FAQ for Total Joint Replacements

 

As each individual's case may be different, your orthopaedic surgeon or family physician is the best person to answer your questions. The information below is very general in nature and must not be considered medical advice.

 

PREPARING FOR SURGERY - BEFORE CONSENT

 

Why is this operation necessary?

Answer: Your family doctor has referred you to an orthopaedic surgeon, because of pain from your hip or knee and increasing disability. Joint-replacement surgery remains the best option for end-stage arthritis after other non-operative treatment has failed. The benefit of this type of surgery is it will decrease your pain and increase your mobility in an effort to regain your personal independence.

 

What happens during surgery?

Answer: HIP: An incision is made down the side of your hip. The hip is a ball and socket joint. The socket in the pelvis is prepared for a replacement cup, the head of the femur bone is removed and a new head and stem are placed inside the femur. The two parts come together as a replacement hip joint. The incision is closed with staples or stitches. KNEE: An incision is made down the front or side of your knee to expose the bottom of the femur and the top of the tibia (shin bone). The damaged joint is removed and an artificial knee is placed on the tibia, femur and patella (knee cap). The incision is closed with staples or stitches.

 

How long will the operation take?

Answer: First-time hip surgery takes about two hours knee surgery is approximately the same amount of time.

 

What type of anaesthesia will be used?

Answer: The anaesthetist will discuss the options with the patient. A person's general health is often considered before proposing a specific type of anaesthesia. Two types are commonly used for arthroplasty: general or regional. The medication for general anaesthesia is injected into the bloodstream, which carries it to the brain and results in your being unconscious. The anaesthetist controls your airway and breathing during this time. A regional anaesthetic is usually given in the spine providing pain relief in the lower extremities. You remain awake and breathing during the operation, if necessary some sedation can be used as required by the patient.

 

What happens if I delay surgery?

Answer: Total joint arthroplasty for arthritis is an elective procedure. People can decide on the exact timing of their surgery based on their own personal circumstances. It is usually better to consider this surgery when you are fit and healthy and your muscle strength remains relatively strong. The longer someone remains immobile the more difficult the rehabilitation will be post-operative.

 

What are the risks involved in this surgery?

 Answer: All surgical procedures carry some risk, albeit very low. These can include: reaction to anaesthesia, blood clots, infection, instability or stiffness of the joint, damage to nearby blood vessels, bones and nerves or incomplete relief of discomfort. Before you make a decision to go ahead with surgery, discuss the benefits and the risks of potential complications with your surgeon. The benefits should always outweigh the risks.

 

How likely are complications?

Answer: There is always a risk of complications, even with the best of surgeons under the best of circumstances. Having said that, hip- and knee-replacement surgery has been perfected during the last twenty years so that risks are reduced to a minimum during and after surgery. Feel free to discuss your risk of complications with your surgeon. And then weigh your risk against the benefits of undergoing the surgery.

 

Will I need a blood transfusion?

Answer: A small percentage of people (10-20 percent) may require a transfusion post-operatively. Your pre-operative blood level, the length of time for the surgery and the difficulty of the operation are some of the factors that may help to determine if you will need one. Patients who take certain medications such as aspirin, anti-inflammatories, or other blood thinners may lose more blood than others. These medications are usually stopped pre-operatively to help prevent this. This will be part of the discussion with your surgeon at your first meeting.

 

If I need blood, can I donate my own?

Answer: This varies from province to province and from centre to centre. Donation of your own blood, known as an autologous blood donation, is usually organized through the Red Cross/Canadian Blood Services. Some people have had to travel to larger centres in order to arrange this. Your surgeon will know the details in your province.

 

How much will I improve?

 Answer: Usually, patients experience significant pain relief and increased mobility after the operation. You could anticipate an overall improvement from 85-90 percent in your pain and mobility following arthroplasty surgery.

 

How long will I have to wait for surgery?

Answer: It's no secret that there are long waiting lists for joint-replacement surgery, but it's hoped that recent increased funding will help clear up the backlog. (See the Foundation's position statement on waiting times.) This surgery has been shown in many studies to be one of the most cost-effective operations performed on Canadians. It is anticipated, with ongoing pressure on our political leaders, that Canadians will experience improvements in the wait times for orthopaedic procedures.

