When a joint has worn to the point it no longer does its job, an artificial joint, or prosthesis, made of metal, ceramics and plastics can take its place. Total joint replacement surgery recreates the normal function of the joint – relieving discomfort and significantly increasing activity and mobility.
- The hip joint is a "ball and socket" in which the upper end of the thighbone rotates inside a rounded area of the pelvis. The knee is a "hinge" that joins the shin to the thigh. Both joints are lined with cartilage, a layer of smooth, tough tissue that cushions the bones where they touch each other. With age and stress, the cartilage wears away and the bones rub against each other, causing friction, swelling, stiffness, pain and sometimes deformity.
- When this happens, hip or knee replacement may relieve pain and restore mobility and quality of life.
Joint replacement is a safe and common procedure. Annually, nearly 150,000 people have hips and nearly 250,000 have knees replaced with positive results. Any surgical procedure involves risk. Hospital staff will review these with you and explain how your post-surgical program can reduce risk and aid in more rapid recovery.
- All patients are required to have routine blood work and urinalysis at least 14 days before surgery. You must also have a physical examination within 30 days of the surgical date.
- Patients over 50, and those with cardiac or respiratory history, must also have an EKG and chest x-ray within days of surgery. Most pre-admission testing can be performed either by your personal physician or at the hospital where the procedure will be performed.
Some surgeries require you to donate blood if possible. This can be done any time within 35 days of surgery. If you can’t donate your own blood, a designated donor may donate blood on your behalf. You may also receive blood from the hospital Blood Bank if necessary. The Blood Bank follows universal guidelines in screening blood and blood products to ensure safety.
You should take an iron supplement, particularly if you will be donating your own blood.
You can take most medications up until the day of surgery. Don’t take anti-inflammatory medications containing aspirin, which can act as blood thinners, within two weeks of surgery unless instructed otherwise by your physician.
- Bring all of your personal toiletries and shaving gear, comfortable, loose fitting clothing, slip-on non-skid shoes or slippers with closed backs, a list of current medications including dosages and any paperwork the hospital has requested.
- If you have a walker, cane or crutches, have someone bring them at discharge so the physical therapist can check them for size and stability.
- Do not bring radios, televisions or large amounts of cash.
- You should arrive two hours before surgery time to go through admissions, change into hospital clothing, meet the anesthesiologist and nursing personnel and address any questions about the procedure.
- Do not eat or drink after midnight on the day of your surgery. You may be allowed to take pre-approved medication with the least amount of water necessary. Report any medication taken, along with dosage, to your admitting nurse.
Your family may stay with you until you are taken to the operating room.
You may have a general anesthetic, which most people call being "put to sleep." Some patients prefer a spinal or epidural anesthetic, which numbs your legs without requiring you to sleep. You can discuss options with your anesthesiologist.
Many patients only experience mild discomfort in the days and weeks following joint-replacement. However, after years of living with joint pain, for most it is a welcome relief. As with any surgery, individual patient results and experiences vary. Make sure to talk with your doctor before surgery about your pain management options. You may receive pain medicine through your IV, through the epidural or in shots or pills. Most likely, you will be mobile within hours of surgery.
Depending upon the difficulty of your case, surgery can take anywhere from one to three hours, with an additional two to three hours in the recovery room.
Your orthopaedic surgeon will perform the surgery. If an assistant helps, they may bill you separately.
Whenever possible, the surgeon or one of his assisting surgeons will meet with family members immediately after surgery. If for any reason this is not possible, you may contact the doctor's office to arrange a time to discuss how the surgery went.
- You will most likely be "groggy" at first from the medications you receive in surgery. You will be transported from the recovery room to your hospital room once your surgeon and medical team deem it safe for you to be transferred.
- Once you are fully awake, you will be able to drink and eat as tolerated. Your vital signs, urinary output and any drainage will be monitored closely by nurses on the orthopaedic surgery floor.
