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PATHOLOGY PERSPECTIVES The surgical approach through the soft tissues is another important variable in the predication for how quickly or successfully a joint replacement surgery will heal. Longitudinal approaches are less damaging to the muscles, but they may require a much longer incision than a lateral approach. The angle at which the socket is secured and the size of the prosthesis are other important factors. Women obviously have differently sized and angled joints than men. These differences have been recognized by surgeons and manufacturers, so prostheses are available in a range of sizes and can be tailored to the individual. Perhaps the most important variable in whether a joint replacement surgery will be successful is the commitment of the patient to manage the rehabilitation process. Not surprisingly, patients who follow well-designed physical therapy programs and exercise appropriately, have the most consistently successful outcomes. Massage therapy can be a useful adjunct in this phase as well, as it can help to reduce pain and provide incentive for rigorous training. "I had total hip replacement in October 2009. I hosted Thanksgiving dinner the next month, and traveled 1,000 miles for Christmas. The secret to my success was two-fold: I had the new 'anterior approach' to hip replacement, where no muscles are cut, and I rehabbed like it was a job. I am a poster child for successful joint replacement surgery!" SHORT-TERM AND LONG- TERM REPERCUSSIONS OF ARTHROPLASTY The possible complications that accompany any major surgery are daunting. They include a reaction to anesthesia, arrhythmia, and blood clots, which may lead to deep vein thrombosis, pulmonary embolism, and circulatory shock. Hospital-borne pathogens may lead to an infection in the joint, urinary tract infection, or pneumonia. diseases. nIh Publication no. 09-5149. Accessed September 2010. www. niams.nih.gov/health_Info/joint_replacement/default.asp. "Complications of hip replacement Surgery." The hip and Knee Institute. Accessed Resources "Arthritis." national Institute of Arthritis and Musculoskeletal and Skin September 2010. www.hipsandknees.com/hip/hipsurgerycomplications.htm. Perlman, A. et al. "Massage Therapy for Osteoarthritis of the Knee: A randomized Controlled Trial." Archives of Internal Medicine (2006) 166: 2533–38. Accessed September 2010. http://archinte.ama-assn.org/cgi/content/full/166/22/2533. "Preparing for joint replacement Surgery." American Academy of Orthopaedic September 2010. www.medicinenet.com/script/main/art.asp?articlekey=497. "Shoulder joint replacement." American Academy of Orthopaedic Surgeons. Accessed September 2010. http://orthoinfo.aaos.org/topic.cfm?topic=A00094. Complications related specifically to arthroplasty include inadvertent fracture of the articulating bones, excessive scarring, and a loss of range of motion that is far beyond what was expected. Later complications can arise relating to a poorly seated prosthesis or failure to bond correctly with bone tissue: these require additional surgery with all the accompanying risks. Longer-term risks are related to a permanently limited range of motion. Depending on which joint is replaced, and what type of surgery is used, arthroplasty patients may need to limit hip and knee flexion and rotation, or risk dislocation and failure of the implant. These limitations will be different for each individual, so it is important to have clear guidelines about which movements and positions are safe. MASSAGE? Massage has some significant benefits to offer clients who are dealing with the prospect or the consequences of arthroplastic surgery. If a person is trying to delay surgery for a few years, massage can help improve arthritis symptoms. Understand that osteoarthritis impacts multiple joints, so it is useful to address postural Surgeons. Accessed September 2010. http://orthoinfo.aaos.org/topic.cfm?topic=A00220. Shiel, w. and d. lee. "Total hip replacement." Medicinenet, Inc. Accessed compensation patterns that may cause pain and interfere with the most pain- free and efficient function possible. After surgery, massage can reduce postsurgical pain and inflammation, and it can improve the quality of scar tissue for better mobility. For clients with older surgeries and no other complications, massage that respects their limited range of motion has all the benefits it does for the rest of the population. "I have had a knee replacement since 1992. I've done tae kwon do, swam, and worked out at the gym. I LOVE my new knee!" Massage Therapy Foundation. She is a writer and NCBTMB-approved provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Her latest book, Disease Handbook for Massage Therapists (Lippincott Williams & Wilkins, 2009), is also available at www.lww.com. Werner can be reached at www.rutherwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is the president of the Author Note: The author wishes to thank all the people who graciously contributed their joint replacement experiences to this piece: your generosity enriches us all. connect with your colleagues on massageprofessionals.com 101