 

What can I do to keep the process moving?

Answer: If your family doctor agrees, you will obtain a referral to see an orthopaedic surgeon. As the date for surgery approaches, you'll attend a pre-surgical clinic where your general health and the state of your hip or knee will be assessed. During this clinic, you'll meet many of the health care providers who will work with you during your hospital stay. There may even be some volunteers who have had the surgery and will happily discuss their experience or any questions you may have. (See Following the Care Path.)

 

Can this surgery be done on an outpatient basis?

Answer: Usually, joint-replacement surgery requires you to stay in hospital for about three to four days. The day after your operation, a physiotherapist comes in to assess your sense of balance and how much weight you can put on your leg. If you're okay, then he/she will assist you to take your first walk: maybe as far as the door to your room or out into the hall - whatever you can tolerate. The idea is to get you moving as soon as possible.

 

How long does it take to recover from total hip or knee replacement? Answer: The stitches or surgical staples come out after two weeks. Wound healing usually takes another four weeks.

 

What is the surgery called?

Answer: The medical term for the procedure is arthroplasty ("arthro" meaning joint and "plasty" meaning remodelling). Thus, the terms and their acronyms: total hip arthroplasty (THA) and total knee arthroplasty (TKA).

 

What can I do while I'm waiting for surgery?

Answer: You can take a number of steps to make life easier during recovery: Most important, do any strengthening exercises that were prescribed at the surgeon meeting or pre-surgical clinic. The fitter the joint muscles, the faster the recovery time in rehab. Treat any respiratory or dental infections ahead of time to improve your healing after joint replacement. Make a few simple changes around the house to reduce the risk of falls, as well as limit the amount of reaching and stair climbing you'll have to do. If you're a smoker, try to stop or cut down to improve your surgery risks and recovery rate. There is strong evidence that smoking hampers bone-healing because it constricts blood vessels.

 

What can I do while waiting to see the surgeon?

Answer: The best thing to do is to try to participate in some form of daily exercise if possible. Weight reduction, if necessary, can be started at this time. Any other health problems should be optimized by a visit to your family doctor.

 

ABOUT RECOVERY

 

How will I feel immediately after the surgery?

Answer: After a general anaesthetic you will feel groggy in the recovery room and there may be some pain for which you will receive medication. You will not remember much of the time spent in the recovery room. After regional anaesthesia you will not be able to move your lower extremities. This is temporary and will improve before you are taken to your room.

 

Will more surgery be necessary?

Answer: Normally, further surgery after your operation is not required. After many years, however, prosthetic joints can become loose and may require revision.

 

Must I stop taking any of my medication before surgery?

Answer: Ask your surgeon if there are any medications that you should not continue taking before your surgery, such as aspirin or some anti-inflammatory medications. You might want to list all of the medications (including herbal remedies) you take, the dose, and how often. Then take your list with you when you go to your pre-admission appointment.

 

How much pain will I have? Will I receive medication for it?

Answer: The post-surgical pain will require potent medication, which is first administered in the surgical recovery room. In many centres you'll be given a device that lets you administer pain medication when you need it. When you leave hospital, you'll be prescribed pain medication.

 

How long will this pain last?

Answer: The most severe pain will be present for 48 to 72 hours after the operation. Usually, a surgical wound takes about four to six weeks to heal, and during this time the pain will gradually diminish.

 

How long will the surgical wound take to heal?

Answer: At two weeks, you can have the staples removed. It will take about four to six weeks for the wound to heal completely and for the implant to settle.

 

How long do I have to stay in bed?

Answer: You may begin to stand and walk within hours after surgery. A physiotherapist will help you and will teach you how much weight to put on your new joint.

 

When do I start physical therapy?

Answer: You may begin to stand and walk within hours after surgery. During your hospital stay, you'll learn skills that will help you strengthen your hip/knee and help you return to normal life. For the quickest, safest recovery, practice what they teach you.

 

How long does rehab last?

