It's A Joint Effort: FAQs on Joint Replacement
Medically reviewed on Mar 11, 2018 by L. Anderson, PharmD.
Joint Replacements: What Are the Basics?
If you've decided to have a joint replacement, you probably have many questions. And 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 today. Over 1 million total hip and total knee replacement procedures are performed each year in the United States. In fact, according to a study in The Journal of Bone and Joint Surgery, around 7 million people in the U.S. are living with a hip or knee replacement. As baby boomers age, they are living longer and want to stay mobile.
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. Quality of life can be dramatically impacted.
Joint replacement surgery involves removing the damaged joint and replacing it with new, shiny parts. It's a fairly common surgery, and you may know others who have had these operations. These surgeries can allow patients to get back to their normal routine.
In certain cases, as published by Australian researchers in 2018, some patients can get back to even high impact sports such as running marathons, downhill skiing and tennis. However, your doctor should always approve your level of sport after recuperation from any joint replacement surgery.
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?
The number of hip replacement surgeries in the U.S. has increased substantially, and the procedure has become more common in younger people, too.
What happens during a 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, 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 1 to 3 days, most likely.
While in the hospital, you'll have quick mobilization to get you up to help prevent blood clots in your legs. Blood thinning drugs may be used, as well as compression stockings or inflatable sleeves to prevent blood from pooling in your veins.
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:
- tibial (shin bone) component
- femoral (thigh bone) component
- 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, where you'll go home later in the same day.
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:
- blood clots
- wear and tear
- joint loosening
- nerve damage (infrequently).
Medicines like antibiotics can be used for infections, and blood thinners are given to help prevent 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 Joint Replacement 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.
- Your 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 Are the Options to Joint Replacement Surgery?
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.
- 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 daily 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.
Does stem cell therapy work for osteoarthritis? It's important to know that there's no medical evidence suggesting that any stem cell therapy can provide a lasting cure for arthritis. Plus, a recent 2018 report noted that the average cost for a knee injection was $5,156.
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?
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:
- Early mobilization after surgery to prevent pooling of blood in the legs.
- At-home exercises to improve circulation.
- Elevation of limbs.
- Pneumatic compression boots, stockings, and compression socks, both after surgery and at home.
- Medications known as anticoagulants (blood thinners) are standard therapy to lower the risk of DVT and PE. The benefits of anticoagulants must be balanced against the possible risks of bleeding.
What Are Anticoagulants or Antithrombotics?
Anticoagulants, often referred to as blood thinners, don't actually "thin your blood"; they block certain naturally occurring coagulating factors that promote blood clotting. Your doctor will decide which blood thinner will best protect you from a clot based upon your risk and the type of surgery you are having. These drugs may also be referred to as antithrombotics.
If you use a blood thinner at home after surgery, be sure you understand the safe use of your drug by discussing with your doctor and pharmacist, as your risk of bleeding in general will be increased while taking these medications.
Following hip or knee replacement surgery, anticoagulation-type medication should be given for at least 10 to 14 days, but may be continued for longer, in some cases up to 35 days. Depending upon the drug, these medications can be given either by injection or in an oral pill.
Recommended agents to help prevent a venous blood clot after orthopedic surgery include:
- Low-molecular weight heparins, i.e., enoxaparin (Lovenox) and dalteparin (Fragmin), given by subcutaneous (under the skin) injection; requires no blood test monitoring compared to warfarin.
- Fondaparinux (Arixtra) injection given by subcutanous injection.
- Warfarin (Coumadin, Jantoven), a vitamin K antagonist, is given by mouth as a tablet. Blood tests are required to monitor effectiveness and safety.
- The oral antithrombotics: apixaban (Eliquis) and rivaroxaban (Xarelto) are Factor Xa inhibitors. Dabigatran (Pradaxa) and desirudin (Iprivask) are direct thrombin inhibitors.
Dalteparin (Fragmin), dabigatran (Pradaxa), and desirudin (Iprivask) are FDA-approved for prevention of venous clots after hip replacement surgery (but not knee replacement surgery.)
Is Aspirin An Effective Blood Thinner After Joint Replacement Surgery?
The powerful anti-clotting drugs like dabigatran (Pradaxa) and rivaroxaban (Xarelto) are often selected to prevent the dangerous clot in your leg or lungs after joint replacement surgery. But what about a cheaper and more accessible blood thinner like over-the-counter aspirin?
A study published in February 2018 in the New England Journal of Medicine says aspirin is just as good.
In the Canadian study, over 3,400 patients undergoing hip or knee replacement took oral rivaroxaban (Xarelto) for five days. After that, they either stayed with rivaroxaban or switched to low-dose aspirin (81 milligrams a day). Knee replacement patients took their medication for nine days. Hip replacement patients took it for 30 days. Researchers noted there was no evidence to support starting aspirin on day one of surgery.
Researchers found that aspirin was just as effective and safe as the newer, more expensive agents, when started after day 5 of rivaroxaban. Only a few patients developed a blood clot after surgery, and those on aspirin did as well as those on rivaroxaban. In the trial, about 1% of patients taking either aspirin or rivaroxaban (Xarelto) had a bleeding complication. In all cases, it was bleeding at the surgical site, according to the researchers.
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 and medication changes.
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
- Anderson DR, Dunbar M, Murnaghan, J, et al. N Engl J Med 2018; 378:699-707 DOI: 10.1056/NEJMoa1712746. Accessed March 10, 2018 at http://www.nejm.org/doi/full/10.1056/NEJMoa1712746
- Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD004179. DOI: 10.1002/14651858.CD004179.pub2. Accessed March 11, 2018.
- Guyatt G, Akl E, Crowther M, et al. Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Published: February 2012. Accessed March 10, 2018 at http://journal.chestnet.org/article/S0012-3692(12)60114-7/fulltext.
- After Knee Replacement, Play On. Drugs.com March 8, 2018. Accessed March 10, 2018 at https://www.drugs.com/news/after-knee-replacement-play-68934.html
- Stem Cell Clinics Pitch Pricey, Bogus 'Cures' for Knee Pain. Drugs.com. March 7, 2018. Accessed March 11, 2018 at https://www.drugs.com/news/stem-cell-clinics-pitch-pricey-bogus-cures-knee-pain-68919.html
- Kremers HM, Larson DR, Crowson CS, et al. Prevalence of Total Hip and Knee Replacement in the United States. The Journal of Bone and Joint Surgery (American). 2015;97(17):1386-1397. Accessed March 10, 2018 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4551172/.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Joint Replacement Surgery: Health Information Basics for You and Your Family. Accessed 3/10/2018 at http://www.niams.nih.gov/health_info/joint_replacement/
- American Association of Hip and Knee Surgeons. Do I Need a Joint Replacement? Accessed 3/10/2018 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 3/10/2018 at http://orthoinfo.aaos.org/menus/arthroplasty.cfm
- U.S. Dept. of Health and Human Services. Agency for Healthcare Research and Quality (AHRQ). Effective Healthcare Program. Advancing Excellence in Healthcare. Systematic Review Update of Venous Thromboembolism Prophylaxis in Orthopedic Surgery. Executive Summary. Comparative Effectiveness Review Number 191. June 2017. Accessed 3/10/2018 at https://effectivehealthcare.ahrq.gov/sites/default/files/related_files/thromboembolism-update-executive-170622.pdf