiffness, restricted motion and a persistent, dull aching. This condition is most frequently associated with diabetes, but in more than half the patients has no known cause. Pain fades after several months, but the shoulder becomes “frozen” and may take two to three years to “thaw” without treatment. Treatment is directed at pain relief until the acute phase passes, followed by therapy and even surgical intervention to regain motion if it does not return spontaneously

Surgical optionsHEMIARTHROPLASTY

Hemiarthroplasty is essentially half a replacement. In this procedure, a surgeon may opt to only replace the ball of the shoulder joint for conditions that affect the ball and not the socket. The ball is the rounded head of the humerus, or arm bone, which rests against the socket in the shoulder blade. Studies show that patients suffering from osteoarthritis may see better results from total shoulder arthroplasty

• Recovery – Patients will begin supervised movement of their shoulder joint following surgery. You will likely need oral pain medication for at least several days. Most patients return home after about three days in the hospital. You will need to wear a sling for about three weeks following surgery, and not drive for the first six weeks. Physical therapy is key to recovery and regaining mobility. Full recovery may take up to a year.

• Benefits – Compared to a full shoulder joint replacement, hemiarthroplasty preserves the normal glenoid (socket). Patients who have hemiarthroplasty are also still candidates for a full shoulder replacement, if needed, down the road.

• Who is a candidate? – If a patient’s shoulder socket is normal and only the head of the upper arm bone, or humerus, has a severe injury, surgeons may

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recommend this option. Other conditions that may warrant hemiarthroplasty are avascular necrosis of the humeral head (bone cell death caused by interrupted blood supply), post traumatic humeral head arthritis when glenoid and cartilage remain healthy, inadequate glenoid bone to place an artificial socket, and severely torn rotator cuff tendons plus arthritis where the socket will not remain stable.

• Risk – Possible (but rare) complications of surgery include blood clots, infection, nerve damage and other risks. Long-term complications may include continued pain, infection, and a failure, loosening or dislocation of the prosthesis.

SHOULDER RESURFACING

For the right patients, resurfacing is a great alternative to a shoulder replacement. This newer procedure replaces only the damaged surface of the shoulder. Broken down cartilage is removed and replaced with a custom-made, metal implant on the humerus.

• Recovery – Patients can expect to stay in the hospital for one to two days. You will be given oral pain medications after the procedure and begin supervised exercises of your shoulder. You will need to wear a sling for up to six weeks after shoulder resurfacing. Physical therapy is an important part of getting back mobility in your shoulder and is started almost immediately.

• Benefit – This surgery preserves bone and is an alternative to traditional stemmed shoulder replacement for arthritis sufferers. It also makes way for an easier transition to total replacement, if needed.

• Who is a candidate? – Patients with intact cartilage on the glenoid, no fresh fractures of the upper arm bone, and those who want to preserve the humeral bone may be considered for this option. The procedure may be recommended for young or very active patients because it avoids the risks of component wear and loosening that may occur with total shoulder replacements.

• Risks – Possible but rare complications of surgery include blood clots, infection and nerve damage. Long-term complications may include continued pain, infection or a loosening of the implant.

TOTAL SHOULDER JOINT REPLACEMENT

This is an option (also called total shoulder arthroplasty) for patients who suffer from joint dysfunction. In a total shoulder replacement, a metal ball is used to replace the humeral head while a polyethylene cup becomes the replacement of the glenoid socket.

• Recovery – You can expect to stay in the hospital for a few days following your surgery. Physical therapy is the most important component of a successful surgery. The first day after surgery, you will be beginning physical therapy and you will become increasingly comfortable with use of the arm as the weeks progress. Your physician will ensure that you have adequate pain medication to be comfortable and to be able to perform therapy. Patients should be able to dress and feed themselves within the first week. Patients should exercise care in driving and only resume doing so when they can handle the vehicle safely. Sports activities may resume after about six to eight months. It may take six months to one year for a full recovery.

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• Benefit – The primary goal of total shoulder replacement surgery is to alleviate pain with secondary goals of improving motion, strength and function.

• Who is a candidate? – Total shoulder replacement is most frequently considered for patients who have osteoarthritis, rheumatoid arthritis and, more rarely, for those who have sustained severe trauma from a shoulder fracture. A physician will exhaust all reasonable non-surgical alternatives of management before contemplating a joint replacement.

• Risks – As with any surgery, risks of infection, nerve and vessel injury, bleeding and wound healing problems do exist, but they occur infrequently. Nursing and medical staff will check the arm frequently to ensure that any problems are identified and treated properly, should they arise. A replacement joint may eventually become worn and the components loosened, or even dislocated. In such cases, a revision procedure may be necessary.