Answer: The hospital physiotherapist will show you a number of strengthening and stretching exercises (much like the ones you were doing before the surgery), which you must now do daily to preserve range of motion and flexibility. This is when exercising before surgery really pays off in terms of quicker recovery and having a daily regimen already established.

 

How long will it be before I can return to my daily routine?

Answer: You won't be able to drive your car for four to six weeks after the surgery. For some activities that involve bending and lifting weight, you may have to wait up to 12 weeks.

 

How will I know I'm progressing with rehab as recommended?

Answer: Barring any accidental falls, infections or undue stress on the joint implant, you should be feeling much better after six weeks and moving about independently.

 

How will I know I'm progressing as expected following surgery?

Answer: After six weeks, your post-operative pain should have lessened noticeably, your surgical wound should have completely healed, and you should be able to move about independently.

 

Will I need to arrange for some assistance at home? If so, for how long?

Answer: The first six weeks after surgery are the hardest, and chances are that you will need some nursing and home-care services, if you live alone or don't want to burden your spouse too much.

 

Are physical therapy, occupational therapy and home care covered by insurance?

Answer: If you have group health coverage through your employer, check the information you received from the insurance company or with your human-resources manager. If you are retired, your provincial public health insurance usually covers costs for a limited time.

 

Will I need any special equipment for my home?

Answer: You will need to obtain a few items to keep you safe and help you carry out your daily activities. This equipment is essential following hip replacement surgery and most people with knee replacement surgery also find these aids useful.

26 inch long-handled reacher (grabber)

24 inch long-handled metal shoe horn

Carry cushion - people 5'0" to 5'9" require a 3" cushion and those taller require a 4" cushion

You may also want to purchase a sock aid

 

 

Will I need to make any modifications to my home?

Answer: To make life easier and safer after surgery, you should consider reducing the amount of reaching and stair climbing you'll have to do. Prepare a room on the main living level if you usually sleep upstairs, or set things up so you have to go upstairs only once a day. Pick up clutter, remove throw rugs and tape down electrical cords. Arrange for a family member or friend who can help you run errands. If you live alone, arrange for someone to stay with you for a few days after surgery. Prior to discharge from hospital a consultation with an occupational therapist is often helpful in planning rearrangements for your home environment.

 

Other suggestions to get your home in shape for convenience and safety include:

 

Ensure the inside of your home is well lit and use night lights, especially on the way to the bathroom

Install a grab bar or secure hand rail in your shower or bath

Be sure that your shower or tub has a non-slip coating or mat and

Install a hand-held shower attachment for easier bathing.

What medications will I need at home, and how long will I need to take them? Answer: Outside of antibiotics to prevent infection of the surgical wound and medication to provide pain relief during the first weeks after surgery, you'll need stool softeners to offset constipation resulting from anaesthesia and the pain medication. If you stopped taking medications for other conditions before surgery, check with your family doctor about when it would be appropriate to start them again.

 

What limits will there be on my activities?

Bending - DO NOT bend your operated hip beyond 90° when sitting, standing or lying. You should never sit with your knee higher than the level of your hip. DO NOT bend forward at the hips to stand up, when getting off the toilet, or at any time.

Driving - Driving is prohibited for at least four to six weeks after surgery to avoid putting undue stress on the new joint implant. Your surgeon will advise you when you can start driving again.

Climbing stairs - You will be able to climb stairs with some modifications. While you are in the hospital, your therapist will teach you how to climb stairs one step at a time. You are advised to have secure handrails on all staircases. Your therapist and surgeon will advise when you can resume stair climbing with either leg.

Using the toilet - A raised toilet seat (available at pharmacies) can remove the strain on hip and knee joints when sitting or rising.

Sex - During the first months of your recovery from surgery, you can participate in gentle sexual activity by assuming a passive position (example, on your back with both your legs spread apart to protect your hip). Stop if you experience pain or discomfort. After three months there are no specific concerns about sexual activity.

 

How often will I have follow-up visits with you?

Answer: Arrangements are usually made for your post-operative visit at six weeks prior to leaving hospital. A common protocol for follow-up after joint arthroplasty is six weeks, three months, six months and one year for follow-up visits. Patients are generally checked with x-ray every one to two years. As your prosthesis ages it may be necessary to re-check more often.