Hip and Knee Pain
Did you know?
Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery.
Rheumatoid arthritis, the most crippling form of arthritis, affects approximately 2.1 million Americans and two to three times more women than men. Further, the average onset for rheumatoid arthritis is between the ages of 20 and 45 years old.
Pain from arthritis and joint degeneration can:
The Orthopaedic Evaluation
A thorough medical history includes:
The information that the surgeon gathers during the medical history usually suggests the possibility of several different diagnoses.
The physical examination enables your surgeon to evaluate important aspects of your joints, including:
X-Rays help show how much joint damage or deformity exists. An abnormal X-ray may reveal:
Additional Diagnostic Tests
Occasionally, additional tests may be needed to confirm the diagnosis. These may include:
What is arthroscopy?
Arthroscopy is a surgical procedure used to visualize, diagnose and treat problems inside a joint.
In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient’s skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint.
During an arthroscopy, loose, pieces, damaged cartilage and inflammation can be wash out. Occasionally procedures to stimulate cartilage growth can be performed. An arthroscopy cannot cure arthritis but may decrease pain and slow progression.
Injections that provide temporary relief:
Partial joint replacement is a surgical procedure in which only the damaged or diseased surfaces of the joint are replaced, leaving much of the natural bone and soft tissue in place.
Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint are removed and replaced with a plastic or metal device or an artificial joint. The artificial joint is designed to move just like a healthy joint.
Joint replacement is a treatment option when pain:
Joint replacement is a decision that should include:
Did you know?
Total joint replacements of the hip and knee have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients.
Source: National Development Conference, National Institutes of Health, December 2003
Preparing for a joint replacement procedure begins weeks before the actual day of surgery.
In general, patients may need:
This is a decision only you and your surgeon can make. Every patient’s experience is different.
However, there are some general guidelines your doctor may give you:
For approximately 12 weeks after surgery certain limitations are placed on your activities. When fully recovered, most patients can return to work. However, some types of work may not be advisable for individuals with a joint replacement. These types of work include:
Athletic activities that place excessive stress on the joint replacement will need to be avoided. Examples of these activities include:
After joint replacement, acceptable physical activities should:
Longevity of Joint Replacement
It is impossible to predict in individual cases how long a joint replacement will last. Many factors determine the outcome including:
Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip, knee or shoulder joints, are removed and replaced with a plastic or metal device called a prosthesis. The prosthesis is designed to enable the artificial joint to move just like a normal, healthy joint.
Hip replacement involves replacing the femur (head of the thighbone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal, and the artificial socket is made of polyethylene (a durable, medical grade plastic). In total knee replacement, the artificial joint is composed of metal and polyethylene and it is used to replace the diseased joint. The prosthesis is anchored into place with bone cement or is covered with an advanced material that allows bone tissue to grow into it.
In shoulder replacement surgery, the artificial shoulder joint can have either two or three parts, depending on the type of surgery required.
Total joint replacements of the hip, knee, and shoulder have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients. While the expected life of conventional joint replacements is difficult to estimate, it is not unlimited. Today’s patients can look forward to potentially benefiting from new advances that may increase the lifetime of the prostheses.
Total joint replacement is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial hip or knee joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology.
Circumstances vary, but generally patients are considered for total joint replacement if:
Your joints are involved in almost every activity you do. Simple movements such as walking, bending, and turning require the use of your hip and knee joints. Normally, all parts of these joints work together and the joint moves easily without pain. But when the joint becomes diseased or injured, the resulting pain can severely limit your ability to move and work. Osteoarthritis, one of the most common forms of degenerative joint disease, affects an estimated 43 million people in the United States.1 Whether you are considering a total joint replacement, or are just beginning to explore available treatments, this website is for you. It will help you understand the causes of joint pain and treatment options. Most importantly, it will give you hope that you may be able to return to your favorite activities.
Once you’re through reading this website, be sure to ask your doctor any questions you may have. Gaining as much knowledge as possible will help you choose the best course of treatment to relieve your joint pain — and get you back into the swing of things.
1. Arthritis Foundation website, Feb. 2006.
Your hip joint is a ball-and-socket joint, formed by the ball, or femoral head, at the upper end of the thighbone, and the rounded socket, or acetabulum, in the pelvis. The bone ends of a joint are covered with a smooth, tough material called cartilage. Normal cartilage cushions the bones and allows nearly frictionless and pain-free movement. The rest of the surfaces of the joint are covered by a thin, smooth tissue lining called the synovium. The synovium produces fluid that acts as a lubricant to reduce friction and wear in the joint.
