Frequently Asked Questions about Joint Replacement Surgery We are glad you have chosen the Mercy Center for Joint Replacement to care for your hip or knee problem. Patients have asked many questions about total hip and knee replacements. Below is a list of frequently asked questions. If there are any other questions or concerns that you have, please ask your surgeon. We want you to be completely informed about your surgery. What is arthritis? Arthritis is an inflammation of one or more joints that result in pain, swelling, stiffness and limited movement. There are more than 100 different types of arthritis; however, the most common type is osteoarthritis. What is osteoarthritis? Osteoarthritis, also called degenerative joint disease or wear and tear arthritis, most frequently occurs in weight-bearing joints such as the knees, hips and ankles. The disease affects the cartilage, which normally covers the ends of each bone and creates a smooth surface within the joint. With osteoarthritis, this smooth surface becomes rough and pitted and may wear away completely. Without cartilage to act as a shock absorber, the bones grind against one another, causing inflammation, pain and restricted movement. Bone spurs may also form. With age, most adults are affected by osteoarthritis to some degree. What are the symptoms? The number one symptom is pain that is often described as deep and aching. Initially, pain may occur after activity and will be relieved with rest; however, as the disease progresses, pain may be felt with minimal movement. In severe cases, there is even pain at rest. Joint stiffness, lasting 20 to 30 minutes is also common, especially upon waking or following periods of inactivity. Other symptoms may include crackling, tenderness, joint enlargement and loss of flexibility. How is it diagnosed? A simple weight-bearing X-ray and examination by your doctor will determine if you have osteoarthritis. Time-consuming and costly diagnostic procedures are not required. 37
What is knee replacement? Arthritic knee Knee replacement Knee replacement, also known as total knee replacement or knee arthoplasty, is a surgical procedure that is performed to remove worn, diseased or damaged bone and cartilage and replace it with an artificial joint, or prosthesis, that is made of metal and plastic. Undergoing knee replacement surgery can help relieve pain and allows patients to return to normal everyday activities. For those who have become bow-legged or knock-kneed over the years, it can also straighten the legs into a more natural position. Arthritic hip What is hip replacement? Hip replacement is a surgical procedure that involves removing a worn, diseased or damaged hip joint and replacing it with an artificial joint, called a prosthesis. The artificial joint is composed of a ball and socket component made of metal and plastic or ceramic. Having a hip replaced can help relieve pain and get you back to enjoying normal everyday activities. Hip replacement What are the major risks? Most surgeries go well, without any complications. However, we are concerned about infection and blood clots. To avoid these complications, we use medications and mobilize you early. We also take special precautions in the operating room to reduce the risk of infections. The chances of this happening in your lifetime are one percent or less. Those having a hip replacement: dislocation of the hip after surgery is a risk. Your surgeon and physical therapists will discuss ways to reduce that risk. Will I need a blood transfusion? Although not typical, you may need a blood transfusion after surgery. Bank blood is considered safe, but we understand if you want to use your own. For more information about donating your own blood, talk with your surgeon. How long does the surgery take? We will reserve two to two-and-a-half hours for your surgery. Some of this time is spent preparing for surgery. Actual time spent in the operating room is about 60-90 minutes. Those having a hip replacement via anterior approach spend at least to 90-120 minutes in the operating room. 38
Do I need to be put to sleep for this surgery? You may have a general anesthetic, which most people call being put to sleep. Some patients prefer to have a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. Most would agree that you do not want to be awake for this kind of surgery. For this reason, no matter what approach of anesthesia is used, you will be sedated. The choice is between you and the anesthesiologist. For more information, read the Anesthesia and You section of this guide. Will the surgery be painful? Yes, you will have discomfort after surgery. Remember, the arthritis pain will be gone; however, you will have surgical pain. Many patients report this pain being more tolerable than the pain they had before surgery. Mercy has a dedicated team that works hard to keep your pain under control. Your surgeon, nurses, and therapists will make a specific pain management plan just for you. Will I need a walker after surgery? Yes. We recommend that you use a walker or crutches for approximately four weeks after surgery. You will be instructed by your therapist and surgeon on when to stop using this equipment. While you are in the hospital, the therapists will teach you how to use a walker. If your balance will tolerate crutches, we will teach you how to use them. Most of our patients go home with a walker because it is the most stable