The hip joint and knee joint both have a layer of smooth cartilage that serves as a cushion between bones and allows for smooth motion. Arthritis is a wearing away of the smooth cartilage, eventually down to bone. Rubbing of bone against bone causes discomfort, swelling and stiffness.
A total hip replacement is an operation that removes the arthritic ball of the upper thighbone (femur) as well as damaged cartilage from the hip socket. The ball is replaced with a metal ball that is fixed solidly inside the femur. The socket is replaced with a plastic or metal liner that is usually fixed inside a metal shell. This creates a smoothly functioning joint that does not hurt.
The knee itself is not replaced, as is commonly thought, but rather an artificial substitute for the cartilage is inserted on the end of the bones. This is done with a metal alloy on the femur and plastic spacer on the tibia and kneecap. This creates a new, smooth cushion and a functioning joint that does not hurt.
Ninety to ninety-five percent of patients achieve good to excellent results with relief of discomfort and significantly increased activity and mobility.
Your orthopedic surgeon will decide if you are a candidate for the surgery. This will be based on your history, exam, X-rays and response to conservative treatment. The decision will then be yours.
Age is not a factor if you are in reasonable health and have the desire to continue living a productive, active life. You may be asked to see your personal physician for his/her opinion about your general health and readiness for surgery.
Most knee and hip replacement patients experience zero complications, however we do use antibiotics and blood thinners to avoid the two most serious complications: infection and blood clots. We also take special precautions in the operating room to reduce the risk of infections.
All implants have a limited life expectancy, which varies depending on an individual's age, weight, activity level and medical condition(s). It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon's recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time.
Just as your original joint wears out, a hip or knee replacement will wear over time as well. The most common reason for revision is loosening of the artificial surface from the bone. Wearing of the plastic spacer may also result in the need for a new spacer. Your surgeon will explain the possible complications associated with total hip or knee replacement.
Your orthopedic surgeon's office will contact your insurance company to pre-authorize your knee or hip replacement surgery. If a second opinion is required, you will be notified.Back to Top
Yes, consult your orthopedic surgeon and physical therapist about the exercises appropriate for you.
Most patients will not need to donate blood. If, however, your physician requests you to donate your own blood, the surgeon's office will help you arrange this.Back to Top
We reserve approximately 2-2 1/2 hours for hip or knee replacement surgery. Some of this time is taken by the operating room staff to prepare for the surgery.
Your orthopedic surgeon will perform the surgery. An assistant often helps during the surgery and that assistant will bill you separately.
Some patients prefer to have a spinal or epidural anesthetic, which numbs your legs only and does not require you to be asleep. The choice is between you, your orthopedic surgeon and the anesthesiologist. Your patient guidebook will also detail your options for you.
You will probably stay in bed the day of your surgery. However, the next morning you will get up, sit in a chair or recliner and should be walking with a walker or crutches later that day.
You will have discomfort following the surgery, but we will try to keep you comfortable with appropriate medication. Many patients are able to stop very strong medication within one day, and most patients are able to control their own medicine with a special pump that delivers the drug directly into their IV.
For hip replacement patients, the scar will be approximately six inches long along the side of your hip. For knee replacement patients, the scar will be approximately six inches long, straight down the center of your knee (unless you have previous scars, in which case we may use the existing scar) There may be some lasting numbness around the scar.
Most hip and knee replacement patients will be hospitalized for two nights after their surgery. There are several goals that you must achieve before you can be discharged.Back to Top
Most hip and knee replacement patients are able to go home directly after discharge. Some may transfer to a sub-acute facility and stay there for 3-5 days. Your joint care coordinator and discharge planner will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have sub-acute benefits.
Three options are usually available to you:
Yes, for two weeks you will use a walker or crutches. You will then progress to a cane. You should not switch to a cane until you have practiced with your physical therapist. Switching to the cane too early can result in a limp because your operated knee or hip is not strong enough to support you.
Yes, the first several days or weeks, depending on your progress, you will need someone to assist you with meal preparation and general daily tasks. Family members or friends need to be available to help. Preparing ahead of time, before your hip or knee replacement surgery, can minimize the amount of help required. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed and single portion frozen meals will reduce the need for extra help.
Yes, you will have physical therapy. Patients are encouraged to utilize outpatient physical therapy. If you need home physical therapy, we will arrange for a physical therapist to provide therapy at your home 3 times a week. Following this, you will go to an outpatient facility 3 times a week to further assist in your rehabilitation. The length of time required for this type of therapy varies with each patient.
The ability to drive depends on whether surgery was on your right knee/hip or your left knee/hip and the type of car you have. If the surgery was on your left side and you have an automatic transmission, you could be driving at two weeks. If the surgery was on your right side, your driving could be restricted for as long as six weeks. Getting "back to normal" will depend somewhat on your progress. Consult with your orthopedic surgeon or physical therapist for their advice on your activity. You must be off all narcotic pain medication before driving.
We recommend that most knee and hip replacement patients take at least one month off from work, unless their jobs are quite sedentary and they can return to work with crutches. An physical therapist can make recommendations for joint protection and energy conservation on the job.
The time to resume sexual intercourse should be discussed with your orthopedic surgeon. The Joint Center has a guide on sexual intercourse and will give you a copy.
Two to three weeks after discharge, you will be seen for your first post-operative office visit. The frequency of follow-up visits will depend on your progress. Many hip and knee replacement patients are seen at six weeks, twelve weeks and then yearly.
Yes, high-impact activities, such as running, singles tennis and basketball are not recommended. Injury-prone sports, such as downhill skiing, are also dangerous for the new joint. Hip replacement patients may be restricted from crossing their legs, twisting the operated leg, bending 90 degrees at the hip or twisting side-to-side. Your therapist will help you understand these restrictions in the hospital.
You are encouraged to participate in low-impact activities such as walking and swimming (once your wound is completely healed). If you experience pain, stop and consult your physician before continuing.
Patients undergoing hip replacement surgery will need a high toilet seat for about three months. We can arrange to have one delivered to you at the hospital, or you can borrow one from friend or family. You will also be taught to use assistive devices to help you with lower body dressing and bathing. You may also benefit from a bath seat or grab bars in the bathroom, which can be discussed with your occupational therapist.