Sometimes called degenerative arthritis because it is a “wearing out” condition involving the breakdown of cartilage and bones. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of arthritis.
Rheumatoid Arthritis (RA)
Causes the synovium to become thickened and inflamed. In turn, too much synovial fluid is produced within the joint space, which causes a chronic inflammation that damages the cartilage. This results in cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body.
May develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth and these irregularities lead to more wear on the joint.
Can result when bone is deprived of its normal blood supply. Without proper nutrition from the blood, the bone’s structure weakens and may collapse and damage the cartilage.
A bone disease that often affects the hip. Bone formation is sped up, causing the density and shape of the bone to change. Joint pain can also be caused by deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move.
Following the orthopaedic evaluation, your orthopaedic surgeon will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:
Hip replacement is one of the most important surgical advances of this century. This surgery helps more than 300,000 Americans each year1 to relieve their pain, and get back to enjoying normal, everyday activities. Hip replacement involves the removal of arthritic bone ends and damaged cartilage and replacing them with prosthetic implants that replicate the hip joint.
Hip replacement surgery may be considered when arthritis limits your everyday activities such as walking and bending, when pain continues while resting, or stiffness in your hip limits your ability to move or lift your leg. Hip replacement may be recommended only after careful diagnosis of your joint problem. It is time to consider surgery if you have little pain relief from anti-inflammatory drugs or other treatments, such as physical therapy, do not relieve hip pain. Hip replacement can help relieve pain and get you back to enjoying normal, everyday activities.
Total hip replacement is often reserved for patients who:
In a total hip replacement operation, the surgeon replaces the worn surfaces of the hip joint with an artificial hip joint. The worn head of the femur (thigh bone) is replaced with a metal or ceramic ball mounted on a stem; the stem is placed firmly into the canal of the thigh bone at its upper end. The acetabulum (hip socket) is prepared and implanted with a metal cup and plastic or ceramic insert. The ball and insert glide together to replicate the hip joint.
1. Orthopedics.about.com website, Feb. 2006.
Total Hip Implants
The conventional arrangement of a metal ball into a special plastic (polyethylene) cup has been shown to have positive results over the years. How long it will last depends not only on age, but also on a patient’s activity level.
Another factor that may affect the durability of a total hip replacement is the bearing surface. The bearings are the two parts of the artificial hip that glide together throughout motion. These bearings can be metal-on-polyethylene, metal-on-metal, ceramic-on-polyethylene or ceramic-on-ceramic.
Technologies That May Impact Implant Performance
There have been significant advancements in improving the bearing surfaces in total hip replacement. Ceramic-on-ceramic bearings provide superior wear performance.1 Stryker’s ceramic-on-ceramic system has demonstrated significantly lower wear than metal-on-polyethylene systems in the laboratory; therefore, it is anticipated that these improved wear characteristics may extend the life of the implant.
There are also new, advanced polyethylene implants available that have demonstrated extremely low wear in the laboratory, and they are expected, over time, to have similar wear performance clinically.2
Your physician will discuss the exact type of prosthesis and surgical procedure with you.
Complications of Hip Replacement
As with any surgery, there is risk of complications after hip replacement surgery. However, they are relatively rare. Blood clots are the most common complication after surgery. Your orthopaedic specialist may prescribe one or more measures to prevent a clot from forming in your leg veins. These measures may include special support hose, inflatable leg coverings and blood thinners.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Accolade, Stryker, Trident and TMZF. All other trademarks are trademarks of their respective owners or holders.
1. Taylor. S.K., Serekian, P., Manley, M., “Wear Performance of a Contemporary Alumina: Alumina Bearing Couple under Hip Joint Simulation,” Trans. 44th Ann. Mtg. ORS, 1998.
2. Stryker Test Report RD–04–099.
Generally, after hip replacement surgery, you may spend approximately 3 to 5 days in the hospital. Most hip replacement patients begin standing and walking with the help of a walker and a physical therapist the day after surgery.
Recovery varies with each person. It is essential that you follow your orthopaedic surgeon’s instructions regarding home care during the first few weeks after surgery; especially the exercise program you are prescribed. You should be able to resume many normal light activities of daily living within 3 to 6 weeks following surgery. Some discomfort with activity, and at night, is common for several weeks. Complete recovery can take from about 3 to 6 months.
While most people will gradually increase their activities and play golf, doubles tennis, shuffleboard or bowling, you will be advised to avoid more active sports, such as jogging, singles tennis and other high impact activities.
