Information
Frequently Asked Questions:
What is a joint replacement?
If you are still suffering from pain despite medications, therapy, and injections, surgery becomes an option. A joint replacement involves removing the old, worn out joint and replacing it with an artificial joint. The replaced joint is designed to work like a normal joint, and its parts can be made out of metal, ceramic, or plastic.
How large will my incision be?
The incision will be of adequate size to give you the best joint replacement possible. Larger or more muscular patients may require a larger incision. The size of the incision has been proven to have no correlation with how well the joint replacement performs or how well the patient heals.
How long will the joint replacement last?
This depends on your age, weight, and your activity level. The younger you are, the heavier you are, and the more active you are, all lead to the joint replacement wearing out faster. Think of your joint as a new tire. If you use that tire to drive across the country every month, you will wear down the treads on the tire faster than if you were just driving around town. The same thing happens with a joint replacement.
What can I do/not do with a joint replacement?
I recommend avoiding high impact activities (such as black diamond downhill skiing, competitive basketball, and recreational running). All hip replacements will have restrictions on certain motions for several months after surgery, which will be reinforced by the therapist.
When can I drive?
If you have had surgery on your left leg, and you drive an automatic transmission car, you may begin driving after 3 weeks. If you had surgery on your right leg, or if your car has a clutch, you may begin driving after 4-6 weeks. You must also be off all narcotic pain killers prior to driving.
When can I return to work?
This will vary depending on what occupation you hold. If it is a desk job, or does not involve a lot of activities, you may return to work after 3 or 4 weeks. If your job requires a higher activity level, you may need more time off.
When can I shower?
You may shower after discharge from the hospital, following the guidelines in your postoperative instructions.
When can I take a bath?
You may immerse the wound in a bath 8 weeks after surgery as long as the wound has not had any drainage.
What to expect before surgery:
Once you have chosen a surgical date, you will need to attend the joint replacement education class, have blood work done, and any other necessary tests within specific time frames based on the planned date of surgery. There will be several opportunities for attending a joint replacement education class, which is mandatory.
You will also need to be seen by your primary care physician before surgery. If you have a medical specialist, such as a cardiologist or pulmonologist, you may need to be seen in that office as well. I recommend visiting the dentist 1-2 months prior to surgery, since I recommend avoiding elective dental cleaning/procedures for 4 months after surgery in order to minimize any risk of infection.
I will meet with you before surgery to ensure that everything is arranged, to obtain consent for the surgery, and to answer any remaining questions. I will also give you a prescription for a blood thinning medication and pain medications.
What to expect in the hospital:
You will be given a time to arrive at the hospital to check in. Please do not be late. Please bring your joint replacement guidebook and my instruction sheets with you. Any home medications that are not part of the hospital pharmacy should be brought with you (eye drops, nasal sprays, CPAP machine, etc…). You should also pack an overnight bag with loose clothing. If you have sensitive skin, you may want to bring a set of sheets from home.
After surgery you will go to the recovery room, and then up to your room. I will be giving you antibiotics, a blood thinner, and a variety of medications to help control your pain. My goal is to provide adequate pain control while minimizing the need for narcotic pain medications (like morphine). Morphine can have unpleasant side effects including nausea, vomiting, sleepiness, delirium, and constipation. Physical therapy typically begins on the same day of your surgery. Our goal is to get you out of bed, and working with therapy as soon as you are able.
The first day after surgery will be focused on more physical therapy and preparing for going home. The case manager will have reviewed your chart and will also be preparing for your discharge. If you want, you may be discharged on the first or second day after surgery if you are doing well with physical therapy and your pain is under control.
The second day after surgery will be completing physical therapy in the hospital and preparing for discharge. Most patients will be able to go home by the second day after surgery. Your bandage will not need to be changed. Home physical therapy and visiting nurse services will be set up if necessary.
