Joint Replacements

Ankle, Shoulder, Elbow, Hip and Knee Joint Replacements

Most people have heard of hip and knee replacements, or know someone who has one. Since 2003 a National Joint Registry has kept statistics on hip and knee replacements. In England and Wales there are now approximately 160,000 hip and knee replacement procedures each year1.

Replacing other joints to relieve symptoms of pain and reduced function is becoming more common. The National Joint Registry is now collecting data on ankle, shoulder and elbow replacements providing a vital database for these increasing popular procedures.

Total Ankle Replacement (TAR)And x-ray of an ankle post replacement

In 2010 the collection of ankle joint replacement data started, with the 2013 report showing 532 ankle replacement procedures taking place per year. Despite the ankle being subjected to the greatest forces and having the lowest contact area, it is remarkably resilient to the development of osteoarthritis. The ankle does however experience more post traumatic arthritis. Most people would have been through many conservative options of management such as physiotherapy, pain medication, shoe/insole changes and activity modification before the decision is made to have a TAR. A TAR can relieve pain and improve function. The design of a TAR allows a patient to be wearing and walking in a special boot after just 2 weeks. At this early stage Physiotherapists can begin working with you towards your rehabilitation goals.

Total Shoulder Replacement (TSR)

TSR data collection began more recently in 2012. Already this figure has exceeded 3000 patients. Our shoulders have a large range of movement and rely on soft tissue for stability due to the small socket called the glenoid. TSR’s can be indicated for arthritis, avascular necrosis or severe proximal humerus fracture.  Patients have often tried a conservative approach to managing their pain and loss of movement with physiotherapy, pain medications, injections, and arthroscopic surgery before progressing to a TSR. More often now we are seeing patients with ‘Reverse Shoulder Replacements’ which is a prosthesis and method of changing the centre of rotation of movement and allowing our large deltoid muscle to work more effectively resulting  in a better functioning shoulder. Reverse shoulder replacements have less post-operative restriction resulting in an earlier start with physiotherapy and return to function.

Total Elbow Replacement (TER)

TER data collection began at the same time as TSR in 2012 but the numbers are much smaller with around 395 in the first full year of 2013. They can be indicated for osteoarthritis, rheumatoid arthritis and complex fractures of the elbow. Primarily this is a pain relieving operation. The individual procedure will dictate how soon physiotherapy can start.


At Central Health Physiotherapy our Specialist Orthopaedic and Musculoskeletal Physiotherapists work closely with Consultant Orthopaedic Surgeons. This allows us to support and treat patients through the entire rehabilitation journey.


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Posted in Anatomy, Shoulder, Knee, Ankle, Elbow, Hip, Post-op rehabilitation and tagged , , , , , .

Victoria Frosdick

Victoria is Lead Physiotherapist at Central Health Physiotherapy, based in St John's Wood. Vicky specialises in orthopaedic physiotherapy and rehabilitation. She has a special interest in enhanced recovery programmes for knee and hip replacements, shoulder surgery and fractured neck of femur rehabilitation.

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