A joint is formed by the ends of 2 or more bones. The hip must bear the full force of your weight and consists of two main parts:
Normal hip joint, showing healthy articular cartilage
Diseased hip joint, showing worn cartilage
What Causes Hip Joint Pain?
One of the most common causes of joint pain is arthritis. The most common types of arthritis are:
May be suitable for patients who:
Each patient is unique, but generally candidates for knee replacement surgery have:
The National Institutes of Health (NIH) has concluded that knee replacement surgery is “a safe and cost-effective treatment for alleviating pain and restoring function in patients who do not respond to non-surgical therapies.”1 According to the American Academy of Orthopaedic Surgeons, knee replacement procedures have resulted in significant restoration of function and reduction of pain in about 90% of patients.2 As you read,make a note of anything you don’t understand. Your doctor will be happy to answer your questions so that you’ll feel comfortable and confident with your chosen treatment plan.
1. National Institutes of Health Consensus Development Conference Statement: Total Knee Replacement 12/10/03.
2. AAOS website, http://orthoinfo.aaos. org/topic.cfm?topic=A00385, accessed April 2011.
Knee Anatomy and Function
The knee is the largest joint in the body and is central to nearly every routine activity. The knee joint is formed by the ends of 3 bones: the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the kneecap (patella). Thick, tough tissue bands called ligaments connect the bones and stabilize the joint. A smooth, plastic like lining called cartilage covers the ends of the bones and prevents them from rubbing against each other, allowing for flexible and nearly frictionless movement. Cartilage also serves as a shock absorber, cushioning the bones from the forces between them. Finally, a soft tissue called synovium lines the joint and produces a lubricating fluid that reduces friction and wear.
Arthritis: The Leading Cause of Knee Pain
One of the most common causes of knee pain and loss of mobility is the wearing away of the joint’s cartilage lining. When this happens, the bones rub against each other, causing significant pain and swelling — a condition known as osteoarthritis. Trauma or direct injury to the knee can also cause osteoarthritis. Without cartilage there is no shock absorption between the bones in the joint. This allows stress to build up in the bones and contributes to pain.
Knee replacement is a surgical procedure — performed in the U.S. since the 1960s — in which a diseased or damaged joint is replaced with an artificial joint called a prosthesis.Made of metal alloys and high-grade plastics (to better match the function of bone and cartilage, respectively), the prosthesis is designed to move just like a healthy human joint. Over the years, knee replacement techniques and instrumentation have undergone countless improvements. Today, knee replacement is one of the safest and most successful types of major surgery; in about 90% of cases it is complication-free and results in significant pain relief and restoration of mobility.1
1. AAOS website, http://orthoinfo.aaos. org/topic.cfm?topic=A00385, accessed April 2011.
Stryker knee replacements are different than traditional knee replacements because they are designed to work with the body to promote easier motion,1,2,3 and a study has shown a more rapid return to functional activities after surgery.2 This is due to the single radius design of the knee implant. Single radius means that as your knee flexes, the radius is the same, similar to a circle, requiring less effort from your quadriceps muscle.1,4,6
Because the thigh muscle (the quadriceps) is attached to your knee, it is unavoidably involved in the surgery. Therefore, the quadriceps muscle can become a source of discomfort or pain during your recovery period. The quadriceps muscle plays an important role in your ability to move your legs so it also has a major impact on your recovery and how quickly you can get back to living your life.2
Knee implants designed to last longer5
Several factors influence how long an implant will continue to perform. Stryker knees are designed to resist wear in many ways — they use advanced bearing surfaces; they’re balanced to help avoid excessive stress in any one spot; and, they’re sized to better fit your personal anatomy. X3 Advanced Bearing Technology has demonstrated up to 96% decrease in wear in laboratory testing compared to competitive premium bearing technologies.5
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker and X3. All other trademarks are trademarks of their respective owners or holders.
1. Ostermeier, S; Stukenborg-Colsman, C, Hannover Medical School (MHH) Hannover, Germany ‘Quadriceps force after TKA — a comparison between single and multiple radius designs,” Poster No. 2060 • 56th Annual Meeting of the Orthopaedic Research Society.
2. Harwin, S.F., Hitt, K, Greene, K.A. Early Experience with a New Total Knee Implant: Maximizing Range of Motion and Function with Gender-Specific Sizing Orthopedic Surgery, Surgical Technology International, XVI. pgs 1-7.
