If osteonecrosis has caused such extensive damage to the femur, or thighbone, that the bone has begun to collapse, causing significant pain in the hip or knee, doctors at NYU Langone may recommend total joint replacement, or arthroplasty. In this procedure, orthopedic surgeons remove the damaged joint in the hip or knee and replace it with long-lasting artificial parts.
The hip and knee are the joints most often affected by osteonecrosis. It may affect other bones and joints, as well, in which case total joint replacement may be an option if the bone has collapsed.
Total joint replacement of the hip or knee is considered the best treatment option for people with advanced osteonecrosis affecting the femur, because the replacement joint cannot be affected by the disease.
Surgeons at NYU Langone perform thousands of successful total joint replacement procedures every year.
To perform total hip replacement, a surgeon removes the entire hip joint, replacing the “ball-and-socket” components—the round top of the thighbone and the bowl-shaped depression in the pelvis—with durable prosthetic parts. A new hip may dramatically improve your quality of life by alleviating pain and restoring full range of motion.
Using general or regional anesthesia, the surgeon makes an incision along the front, side, or back of the hip to reach the joint, minimizing the damage to surrounding muscles. He or she removes the top of the femur, called the femoral head, as well as any cartilage or other tissue in the pelvic socket, called the acetabulum. The surgeon then puts the prosthetic components in place and closes the incision with stitches. Finally, he or she injects pain relief medication into the surrounding tissues to keep you comfortable after the operation.
The knee joint connects the bottom end of the thighbone, called the femur, and the top end of the shin bone, called the tibia. In a total knee replacement, surgeons replace damaged bone and cartilage with prosthetic parts made of plastic or metal. These parts are composed of two metal caps, which are put on the ends of the femur and tibia, and a plastic insert, which is placed between them. The insert provides a smooth gliding surface between the bones, allowing the knee to have a full range of motion.
Surgeons perform knee replacement using general or regional anesthesia.
After the anesthesia wears off, you may feel pain in the hip or knee. This is normal, and pain management specialists work with you to ensure you are comfortable while your body heals.
As soon as you are able, NYU Langone physical therapists help you stand and walk. Moving around helps you regain strength in your muscles and joints and increases blood flow to the injured area. It may also help speed your overall recovery. These specialists quickly help you learn to walk using your new joint.
Most people leave the hospital within two days, and some young, healthy people can go home on the same day of surgery or the next day. Two weeks later, the stitches are removed.
Doctors provide crutches, a cane, or a walker for you to use for two to four weeks after the procedure. Over-the-counter or prescription pain medication may be helpful during this time. A follow-up appointment is made with your surgeon within two to four weeks after the operation.
After you can walk unassisted and without pain, NYU Langone physical therapists can help you rebuild muscle and increase the flexibility and range of motion in the hip or knee. Our rehabilitation experts create an exercise routine that you can do at home to condition and strengthen muscles in between therapy sessions. Physical therapy should continue for 6 to 12 weeks, at which time NYU Langone doctors assess your progress before determining if further physical therapy is needed.
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