Upcoming Joint Replacement? Your 13 Most Common Questions Answered
Joint Replacements: What Are the Basics?
If you've decided to have a joint replacement, you probably have many questions. But you need answers, so you can get back to your activities and life! First, the basics: in joint replacement surgery part of your arthritic or damaged joint is removed and replaced with a metal, plastic or ceramic device called a prosthesis. The prosthesis is designed to replicate the glide of a healthy joint.
Joint replacement surgeries are common and occurring in younger patients; in fact, around 7 million people in the U.S. are living with a hip or knee replacement. Other joints, such as the ankle, wrist, shoulder and elbow can be replaced too.
Why Do I Need A Joint Replacement?
Dealing with the pain of a worn down or injured hip or knee joint can take it's toll. It's physically and mentally draining to deal with the constant ache and avoid daily activities. Joint replacement surgery involves removing the damaged joint and replacing it with new, shiny parts. It's a fairly common surgery, so you may know others who have had these operations.
Reasons for joint replacement include:
- Joint pain, stiffness due to arthritis
- Negative affect on quality of life
- Bone damage from accident or injury
- Medical treatment failure
- Joint deformity
What's Involved In Hip Replacement Surgery?
You'll arrive at the surgery center, most likely early in the morning for a hip replacement. You are usually given a general anesthetic and spinal or local pain medication to keep you asleep and control pain. An incision is made into the skin and through the muscles to reach the hip joint. The diseased bone and cartilage are removed, but the healthy parts of the joint are left intact. The surgeon replaces the head of the femur (thigh bone) and hip socket (acetabulum) with new, artificial parts. These new parts allow a more natural gliding motion of the joint. The surgery usually lasts 2 to 3 hours, but varies. You'll stay in the hospital for a few days, most likely.
What's Involved With a Knee Replacement?
With a knee replacement, the surgeon will remove the damaged knee joint and resurface the knee joint with a piece made of metal and plastic. The new joint is attached to the intact bone with surgical cement, or it may also contain uncemented pieces, which grows to a porous surface on the bone.
The replacement joint is usually made of 3 components: 1. tibial (shin bone) component; 2. femoral (thigh bone) component; 3. a patellar (kneecap) component which prevents the kneecap from rubbing against the thighbone. Surgery can last 1-3 hours; you'll be in the hospital for 1-3 days but may be a candidate for outpatient surgery, too.
How Will A New Joint Affect Me?
Each person has an individual response to surgery. Most have a successful procedure and their quality of life will be greatly enhanced. Follow all your doctor's directions, including physical therapy, medicines, diet, and at-home exercise programs.
Possible complications of a new joint may include infection, blood clots, dislocation, wear and tear, joint loosening, and infrequently, nerve damage. Medicines like antibiotics can be used for infections, and blood thinners are given for blood clots. Most new joints typically last 10 to 15 years, so if you are younger when you have your surgery you may need more than one replacement.
What Happens After Surgery?
Your care team at the hospital will have you up and moving your new joint the next day after surgery. Physical therapy will focus on range of motion and strengthening exercises. You will need support at first, like a parallel bar, walker, cane, or crutches to help support your full weight. You healthcare team will give you pain control medications to help with physical therapy.
After surgery it's often easier to prevent pain than treat it after its set in, so request analgesia at the first sign of pain. In 2 to 5 days, you may go home if you have help, or to an extended care facility to re-learn your daily activities like bathing and dressing. You may also have several months of outpatient physical therapy to strengthen your surrounding muscles.
What Other Options Do I Have?
If you have an upcoming hip or knee joint replacement, you've probably tried other options first. Over-the-counter (OTC) anti-inflammatory medicines like NSAIDs are usually initial therapy, and local corticosteroid or lubricating shots may provide relief. Physical therapy, walking aids such as braces or canes, and periods of rest may be tried.
However, you may get to the point that you can't do regular activities, like bathing, walking up stairs, or even walking down the block. It's at this point that your doctor may recommend consultation with an orthopedic surgeon for evaluation, if you also agree to surgery as a possible solution.