3. Greene, K.A. Range of Motion: Early Results from the Triathlon® Knee System, Stryker Literature Ref #LSA56., 2005.
4.Wang, H., Simpson, K.J., Ferrary M.S., Chamnongkich, S., Kinsey, T, Mahoney, O.M., Biomechanical Differences Exhibited During Sit- To-Stand Between Total Knee Arthroplasty Designs of Varying Radii, JOA, Vol. 21, No. 8, 2006.
5. Stryker Orthopaedics Test Report: 06-013.
6. The effect of total knee arthroplasty design on extensor mechanism function, JOA, Vol. 17, Issue 4, June 2002, pp. 416-421.
To begin the surgery, the surgeon will make an incision on the front of your knee, cutting through the tissue surrounding the muscles and bone. The kneecap, or patella, is rotated to the outside of the knee, to help your doctor see the area where the implant will be placed. The surgeon will use special cutting instruments to measure and make precise cuts of the bone. The end of the femur (thigh bone) is cut into a shape that matches the corresponding surface of the metal femoral component. The femoral component is then placed on the end of the femur.
The tibia (shin bone) is prepared with a flat cut on the top. The exposed end of the bone is sized to fit the metal and plastic tibial components. The metal tibial component is inserted into the bone. Then a plastic insert is snapped into the tibial component. The femoral component will slide on this plastic as you bend your knee.
If needed, the patella (kneecap) is also cut flat, and fitted with a plastic patellar component. Bone cement may be used to help secure the implants onto your bone. Your surgeon will conduct several tests during the surgery to ensure the correct sized components are used to help you regain good balance and motion in your knee. Your surgeon will then close the wound in layers with stitches and/or staples.
But as good as the results can be, knee replacement is major surgery, and as such, there are certain risks and expectations that must be recognized. As with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications, the vast majority of which can be successfully avoided or treated. In fact, the complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients.1 Other possible complications include blood clots and lung congestion, or pneumonia. Talk to your doctor for a complete assessment of the potential risks.
Life After Knee Replacement
The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living. However, joint replacement surgery will not allow you to do more than you could before joint problems developed. Your doctor will recommend the most appropriate level of activity following joint replacement surgery.
1. Hanssen, A.D., et al., ‘Evaluation and Treatment of Infection at the Site of a Total Hip or Knee Arthroplasty,” JBJS, Vol.80-A, No. 6, June 1998, pp. 910-922.
Don’t let severe knee pain limit your activities. If you haven’t experienced adequate relief with medication and other conservative treatments, joint replacement may provide the pain relief you long for and enable you to return to your favorite activities. Remember, even if your doctor recommends knee replacement for you, it is still up to you to make the final decision. The ultimate goal is for you to be as comfortable as possible with your choice — and that always means making the best decision based on your own individual needs.
For more information visit AboutStryker.com and contact your doctor.
Femur – thigh bone
Cartilage – tissue between bones that provides cushioning
Patella – knee cap
Tibia – shin bone
Synovium – tissue that provides lubricating fluid to joint
Ligament – flexible tissue that holds knee joint together
What Causes Knee Joint Pain?
One of the most common causes of joint pain is arthritis. The most common types of arthritis are:
May be suitable for patients who:
Total Knee Joint Replacement
Every individual is different and every treatment plan is different. The length of hospital stay after joint replacement varies and depends on many factors including age and physical ability.
Estimated Recovery Schedule
Recovery — Rehabilitation
Following joint replacement the physical therapist begins an exercise program to be performed in bed and in the therapy department. The physical therapist or another member of the staff works with the patient to help the patient:
About Joint Replacement
About Hip Replacement
About Knee Replacement
More Interesting Facts
1. Merrill Lynch Orthopaedic Industry Report, 2002.
2. Harris Interactive® Patient Study commissioned & conducted by Stryker, September 2003.
3. American Academy of Orthopaedic Surgeons.
4. Ortho Fact Book™ US 3rd Edition. Knowledge Enterprises, 2002-2003.
5. Arthritis Foundation.
6. U.S. Census Bureau, 2000a; U.S. Census Bureau, 2000b.
7. Centers for Disease Control and Prevention (CDC), National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health (NIH), and the Arthritis Foundation.
8. “The Age of Arthritis,” Time Magazine, December 9, 2002.
Getting physically and psychologically ready for joint replacement surgery can be an intense process. Those who are better prepared tend to achieve better results. Here are 20 tips for achieving optimal results: *
The surgeon and surgical team do their work in the operating room. The rest is up to you. With inspiration and hard work, you will achieve great success throughout your rehabilitation, recovery and beyond.