What to expect after discharge:
You will continue physical therapy at home and as an outpatient. I will see you in my office 2 weeks after surgery to remove the bandage. Do not remove the bandage at home unless it is soiled or falling off on its own. You may need stronger pain medication at first, but as you heal, you will be able to use regular strength pain medication. Post-surgical office visits will be at 2 weeks, 2 months, 1 year, and then every other year afterward for routine visits.
Joint replacement surgery is major surgery, and can result in an amazing improvement in your life. If you have any questions or concerns, please do not hesitate to call me at 860-889-7345.
Risks of Joint Replacement Surgery
Infection:
There is a risk of infection with any surgical procedure. Surgery is performed under stringent sterile conditions in order to minimize the risk of infections. I will give you antibiotics right before surgery and for 24 hours afterward to minimize the risk of infection related to the surgery. An infection in your joint replacement can also happen after any procedure where there is a chance of bacteria getting into the blood stream. This includes invasive dental procedures (periodontal procedures, root canals, etc…), podiatric procedures (ingrown toe nails, bunion removal, etc…), and all surgeries. If you plan on having one of these procedures and have not received a prescription for antibiotics, please call the office and I will give you a prescription to be taken one hour before the procedure.
Blood Loss:
A joint replacement is major surgery. As with any surgery, there is a risk of blood loss. Many patients do not require a blood transfusion, but some do. I perform the surgery using techniques to minimize the need for a transfusion. I will give you a transfusion only if you are severely anemic, have symptoms of severe anemia (dizziness, low blood pressure when you sit up, etc…), or if you have a heart condition. The risk of infection from a transfusion of banked blood is extremely low due to thorough testing and careful selection by the blood bank. If you wish to donate your own blood before surgery, you may do so. However, many patients who donate their own blood end up requiring not only their own blood, but also blood from the blood bank because they come into surgery anemic.
DVT/PE:
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are serious complications of joint replacement surgery. A deep vein thrombosis is a clot that forms in your leg after surgery, which can become loose and move up to your lungs where it becomes a pulmonary embolism. A large pulmonary embolism can be deadly. Prevention of clot formation is very important. I will give you blood thinning medication to take several days before surgery, and then for 6 weeks after surgery to prevent any clot from forming. The medication is called warfarin (also known as coumadin). I will give you a low dose leading into surgery, a higher dose while you are in the hospital, and then a low dose for 6 weeks after surgery when you are at home. If you have a history of a clot, or at higher risk for blood clots, or take blood thinning medication daily, I may give you different blood-thinning medications.
Leg Length Inequality:
People who need a hip replacement often have different leg lengths. Most people cannot sense the difference because it happened gradually over a long period of time. I will perform the surgery to restore your legs to their appropriate lengths. After surgery your leg will feel different from what it was. This is due to swelling and a sudden return to the appropriate position of the hip. As your hip recovers from surgery, your body and muscles will return to normal alignment. In order to allow this to happen, I recommend walking, therapeutic exercise, and avoiding shoe lifts.
Unfortunately there are rare circumstances that require me to lengthen a patient’s limb in order to prevent a dislocation. In many cases, I will know this before surgery and will discuss this with you if I feel there is a chance of having to lengthen your leg.
Nerve and Muscle Damage:
There are many muscles and nerves around joints. I perform the surgery using proven techniques in order to minimize the risk of nerve and muscle damage. However, in extremely rare instances, nerve or muscle damage can occur. Certain patients will be at higher risks for nerve damage due to the severity of arthritis in their joints or pre-existing neuropathy. If you are one of these patients, we will discuss these risks. If nerve or muscle damage does happen, we will work together to recover your function through therapy and exercise.
Dislocation:
After a hip replacement, there is a chance that the ball could come out of the socket. This is called a dislocation. Dislocations can happen for a variety of reasons. My job is to put the hip replacement in the correct position to minimize the risk of dislocation. Your job will be to avoid certain positions for several months after surgery in order to allow your body to heal enough to prevent a dislocation. Your therapist and I will go over these restrictions, and they are also located your postoperative discharge instruction handout.