What About A Minimally Invasive Procedure?
Minimally invasive surgery uses a smaller incision and can result in less post-operative pain, a shorter recovery time, and a smaller scar. This kind of surgery often requires special equipment not available in all hospitals. Unfortunately not everyone is a candidate for minimally invasive joint replacements. In general, candidates for minimal incision procedures are younger, healthier, not overweight, and more motivated to participate in the rehabilitation process. Ask your surgeon if you are a candidate, if minimally invasive procedures are available in your area, and if there are doctors that are trained in this special procedure.
How Is Pain Managed After Joint Replacement Surgery?
Rest assured that every effort will be made to control your post-operative pain. Treating your pain will allow you to more easily start your rehabilitation program, too, which will speed you to your full recovery. Pain management may include:
- IV or oral opioids (like morphine, meperidine), also used in patient-controlled analgesia
- Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen and diclofenac
- Acetaminophen (Tylenol)
- Local anesthetics like lidocaine, bupivacaine, and ropivacaine; may be used in epidural anesthesia.
Should I Be Concerned About Possible Blood Clots?
One of the major risks with any surgery, but especially joint replacement, is a clot formation, either a deep vein thrombosis (DVT) or a pulmonary embolism (PE). A DVT is the formation of a clot in a deep vein, often in the leg. A PE is a clot that travels to the lungs and blocks the flow of blood to the lungs and heart. To help prevent a clot, your doctor will prescribe ways to lower your risk:
- Exercises to improve circulation
- Elevation of limbs
- Pneumatic compression and compression stockings
- Medications known as anticoagulants (blood thinners)
What Are Anticoagulants?
Your doctor will decide which blood thinner will best protect you from a clot, but how do these drugs work? Anticoagulants don't actually "thin your blood" but block certain coagulating factors that promote blood clotting. Be sure you understand the safe use of your blood thinner by discussing with your doctor and pharmacist, as your risk of bleeding in general will be increased while taking these medications. Depending upon the drug, they can be given either by injection or in an oral pill.
I Wonder What Others Have Experienced?
Group support is a great way to gain confidence prior to surgery. Joining the Drugs.com Hip Replacement Support Group or the Knee Replacement Support Group is a great way to discover others with related questions and similar concerns, to read news, and share your own experience.
Maybe you have questions about how the stairs or bathing are handled? What are some useful ways to spend your recovery time at home? Do you have questions about medication costs or insurance coverage? Any of these topics can be fair game. But remember, your healthcare provider is always the best source for individual medical and drug information.
Your Job? Ask Even More Questions
Having joint replacement surgery requires preparation. Open communication with your doctor is very important to ensure success. Consider taking a family member or friend to your appointments to lend a hand, provide morale support, and help record answers to questions such as:
Finished: Upcoming Joint Replacement? Your 13 Most Common Questions Answered
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Joint Replacement Surgery: Health Information Basics for You and Your Family. Accessed 2/6/2017 at http://www.niams.nih.gov/health_info/joint_replacement/
- American Association of Hip and Knee Surgeons. Do I Need a Joint Replacement? Accessed 2/6/2017 at http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-replacement/
- American Academy of Orthopaedic Surgeons. Ortho Info. Joint replacement. Section Editor: Jared R. H. Foran, MD. Accessed 2/1/2017 at http://orthoinfo.aaos.org/menus/arthroplasty.cfm
- Agency for Healthcare Research and Quality (AHRQ). Advancing Excellence in Healthcare. Preventing Blood Clots After Hip or Knee Replacement Surgery or Surgery for a Broken Hip: A Review of the Research for Adults. AHRQ Pub. No. 12-EHC020-A Accessed 2/7/2017 at http://effectivehealthcare.ahrq.gov/ehc/products/186/1144/vte_ortho_surg_cons_fin_to_post.pdf
- Kremers M. et al. Prevalence of Total Hip and Knee Replacement in the United States. J Bone Joint Surg Am. 2015 Sep 2;97(17):1386-97. Accessed 2/4/2017 at https://www.ncbi.nlm.nih.gov/pubmed/26333733