*Adapted from an excerpt of “Arthritis of the Hip & Knee,” by Allen, Brander M.D., and Stulberg M.D., as it appeared onhttp://arthritis.about.com/od/surgicaltreatments/a/tipsforsurgery.htm.
If you’re reading this website, you are likely scheduled for joint replacement surgery. The information in this website is intended to help you prepare for the day of surgery and answer some questions that may be on your mind. This website will provide you with information so you know what to typically expect before, during and after your joint replacement. By better understanding the surgical experience, hopefully your mind will be put at ease.
This information was written by medical professionals. It provides general responses to frequently asked questions from patients like you. Each patient is unique and therefore patient needs may be unique. Please discuss your specific instructions with your orthopaedic specialist.
What kinds of tests will I need before surgery?
All patients are required to have routine blood work and urinalysis performed. These tests should be performed within 14 days of the scheduled surgery in order to be acceptable. In addition, all patients are required to have a physical examination which can be performed at any time within 30 days of the surgical date. Patients over the age of 50 are required to have an EKG and chest x-ray performed within 30 days of the surgical date. Patients below the age of 50 with any cardiac or respiratory history may also be required to have these tests performed.
Most pre-admission testing and physical evaluations can be performed either by the patient’s personal physician or at the hospital where the procedure will be performed.
Please be advised that if an abnormal exam or test result is reported, a further evaluation or repeat testing may be required. This does not necessarily mean surgery is canceled, but for your own safety, it is standard procedure to conduct further investigation.
Will I need to donate blood before surgery?
The patient will receive blood from the hospital blood bank if necessary. Hospitals follow universal guidelines in screening blood and blood products to assure the patient’s safety as much as possible in this situation.
Are there any medicines I need to take before surgery?
It is recommended that patients take an iron supplement prior to surgery particularly if you will be donating your own blood. These supplements may be purchased at any drugstore or recommended by your family physician. Consult your physician for suggested iron supplements before purchasing them.
How long will I be in the hospital?
For joint replacement surgery, most patients are hospitalized for 4 days, including the day of surgery. Hospital stays may vary if the patient is either going to a rehabilitation center, a sub-acute facility, or not cleared medically or surgically for discharge home.
Please be advised that most insurance plans cover 3-4 days of acute care in the hospital for total knee replacement surgery. Some insurances do provide for further care in several other types of facilities. It is advisable for each patient to contact their health insurance provider for specific programs covered and to obtain these provisions in writing.
What should I bring to the hospital?
All patients should bring with them personal toiletries and shaving gear, loose fitting, comfortable clothing, non-skid shoes or slippers (slip-on type with closed back preferred), a list of their current medications (including dosages), and any paperwork the hospital may have requested.
Please be advised that the hospital provides pajamas, gowns, robes, slipper socks, and a small toiletries supply. Most patients, however, do supplement these with the articles outlined above, at least in terms of toiletries.
In addition, if you have an assistive device that you plan to use after discharge (i.e., walker, cane, crutches) but are not currently using, you should have someone bring this in prior to discharge so the physical therapist can check to assure that it is the adequate size for you. Contact the hospital where your surgery will take place for specific information regarding your hospital stay and assistive devices.
It is not recommended that you bring radios, TVs, or large amounts of cash.
When should I arrive at the hospital for my surgery?
Patients are generally requested to arrive at the hospital 2 hours prior to the scheduled surgery time. This allows time for you to go through the admission process, change into hospital clothing, and meet the anesthesiologist and nursing personnel who will be with you during your surgery and will be able to answer your questions.
Please be advised that you should not eat or drink from midnight on the day of your surgery. In some cases your physician may allow you to take a medication the morning of surgery. If this is the case, you should take the medication with the least amount of water necessary. Report to the admitting nurse any medications (and dosage) you may have taken.
Can my family stay with me during this time?
Families may stay with patients until the patient is taken to the operating room. Consult your hospital for their specific rules.
Will anyone contact me before surgery to discuss any concerns I may have?
The orthopaedic surgery patients are followed throughout their experience by a case manager. The case manager’s role is to assist the patient in planning for discharge, answer any questions the patient may have in terms of their case, and provide a supportive link throughout the patient’s surgical experience. You will be contacted by the case manager prior to your surgery and assisted in planning for your individualized case management. The case manager will also schedule you to attend a pre-operative class in which you and your family members will receive instructions for each phase of your surgical experience. The classes are held on a rotating weekly schedule for total hip and total knee patients and are highly recommended. By attending class, both you and your case manager are better able to plan for your upcoming surgical experience. Contact the hospital for further details about the pre-operative class.
