FAQ - Total Joint Replacement

Q :		Is it really worthwhile going to all of this trouble having a hip or knee operated on?
A :		The best thing to do is to ask someone who has undergone hip or knee replacement surgery. Most people will tell you that it was well worth the effort because it decreases the amount of pain that they suffered, and increases their activity level.

Q :		What does the term total joint replacement mean?
A :		Total joint replacement means replacing both sides of the surface of a joint. In the knee it means replacing both the thin cartilage surface on the lower joint surface which is the tibia, and the upper joint surface which is the femur. Also, the joint surface under the kneecap is replaced. This requires removing the thin cartilage surface and a thin surface of bone for replacement with a metal and plastic surface. This allows all movement of the joint to occur between the metal and plastic parts rather than the raw bone left by arthritis.

Q :		What are the possible complications of total joint replacement surgery?
A :		Possible complications with any surgical procedure are of two types. The first is possible anesthetic complications such as strokes, heart attack, blood clots, or pneumonia. It is absolutely necessary to have a complete physical examination and laboratory tests before surgery of this nature to make sure that one is in the best possible physical condition. People who are in good physical condition have a very low incidence of surgical complications. The other class of complications is pertinent to the specific surgery itself. On total hip and total knee replacement surgery, there is a possibility of wound infection, scar formation, body rejection of the prosthesis, and others. Modern surgical techniques and the use of antibiotics produce minimal and acceptable risk.

Q :		Will I need blood transfusions for surgery?
A :		There is frequently a need for some blood transfusions during total joint replacement surgery. Most of the blood lost in surgery can be reused at the time of surgery by being filtered and re-administered to the patient. For hip surgery particularly, we advise that patients store some of their own blood prior to surgery for use at the time of surgery. This precludes any possibility of problems during the administration of blood at the time of or after surgery.

Q :		What does the term arthritis mean?
A :		Arthritis is a general term that means anything wrong with the joint, and there are many kinds of arthritis. The most common kind of arthritis is called “osteoarthritis,” or degenerative arthritis. These two terms are the same and indicate the kind of arthritis that is due to simple wear and tear of the joint surfaces usually over a period of time. Any injury to the joint will frequently cause accelerated wear of a joint. The most frequent joints to wear out are weight bearing joints such as knees and hips.

Q :		How would I know if I need a total joint replacement?
A :		Total joint replacement is usually the last thing to be done for a joint that is undergoing degeneration or damage. There are many treatments for joint pain such as joint injections, joint medication, physical therapy, arthroscopic surgery, and others. Usually more conservative treatments should be tried before considering joint replacement surgery. If all other means have been exhausted, total joint replacement is very successful in relieving pain and returning joint function.

Q :		How do I know if I am ready for a new hip or knee?
A :		The answer to that question is usually, "You will know." When all other means of treatment have been exhausted, and when the amount of pain in the joint limits activity, causes sleeplessness, and in general decreases the quality of life, it is time to consider a joint replacement procedure.

Q :		How old do I have to be to consider a new hip?
A :		Previous thinking was that a person had to be 65 years of age of older to consider joint replacement surgery. Most of the people who need these operations are over 65. However, this doesn’t help people in a younger age group who have painful joints unresponsive to therapy. The modern tendency is to permit surgery at younger ages. Aiding this are new surgical techniques which hopefully will allow artificial joints to serve longer, even in people who are physically quite active.

Q :		How much pain could I expect after joint replacement surgery?
A :		The pain after joint replacement surgery is minimal compared to months and years of pain suffered before having joints replaced. The first few days are of course of most concern. However, comfort can be achieved with the use of continuous spinal analgesia for the first several post-operative days, or “patient controlled anesthesia” activated with a single button by the patient when he or she wishes to have pain medication given intravenously. After several days, discomfort is markedly diminished, and oral medication will suffice. Most people feel it is a small price to pay for the amount of relief achieved.

Q :		How much time is it necessary to spend in the hospital for joint replacement of hips and knees?
A :		The amount of hospitalization required after joint replacement varies depending on the patient. If an individual has been active, vigorous, and is in good physical condition, three days is sufficient for hip and knee surgery of this nature. If one’s physical activity has been low or impaired and for older individuals, several days more are required. Medicare allows patients to have a period of in hospital rehabilitation for five to ten days to allow additional rehabilitation between hospital stays and home stays.

Q :		How much physical therapy would I need after joint replacement therapy?
A :		Physical therapy should be started probably the day after surgery. It should be continued in the hospital and at home after discharge. The ideal situation is to begin physical therapy before the procedure is done so that the patient knows exactly what to do after surgery has been accomplished.

Q :		What can I do before surgery to make recovery faster?
A :		It is very valuable to begin physical therapy before hip and knee surgery. Use of crutches and walkers will be necessary after surgery, and it is advisable to strengthen arms and shoulders in preparation for the use of crutches and walkers. Also, strengthening hip and knee muscles prior to surgery is of considerable benefit in preparation for physical therapy which will be necessary after surgery.