Patients may be prescribed exercise therapy in advance of their surgery to promote recovery afterward.

People with a condition that can complicate arthroplasty or recovery from the surgery may be put on a program to improve management of that condition weeks or even months in advance. For example, people with unstable diabetes will typically undergo more intensive measures to control and monitor their glucose (blood sugar).

The physician may recommend an autologous blood donation, in which the patient’s own blood is collected before surgery in case a transfusion is necessary. Generally, one unit of blood is obtained per week for several weeks prior to the procedure.

The patient’s medical history is evaluated, with emphasis on symptoms, level of pain, interference with daily activities due to pain, other medical problems, medications and allergies. The physician performs a physical examination, including observation of the joint, palpation (feeling and moving the joint) and other tests to assess range of motion, stability and strength. The patient may be asked to complete a pain assessment form before the surgery and after recovery.

The physician may also order imaging tests and laboratory tests, such as:

• X-rays. Painless tests in which an image is created of part of the body by using low doses of electromagnetic radiation that are reflected on film or fluorescent screens. X-rays are typically taken from multiple angles to determine the extent of the damage.
  
  
• Arthrography. An x-ray test that uses a contrast medium to highlight a joint.
  
  
• Magnetic resonance imaging (MRI). A safe and noninvasive or minimally invasive test that produces cross-sectional or three-dimensional images of the body’s tissues, even through bone and other obstructions.
  
  
• Bone scan.  A nuclear imaging test that identifies areas of breakdown or new growth in the bone. Bone scans are performed by injecting small amounts of a radioactive substance called a tracer into the body through a vein in the arm. The tracer travels through the bloodstream and to the bones. A special device called a gamma camera detects radioactivity and is used to produce images of the bones.
  
  
• Electrocardiogram (EKG). A recording of the heart’s electrical activity as a graph or series of wave lines on a moving strip of paper. EKGs are noninvasive, quick, safe and painless.
  

• Complete blood count (CBC). A routine blood test that measures the composition of blood cells within the body.
  
  
• Urine tests. Tests that detect abnormally high or low levels of substances in the urine.

The physician typically reviews the risks and benefits of the procedure and treatment alternatives with the patient before prosthetic components (if any) are selected.

Medications (e.g., corticosteroids, nonsteroidal anti-inflammatory drugs) may be adjusted or halted before the procedure. The patient will typically be instructed not to eat or drink after midnight before the procedure. The patient should plan to be hospitalized for several days after the procedure and make appropriate arrangements (e.g., schedule time off from work, cancel newspaper delivery).

Arthroplasty is typically performed in a hospital. Anesthesia is administered prior to the procedure. It may be general, regional (e.g., epidural) or local, depending upon the joint being worked with, the extent of the surgery and the wishes and needs of the patient and surgeon. Antibiotics are typically administered to help prevent infection.

The procedure itself may last from one to four hours, depending upon the joint being worked on and the type of arthroplasty employed. Vital signs (e.g., heart rate, blood pressure, blood oxygen levels) are monitored throughout the procedure.

The joint will be angled or manipulated to expose all surfaces. This may mean dislocation. An incision is made over the joint, and the muscles and connective tissues around the joint are moved aside. The size of the incision used depends on the joint being worked on and the type of arthroplasty used but is typically several inches in length.

Many forms of arthroplasty involve removal of osteophytes (bone spurs) or pieces of inflamed synovium (fluid sac lubricating the joint). Damaged bone and cartilage are cut away or reshaped. If a prosthesis (artificial part) is to be used, it will be inserted after measurements have been made to ensure a proper fit. The joint is then manipulated, tested and balanced to ensure proper function, and the incision is closed.