What type of anesthesia will I have?
Most cases are performed under spinal anesthesia. Unless there is a recommendation to the contrary from the anesthesiologist, this is the method preferred. You will be meeting with the anesthesiologist on the day of surgery and at that time any questions or concerns regarding this will be addressed.
How long will the surgery take?
Surgery times may vary depending upon the difficulty of your case. The surgery may take several hours. Generally, you may spend 2-3 hours in surgery and 2-3 hours in the recovery room.
Will the surgeon see my family immediately after the surgery is completed?
The surgeon or one of his assisting surgeons will try to meet with family members immediately after surgery. If for any reason the family misses seeing the surgeon, they should contact the surgeon’s office the next day and all efforts will be made to arrange a time for the surgeon and family to discuss the patient’s surgery.
What will my hospital stay be like?
The first night of your stay, you will most likely be somewhat “groggy” from the medications you receive in surgery. You will be taken to your hospital room directly from the recovery room in your hospital bed to avoid transferring you from stretcher to bed. Once you are fully awake, you will be able to eat and drink as tolerated. Your vital signs, urinary output, and any drainage will be monitored closely by the nurses on the orthopaedic surgery floor. Appropriate pain medicine for the first 24 hours may be administered by intravenous method.
Starting on day one post-operatively, you will be getting out of bed and attending physical and occupational therapy sessions. These sessions are vital to your progress and are arranged for 2-3 sessions. The physical therapists attending you will teach you the exercises needed for your optimal recuperation and instruct you on your weight bearing technique using a walker or crutches. The occupational therapist is trained to assist you in adapting your activities of daily living to your post-operative limitations. Activities such as bathing, dressing, using the bathroom, transfers from bed to chair, ambulation, and stair climbing will all be addressed during these sessions. Instructions for traveling by various modes of transportation will also be discussed.
Will I see my doctor regularly while in the hospital?
The attending doctors make rounds daily on their patients whenever possible. In addition, the orthopaedic resident doctors or physician assistants make rounds twice daily to monitor your progress and make any changes required for your care. The case manager will also meet with you (and family members if necessary) in order to assure the proper discharge plan for your particular case. Arrangements for transfer to a rehabilitation floor or sub-acute floor either at the hospital or elsewhere will be evaluated by you and the case manager if this becomes an option.
How will I know whether to go home or to another facility for further rehab?
In general, if you live with someone who will be assisting you, discharge home is the usual procedure. Arrangements for further home or outpatient physical therapy will be made by the case manager. Most patients can go directly home if they are deemed safe by the physician and therapists. While not required, it is highly recommended to have someone to assist you the first 48-72 hours after discharge on a full-time basis and perhaps part-time the first week or two after this. If you live alone or are in an environment at home where your safety is in question (i.e., physical therapy/ occupational therapy goals not met), you may be recommended for placement in a rehabilitation center. These facilities are usually available to a patient for a 3-5 day stay, with emphasis on returning the patient home in a short period after aggressively addressing any problems with patient independence. If you live alone or are not progressing rapidly enough in therapy sessions and it is unlikely you will be able to do so in a rehab setting, a sub-acute facility may be recommended for a longer period of recuperation. The choices available depend upon the patient’s insurance coverage and, therefore, will need to be discussed by the patient, the case manager, and the insurance company as warranted.
When will I be ready for discharge?
Depending on whether you go home or to another facility to recuperate will play a role in when discharge occurs. In general, a patient may be transferred to the rehabilitation floor on the 2nd post-operative day. Transfer to the sub-acute floor may also occur on the 2nd or 3rd post-operative day. If you are being transferred to another facility, transfers usually occur on the 2nd or 3rd post-operative day as well. Discharges to home usually occur on the 3rd to 4th post-operative day in general.
What can I expect the first few days after discharge?
Expect a time of transition. You may feel overwhelmed the first day or two after discharge and may even feel you’ve made a mistake coming home so soon.This may occur even after discharge from a rehab or sub-acute floor. Be patient, and give yourself some time to adjust. Many patients report that after the first day or two of practical problem solving and establishing a routine, they experience a change in their progress and notice a definite upward trend in their recuperation. If, on the other hand, you are experiencing pain or discomfort or have concerns about your condition, please consult your physician.
In addition, during this phase of discharge, usually within the first 24-72 hours, you will receive a telephone check-up from your case manager. You will be asked several questions to establish your progress and whether your post-discharge home or outpatient therapies have been started. This phone call also allows you to ask any questions or voice concerns regarding your home situation so they can be addressed.