- Pain medicine may be monitored closely. Make sure to talk with your doctor before surgery about your pain management options. You may receive pain medicine through your IV, through the epidural or in shots or pills. It may also be administered intravenously by "pain pump" for the first 24 hours, which allows you to control your own pain level up to a predetermined dosage.
- Starting on day one post-operatively you will work two to three times a day with physical and occupational therapists, who will go over exercises and help you adapt daily activities to your post-operative limitations.
Most patients are hospitalized about two to four days, including the day of surgery. This may be extended to include treatment at a rehabilitation center or sub-acute facility. You should contact your health insurance provider to find out what, exactly, is covered and to obtain these provisions in writing.
It is best for someone to be with you the first 24 to 72 hours after discharge. If you live alone and a friend or relative offers to stay with you, take them up on the offer! If you can't arrange a full-time helper, perhaps a friend of neighbor can call daily to check on your progress. Home care can also be arranged through your case manager.
Many patients can climb stairs before leaving the hospital.
Most patients do benefit from a short-term course of pain medication. Expect to take some kind of pain medication for several weeks after discharge – especially at night or before therapy sessions. You can call your doctor's office for prescription renewals.
Your orthopaedic surgeon will work with your physical therapist to develop your specific ambulation plan. Generally, patients use a walker or crutches for the first six weeks after surgery. Then, they can graduate to a cane for about six weeks before walking on their own.
You may go outside at any time. Start with short trips at first – therapy, church – and increase the number and length of outside activities, as you feel more comfortable.
Sutures are usually removed in the office at the first post-operative visit at 14 days. If you are unable to come to the office at 14 days after the operation, the home health nurse will remove the sutures.
Most patients must wait for six weeks before driving. However, some physicians may allow the patients to drive earlier if they feel the patients can do so safely. The type of surgery, side of surgery (left leg vs. right leg), and the patient’s overall general condition will play a part in that decision. If you wish to drive earlier than the 6-week routine prescribed, you should discuss this with your surgeon and obtain his/her approval. Consult with your surgeon for further details.
Most patients wait until at least six weeks post-surgery to return to work. Some may return earlier if they can do so safely. You should discuss your own situation with your surgeon during a follow-up visit.
You will need to schedule your first post-operative visit two to three weeks after discharge. The frequency of additional visits will depend on your progress. Many patients are seen at six weeks, 12 weeks and then yearly.
- You may be able to try swimming, distance walking, hiking, bicycle riding, golfing and other low impact sports activities after a few weeks of rehabilitation and recovery.
- Discuss your activity level and abilities with your surgeon.
In most cases, you may resume sexual activity when you feel comfortable enough to do so. Make sure to heed any position restrictions recommended by your caregivers. In general, most patients resume normal sexual activities within 4 to 6 weeks after surgery.
You may have a small area of numbness on the outside of the scar for a year or more. Kneeling may be uncomfortable for a year or so, and you may notice clicking when you move your knee.
The numb area along the front and outside of your knee (and sometimes-lower leg) is the expected result of making the incision in the front of your knee. This incision interrupts small superficial skin nerves that supply the skin on the front and outside of the knee. This area of numbness shrinks in size over time, so that what starts out as a large area usually ends up as only a small area. This process can take six months to a year. This area of numbness is not harmful, but can be annoying. It occurs in everyone and is permanent. Also, if the operation takes two hours or more, some people experience a transient feeling of numbness in the whole leg which disappears in 24 to 48 hours.
The drain helps prevent excessive swelling/bleeding that might otherwise require removal with a needle on the first day or two after surgery. The drain will be removed at your first postoperative visit.
Yes you do. For the rest of your life you need to use antibiotic prophylaxis to reduce the chance that infection develops in the bone or around the implant.
We recommend you take antibiotics to protect your joint replacement if you are having any genito-urinary procedures such as a cystoscopy or TURP. You should also be protected for any gastrointestinal or biliary (gallbladder) surgeries. Any skin infections such as a boil, furuncle, or abscess also require treatment.
