Below are commonly asked questions and answers about total joint replacement surgery. If you have further questions, please ask your surgeon or the Total Joint Center Program Coordinator.
What are the causes of serious hip and knee pain?
Problems with major joints like the hip and knee are most frequently the results of arthritis.
- Osteoarthritis is the most common form of arthritis. It is most often related to the wear and tear of the cartilage over the years. Its onset is usually after age 50. As the cartilage is worn away, exposed bones rub together causing pain, inflammation, immobility and further damage to the joint. Factors that may predispose this condition include family history, obesity and previous joint surgery or fractures.
- Rheumatoid Arthritis (RA) is one of the more common kinds of inflammatory arthritis. It is a long-term disorder that affects the joints of the body. RA is likely an autoimmune disease, which means body cells irritate the lining around the joint leading to destruction of the cartilage. RA can occur in all age groups.
What does a total hip replacement involve?
The arthritic ball of the thigh bone (femur) is removed and replaced with a metal ball that is fixed solidly inside the femur by a shaft attached to the ball. The hip socket is replaced with a plastic or metal liner that is fixed inside a metal cup. These new parts move freely and smoothly against each other.
What does a total knee replacement involve?
A metal platform is secured to the tibia (shin bone) and to the femur (thigh bone). Between these two metal implants a spacer is inserted to serve as your new cartilage. The surface of the patella (knee cap) is resurfaced or may be replaced. These new parts move freely and smoothly against each other.
What are the risks of joint replacement surgery?
Joint replacement is major surgery. As with any surgery, there are potential risks and complications. These include problems from anesthesia, infection, bleeding from your incision, blood clots, damage to nerves or blood vessels, dislocation with hip replacement, and very rarely, death. These complications are rare and every precaution is taken by your healthcare team to avoid them.
What can I expect from a joint replacement?
Generally, joint replacement is successful. Pain is relieved, deformity is corrected, and patients resume former activities and a more active lifestyle. Long-term success rates vary from 10 - over 20 years, depending on age, weight and activity level. A critical concept for successful joint replacement is early mobility.
Am I too old for this type of surgery?
As long as you are in reasonably good health and are willing to put time and effort into the rehabilitation process, you are a candidate for this type of surgery.
How long will my new joint last?
A number of factors will affect the success of your new joint implant. There is no guarantee how long your implant will last. Factors that are under your control that can affect the longevity of your new joint include weight, activity and medical condition stability. It is important to remember that an implant is a medical device subject to wear and tear. Statistically, loosening or wear rates requiring repeat surgery are about one percent per year. In other words, about 90 percent of replacements will last 10 years and about 80 percent will last 20 years.
Should I exercise before this surgery?
Your surgeon and the Total Joint Center team see quicker and safer mobility in patients who have taken measures to strengthen major muscle groups prior to surgery. The better toned your muscle groups are, the easier the rehabilitation process will be. Please see the pre-operative exercises at the back of this handbook.
How long will I be in bed after surgery?
You will be assisted to stand the day of your surgery by your physical therapist and/or your Total Joint Center nurse. Studies have shown, and your surgeon believes, that the more quickly patients get back up and on their feet, the more quickly the body’s hemodynamics (appropriate balance in blood pressure, pulse, hemoglobin level and fluid volume) will stabilize. Your first several times out of bed will require one or two staff members to assist you. We will assist you to the Total Joint Center dining room for breakfast the morning after your surgery, and you will take all further meals in the dining room. We do not use bedpans so you will be assisted to a bedside commode when needed. Please keep in mind that the Total Joint Center staff is specifically trained in the proper technique for getting patients with new joints out of bed safely. Listen to and use their tips.
How long will I be at the Total Joint Center?
The average number of days in the hospital for a joint replacement is three; however, with the advent of Total Joint Centers, shorter stays are becoming more common.
How long does this surgery take?
Total operating time from skin incision to closure is about 45 - 90 minutes. The time elapsed from entering the operating room to exiting into recovery is one to two and a half hours. This time includes anesthetic induction, positioning and surgical site preparation; it is not all “operating time.”
How painful is joint replacement?
You can expect discomfort after your surgery. Most patients report that the initial eight to 10 hours out of recovery are the most painful. The Total Joint Center team members are specifically trained in post-operative pain management techniques. Your RN will work closely with you to ensure that you are as comfortable as possible. Many patients initially require intravenous (IV) narcotic pain medication; however, most patients are able to stop using IV narcotics and take pain pills with breakfast the day after surgery. It is important to keep in mind that extended use of IV narcotics has been shown to slow the body’s ability to heal. IV narcotics slow digestion, which may increase your risk for nausea and loss of appetite. Most importantly, IV narcotics decrease your ability to participate and make decisions in your care. It is a misconception that IV narcotics are the best way to handle surgical discomfort. The Total Joint Center team members have found that many of our patients experience fewer complications and regain their mobility more quickly with the use of oral pain medication. There are non-medicinal approaches to pain relief, such as cold therapy, that are very effective in pain relief after total joint surgery.
Will I use a walker after surgery?
You will need a walker or some form of assistive device for stability after surgery. The length of time you will need to use an assistive device will be determined by your surgeon and/or your physical therapist. Do not discontinue the use of your walker or crutches without checking with your surgeon and/or physical therapist.
Will I need help at home?
Most joint replacement patients can return home with only a few modifications to their home and a few hours of daily assistance from a family member or friend. Preparing your home prior to your surgery may reduce the amount of assistance you will need after surgery.
As your recovery process continues, your need for daily assistance will lessen. Some surgical incisions require a dressing change, and you may need help with this procedure.
Will I need home health or physical therapy once I return home?
Most joint replacement patients will return home with home health and physical therapy services.
Most joint replacement patients require consistent exercise and stretching to loosen tight ligaments and prohibit stiffness and swelling. Your surgeon will discuss with you the frequency and duration of your outpatient physical therapy.
When can I drive?
Your surgeon will instruct you on this prior to discharge.
When can I return to work?
Overall, the recommendation is not to return to work for one month. There may be exceptions to this, largely dependent on what you do for a living. If you have specific questions about how to perform your job tasks once you return to work, please ask the occupational therapist during your evaluation and treatment while in the hospital.
When do I see the surgeon after I return home?
Each surgeon prefers to see their patients at different times. The Total Joint Center team will schedule an office appointment for you before you are discharged from the hospital.
Will this new joint feel different to me?
It is very common to have a small area of numbness outside of your scar line. This could last a year or more. You may also hear or feel a clicking noise when you move. This is the artificial surfaces of your joint moving over each other and is nothing to be alarmed about.
What else should I know?
Your surgeon will require that you take antibiotics prior to all future dental procedures. Please talk with your surgeon at your first post-operative appointment about this requirement.
What restrictions will I have after this surgery?
You will not be able to run, jump or perform activities that could require “high-impact” on your new joint. If you have had a total hip replacement there are some movements you should not make.