Do I need someone to stay full-time with me when I go home?
It is our recommendation that someone be with you the first 24-72 hours after discharge. Many patients do live alone and we realize this is not always possible. But if you have a relative or a friend who offers to stay with you, take this offer for your own ease of mind. Many times patients have family members or friends who stay with them all day in the hospital. While this is certainly welcomed, it is often more helpful that this person be available after you leave the hospital. If you do live alone and either are discharged from rehab or from the orthopaedic floor with no help available at home, perhaps a friend or neighbor can call you daily to check on your progress. In addition, if home care has been arranged, these visits usually can be arranged so that someone is checking on you daily. The case manager will be discussing options available for your particular circumstances, and together you will develop a discharge plan, which will address your particular situation.
When can I go up and down stairs?
Stair climbing will be practiced in the physical therapy program before you leave the hospital. Most patients can climb stairs before leaving the hospital. If you live in a 2-story home and have practiced stair climbing, stairs can be done one to two times a day after discharge, depending upon your comfort level and provided that your physician has approved this activity.
Will I need pain medicine after I’m discharged from the hospital?
Most patients do require a short-term course of pain medicine. Renewals on these prescriptions can be obtained by calling your surgeon’s office. Expect to be on some type of pain medication for several weeks after discharge. Most patients take these medications especially at night or before therapy sessions.
How long will I need to use my walker or crutches?
Walkers and/or crutches are usually used the first 6 weeks after surgery. You will then be allowed to use a cane, which again will be used for approximately 6 weeks. After that time, most patients do not need any support for walking.
When can I go outside?
Consult your physician for a recommended time to engage in outdoor activities. Comfort and safety should be the primary guidelines for doing this. It is suggested to start with short trips at first, perhaps to therapy (if nearby) or your local supermarket or church, for example. Gradually increase the number and length of outside activities as you feel more comfortable.
When can I drive?
Driving routinely is not permitted before 6 weeks from the time of your surgery. However, some physicians may allow the patient to drive earlier if they feel the patient can do so safely. The type of surgery, side of surgery (left vs. right leg), and the patient’s overall general condition plays a part in this decision.
If you feel you will need to drive earlier than the 6-week routine prescribed, you should discuss this with your surgeon and obtain his/her approval. Consult your physician for further details.
When will I be able to return to work?
This varies with each patient. In general, patients usually do not return to work until after their first check-up at 6 weeks from surgery. Some patients do return to work earlier if they can do so safely. This should be discussed with your physician so that the best decision for your individual situation is made.
When will I be able to participate in sports activities?
Depending upon what activity you want to participate in will determine when you can safely start these activities again. Swimming, walking distances (hiking), bicycle riding, golfing, and other low impact sports activities can likely be tried after a few weeks. Returning to high impact activities such as jogging, tennis, or aerobics exercises will probably not be recommended for quite some time. Your return to any of these activities should be discussed with your surgeon.
When will I be able to have sexual intercourse after my surgery?
In most cases, sexual activities can be resumed when the patient feels comfortable enough to do so. If the patient has been cautioned to maintain certain position restrictions, these restrictions should be followed in this instance also. In general, most patients resume their normal sexual activities between 4-6 weeks following surgery.
Hopefully this website has answered some of your questions about joint replacement surgery and provided you with a better understanding of what to expect during the surgical experience. Your orthopaedic specialist will be happy to answer any additional questions so that you’ll feel comfortable and confident with your upcoming surgery. As individuals vary, please discuss your specific instructions with your orthopaedic specialist.
Life After Total Joint Replacement
The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living. Your physician will recommend the most appropriate level of activity following joint replacement surgery.
It is important to understand that there are risks associated with any major surgical procedure and total joint replacement is no exception. Although the occurrence of complications is low in number, each patient needs to be informed of these possible risks prior to surgery. In all cases, discussion between the patient and the treating physician is imperative so that the patient is aware of potential complications and how to minimize them.
This information has been provided with permission by the authors:
David Hungerford, MD, Lynne Jones, PhD, Pat Pietryak, RN
Johns Hopkins University and Health System Baltimore, MD
The complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients. Nevertheless, as with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications — many of which can be successfully avoided and/or treated.
Infection: Infection may occur in the wound or within the area around the new joint. It can occur in the hospital, after the patient returns home, or years later. Following surgery, joint replacement patients receive antibiotics to help prevent infection. Joint replacement patients may also need to take antibiotics before undergoing any medical procedures to reduce the chance of infection spreading to the artificial joint.