option for your balance after surgery. Will I need any other equipment? Those having a total knee replacement may be advised to use a continuous passie motion (CPM) machine for up to 6 weeks after surgery. If your surgeon sends you home with a CPM machine, we will make sure you are instructed on how to use it prior to leaving the hospital. Knee patients are also typically sent home with a cooling ice wrap machine. This would also be sent home with you for 6 weeks. You will be given instructions on machine return or pick-up before leaving the hospital. Those having a hip replacement may need a high toilet seat for a few months. You will be taught to use assistive devices to help with lower body dressing and bathing. You may benefit from a bath seat or grab bars in the bathroom. This can be discussed with your occupational therapist while you are in the hospital. Other equipment needs (with instructions for use) will be arranged by the Joint Camp staff. How long will I be in the hospital? Most patients are discharged on the second or third day after surgery. For example, if your surgery is Monday, you would be sent home on Wednesday or Thursday. Remember, there are several goals to achieve before leaving the hospital. 39
Where will I go after being discharged from the hospital? Most patients are able to go directly home. A social worker and care manager will help you with this decision and make the necessary arrangements, if needed. Will I need help at home? Yes. For the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation, laundry, cleaning, etc. Family or friends should be available to help. What if I live alone? Your progress will be watched closely. If you are unsafe to go home by yourself, our social worker and care manager will discuss different options with you. Most patients generally do better if they can return to their familiar home environment. One option available is to return home with family support. Sometimes a home health nurse, home physical or occupational therapist may be indicated. If a skilled nursing home is needed, our care coordination team will make those arrangements for you while you are in the hospital. Will I need physical therapy when I go home? Knee patients: Yes. We encourage you to attend outpatient physical therapy after leaving the hospital. Try to make your first appointment ahead of time: this should be made for the first business day after you go home. Therapy will continue up the three times a week for six weeks, depending on your progress (length of time varies with each patient). Hip patients: Your recovery involves a progressive walking program. Typically, patients do not need physical therapy once discharged from the hospital. If you do, our social worker and care manager will help arrange this for you. Do I have any restrictions after surgery? Yes. High-impact activities, such as running, singles tennis and basketball are not recommended. Injuryprone sports such as downhill skiing are also dangerous for the new joint. Some hip patients will be restricted from crossing their legs, bending their hips more than 90 degrees, and twisting/pivoting for the first six weeks after surgery. What are some safe activities I can do after I recover? You are encouraged to participate in low-impact activities such as walking, dancing, golf, hiking, swimming, bowling, and gardening. 40
When can I can drive? Do not drive without the permission of your surgeon. The ability to drive depends on whether surgery was on your right or left leg, and what type of car you have. If the surgery was on your left leg and you have an automatic transmission, you could be driving again in four to six weeks. If the surgery was on your right leg, your driving could be restricted at least six weeks. When can I go back to work? Do not return to work without the permission of your surgeon. Usually, we recommend you take at least one month off from work. A therapist can make recommendations for joint protection and energy conservation on the job. When can I have sexual intercourse? The time to resume sexual intercourse should be discussed with your surgeon. The physical therapist also has information available. How often do I need to see my surgeon? You will be seen for your first postoperative office visit within two weeks of your surgery. The frequency of follow-up visits will depend on your progress. Many patients are seen at six weeks, twelve weeks, and then yearly. Your surgeon will let you know when to schedule your next visit. Will I notice anything different about my new hip/knee? Knee patients: Yes. You may have a small area of numbness outside of the scar; this is not serious. It may last a year or more. Kneeling may be uncomfortable for a year or more. Some patients notice some clicking when they move their knee. This is the result of the artificial surfaces coming together and is not serious. Hip patients: In many cases, patients with hip replacement think that the new joint feels completely natural. However, we recommend avoiding extreme positions or high impact physical activity. The leg with the new hip may be longer than it was before. This could be from a previous shortening caused by the hip disease, or because of a need to lengthen the hip (to help prevent dislocation). Most patients get used to this feeling in time, or can use a small lift in the other shoe. Some patients may have aching in the thigh for a few months after surgery. 41