REVERSE TOTAL SHOULDER REPLACEMENT

Another type of shoulder replacement is called reverse total shoulder replacement, where the socket and metal ball are switched. That means a metal ball is attached to the shoulder bone and a plastic socket is attached to the upper arm bone. This allows the patient to use the deltoid muscle instead of the torn rotator cuff to lift the arm.

• Recovery – Most patients can eat and return to mobility within a day of surgery, and go home – wearing a sling – within three days. The sling may be necessary for up to four weeks. Physical therapy often starts shortly after surgery and will help patients regain their strength and flexibility. Rehabilitation will include exercises to be done at home.

• Benefits – Reverse shoulder replacement is a good solution for patients with irreparable rotator cuff tears plus arthritis, whose conditions cannot be solved by a standard shoulder replacement.

• Who is a candidate? – People who have an unsuccessful shoulder replacement, significant rotator cuff tearing and arthritis, or severe arm weakness because of totally torn rotator cuffs may be considered for the procedure. Regular shoulder replacement may not completely alleviate pain for such patients.

• Risks – Infection is possible, though infrequent, in the wound itself or near the prosthesis. A replacement joint may become worn and the components loosened, or even dislocated. In such cases, a revision procedure may be necessary. A more rare complication could involve nerve damage surrounding the surgery area. This type of damage is known to heal with time.

The ankle jointThe ankle is a complex mechanism. What we normally think of as the ankle is made up of two joints: the subtalar joint, and the true ankle joint. The true ankle joint is composed of 3 bones: the tibia, the fibula and the talus, and is responsible for the up and down motion of the foot. Beneath the true ankle joint is the second part of the ankle, the subtalar joint, which consists of the talus on top and calca-neus on the bottom. The subtalar joint allows the side to side motion of the foot.

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What causes ankle pain?OSTEOARTHRITIS

The most common form of arthritis found in the ankle is osteoarthritis or “wear-and-tear” arthritis, which becomes more prominent as people age, or can develop after the joint sustains an injury in which case it is called “post-traumatic” arthritis. In ankle arthritis, progressive joint deterioration occurs and the smooth “cushioning” cartilage between the shin bone and the ankle bone is gradually lost, resulting in the bones wearing against each other. Soft tissues in the joints also may begin to wear down. Ankle arthritis can be painful and eventually result in tenderness, pain, stiffness, swelling, limited motion, loss of function, and deformity.

Surgical optionsANKLE JOINT REPLACEMENT SURGERY

• Recovery – Most people go home within a few days to a week after surgery. Some people who need more therapy or who have other health problems may go to a rehabilitation hospital before going home. With routine ankle replacement surgery, it usually takes at least six months for full recovery. If the surgery was more complex, recovery can take longer than one year.

• Benefits – Studies show that total ankle replacement can safely relieve the pain of arthritis of the ankle, improve the ability to walk and improve quality of life.

• Who is a candidate? – Patients with severe deformity or instability of the ankle or with associated medical problems (such as diabetes or poor blood supply) are probably best treated with a simpler procedure such as such as ankle fusion.

• Risks – As with any surgery, risks of infection, nerve and vessel injury, bleeding and wound healing problems do exist, but they occur infrequently. Nursing and medical staff will check the ankle frequently to ensure that any problems are identified and treated properly, should they arise. A replacement joint may eventually become worn and the components loosened, or even dislocated. In such cases, a revision procedure may be necessary.

Making an appointmentCall 866.275.7496 to make an appointment with any of our experts at Cleveland Clinic’s Orthopaedic & Rheumatologic Institute.

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Why should I choose Cleveland Clinic?At the Orthopaedic & Rheumatologic Institute, our team of orthopaedic physicians and surgeons, rheumatologists and physical therapists offers the most comprehensive and person alized solutions for all types of joint pain.

We even offer new, innovative computer software technology that allows us to better plan your care based on your unique joint structure. Our software virtually recreates your joint anatomy from standard CT scans and generates an exact 3-D replica of your bone that includes the position of the implant you’ll receive. This is used as a reference guide on the day of surgery in the operating room.

Being part of Cleveland Clinic also means you have easy access to our other specialists to manage any related conditions. Both our orthopaedic and rheumatology services have been con-sistently ranked among the top five programs in the nation by U.S. News & World Report.

Need a second opinion but cannot travel to Cleveland?Our MyConsult service offers secure online second opinions for patients who cannot travel to Cleveland. Through this service, patients enter detailed health information and mail pertinent test results to us. Then, Cleveland Clinic experts render an opinion that includes treatment options or alternative recommendations regarding future therapeutic considerations. To learn more, visit clevelandclinic.org/myconsult.

Documents

Treatment Guide Joint Replacement