Blood Clots: Blood clots can result from several factors, including the patient’s decreased mobility following surgery, which slows the movement of the blood. There are a number of ways to reduce the possibility of blood clots, including:
Lung Congestion: Pneumonia is always a risk following major surgery. To help keep the lungs clear of congestion, patients are assigned a series of deep breathing exercises.
Hip Replacement Surgery Understanding the Risks: Download Booklet
Knee Replacement Surgery Understanding the Risks: Download Booklet
On the first day after your surgery, you may get out of bed and begin physical and occupational therapy — typically for several brief sessions a day. These are first steps on your way to getting back into the routines of your life!
In the days following surgery, your condition and progress will continue to be closely monitored by your orthopaedic specialist, nurses, and physical therapists. A good deal of time will be given to exercising the new joint, as well as deep-breathing exercises to prevent lung congestion. Gradually, pain medication will be reduced, the IV will be removed, diet will progress to solid food, and you will become increasingly mobile. Every individual is different, and insurance coverage will differ as well. Generally speaking, a total of four days (including the day of the surgery) in the hospital is typical.
Joint replacement patients are generally discharged from the hospital when they are able to achieve certain rehabilitative milestones, such as getting in and out of bed unassisted or walking 100 feet. Your physician will assess your progress and decide whether you are ready to go directly home or to a facility that will assist with your rehabilitation.
Usually a case manager is assigned to work with you as you move through your rehabilitation routines. As the days progress, expect to become more independent using two crutches or a walker.
If you need to work with a physical therapist after your joint replacement surgery, the therapist will begin an exercise program that you can perform in bed and in the therapy department. The physical therapist will work with you to help you gain confidence and increase your range of motion.
To help you gain confidence with your new joint, the physical therapist (or nurses) will also show you:
Leaving the hospital will depend on when you “graduate” from physical therapy. When you leave the hospital, the physical therapist should give you a list of activities, exercises, and “do’s and don’t’s” to follow. An occupational therapist or nurse may also be assigned to help with special needs. An occupational therapist may show you how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing.
You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. However, you should soon get a routine going and gain confidence in your new joint — the start of a new life with less pain. (As with any surgery, expect to take pain medication for a few days while you are healing.)
If you had a hip or knee replacement, you may need a walker and/or crutches for about six weeks, then a cane for another six weeks or so. Your doctor or orthopaedic specialist as well as your case manager will be in touch with you, so use these opportunities to ask questions or discuss concerns, and keep your team up-to-date on your progress.
The decision to resume a normal daily routine is one that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines that your doctor may give you.
Most people experience reduction in joint pain and improvement in their quality of life following joint replacement surgery. While joint replacement surgery may allow you to resume many daily activities, don’t push your implant to do more than you could before your problem developed.
Give yourself at least six weeks following surgery to heal and recover from muscle stiffness, swelling and other discomfort. Some people continue to experience discomfort for 6-12 weeks following their joint replacement.
During visits to the physical therapist’s office, your therapist may use heat, ice or electrical stimulation to reduce any remaining swelling or pain. You should continue to use your walker or crutches as instructed.
Your physical therapist may use hands-on stretches for improving range of motion. Strength exercises address key muscle groups, including the buttock, hip, thigh and calf muscles. You can work on endurance through stationary biking, lap swimming and using an upper body ergometer (upper cycle). Physical therapists sometimes treat their patients in a pool. Exercising in a swimming pool puts less stress on your joints and the buoyancy lets you move and exercise easier.
When you are safe putting full weight through the leg, several types of balance exercises can help you further stabilize and control the hip or knee. Finally, you will work with a group of exercises to simulate day-to-day activities, such as going up and down steps, squatting, rising up on your toes, bending down and walking on uneven terrain. You may be given specific exercises to simulate your particular work or hobby demands.
By six weeks, you may be able to return to many normal activities such as driving, bicycling and golf. When you see your surgeon for follow-up two to six weeks after surgery, he or she can advise you on both short and long-term goals.
As a rule, all joint replacement recipients should heed the following limitations during the first weeks after surgery:
In general, physical activities should:
Additional tips for living with your new joint:
Most patients have less pain and better mobility after joint replacement surgery. Your physical therapist will work with you to help keep your new joint healthy for as long as possible. This may mean adjusting your activity choices to avoid putting too much strain on your joint. You may need to consider alternate work activities to avoid the heavy demands of lifting, crawling and climbing.
More extreme sports that require running, jumping, quick stopping or starting and cutting are discouraged. More low impact exercises such as cycling, swimming, golfing, bowling and level walking are ideal.