Joint Replacement
Procedure

Your Treatment Options

Hip and Knee Pain

Topics

• Understanding the Causes of Joint Pain
• Treatment Options
• What Joint Replacement Surgery Involves
• Realistic Expectations After Joint Replacement

The Hip Joint

The Knee Joint

Did you know?

• More than 300,000 knee replacements are performed each year in the US.
• More than 300,000 hip replacements are performed in the United States each year.

Most Common Types of Arthritis

• Osteoarthritis
• Rheumatoid Arthritis
• Post-traumatic Arthritis
• Avascular Necrosis
• Paget’s Disease

Hip Osteoarthritis

Knee Osteoarthritis

Did you know?
Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery.

OA Symptoms

• May develop suddenly or very slowly
• Arthritis can cause pain and stiffness
• Some types of arthritis may cause swelling
• Simple tasks may be difficult to do

Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip and knee 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.

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. 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

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:

• Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
• Pain is not relieved by more conservative methods of treatment, such as those described above, by the use of a cane, and by restricting activities
• Stiffness in the joint is significant
• X-rays show advanced arthritis or other problems

Nearly half a million hip and knee replacements are performed each year in the U.S. using conventional metal/plastic prostheses. Although these procedures have yielded positive results, over the years, the artificial joints can become loose and unstable, requiring a revision (repeat) surgery.

These issues, coupled with the facts that increasing numbers of younger and more active patients are receiving total joint replacements and that older patients are living longer, have challenged the orthopaedic industry to try to extend the life cycle of total joint replacements.

Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic prostheses and new plastic joint liners, provides orthopaedic surgeons with options that may help to increase the longevity of the prosthesis.

Patient Guide

What to do Before you Check In

Preparing for total joint replacement begins weeks before the actual surgery. In general, you may be told to:

1. Donate blood –While some total joint procedures do not require blood transfusion, you may need blood before or after surgery. You may use donor blood or plan ahead to make an autologous donation of your own. You may also have a family member or friend with the same blood type as you designate a donation specifically for you.
2. Exercise under your doctor’s supervision – It’s important to be in the best possible overall health to promote the best possible surgical experience. Increasing upper body strength is important to help you maneuver a walker or crutches after surgery. Strengthening the lower body to increase leg strength before surgery can reduce recovery time.
3. Have a general physical examination – You should be evaluated by your primary care physician to assess overall health and identify any medical conditions that could interfere with surgery or recovery.
4. Have a dental examination – Although infections after joint replacement are not common, an infection can occur if bacteria enter the bloodstream. Therefore, dental procedures such as extractions and periodontal work should be completed before joint replacement surgery.
5. Review medications – Your orthopaedic surgeon can tell you which over-the-counter, prescription medications and herbal supplements should not be taken before surgery.
6. Stop smoking – Breaking the habit is particularly important before major surgery to reduce the risk of post-operative lung problems and improve healing.
7. Lose weight – For patients who are overweight, losing weight helps reduce stress on a new joint.
8. Arrange a pre-operative visit – It’s important to meet with healthcare professionals at the hospital before surgery to discuss your personal hospital care plan, including anesthesia, preventing complications, pain control and diet. Bring a written list of past surgeries and medications and dosages you normally take at home.
9. Get laboratory tests – Your surgeon may prescribe blood tests, urine tests, an EKG or cardiogram, and chest X-ray to confirm you are fit for surgery. These tests should be performed within 14 days of the scheduled surgery in order to be acceptable.
10. Complete forms – You will need to fill out a consent form for your surgeon confirming that you agree to have the operation and that you know the risks involved, as well as hospital forms about your past history, medications, previous operations, insurance and billing information.
11. Prepare meals – You may want to prepare meals in advance and freeze them so they’re ready when you return.
12. Confer with physical therapist – The physical therapist will record a baseline of information, including measurements of current pain levels, functional abilities, the presence of swelling, and available movement and strength. You will also practice post-operative exercises using either a walker or crutches.
13. Plan for post-surgery rehabilitative care – Total joint replacement recipients may need help at home for the first few weeks, including assistance bathing, dressing, preparing meals and with transportation. If you can’t arrange for someone to help you at home, you may need to stay in a rehabilitation or skilled nursing facility. A medical social worker can assist with arrangements. Home therapy visits should end when you can safely leave the house and outpatient physical therapy should begin.
14. Fast the night before – No eating or drinking after midnight before surgery; however, you may brush your teeth or have a few sips of water if you need to take medicines. Discuss the need to take medications such as insulin, heart or blood pressure pills with your doctor or nurse to make sure you don’t miss them.
15. Bathe surgical area with antiseptic solution – Use antiseptic scrub brushes supplied by your health team the night before and morning of to reduce the risk of infection. Tell the nurse if you are allergic to iodine or soap. If possible, shampoo your hair. You must remove all nail polish and make-up. Do not shave your legs within 3-4 days of surgery.

The Day of Surgery

What to Expect Throughout

Your hospital stay will progress something like this:

Pre-Op

1. Arrive at the hospital at the appointed time.
2. Complete the admission process.
3. Have final pre-surgery assessment of vital signs and general health.
4. Remove all personal belongings – dentures, hearing aids, hairpins, wigs, jewelry, glasses, contact lenses, nail polish, all underwear – and leave them with your family or friends during surgery. You will be dressed in a hospital gown and nothing else.
5. There will be several checks to make sure the correct joint is being replaced: your surgeon will review your X-ray and mark the area to be operated on; nursing staff will check the consent form you signed to make sure it agrees with the procedure on the operating room list.
6. Final meeting with anesthesiologist and operating room nurse.
7. Start IV (intravenous) catheter for administration of fluids and antibiotics.
8. Transportation to the operating room.

In Surgery

Many people will be with you in the operating room during your one to three-hour surgery, including:

• Orthopaedic surgeon(s) – your doctor(s) who will perform surgery.
• Anesthesiologist or nurse anesthetist – the doctor or nurse who gives you anesthesia.
• Scrub nurse – the nurse who hands the doctors the tools they need during surgery.
• Circulating nurse – a nurse who brings things to the surgical team.

Your surgeon and the anesthesiologist or nurse anesthetist will help you choose the best anesthesia for your situation. No matter what type of anesthesia you have, be assured you will not feel the surgery. Options include:

• General Anesthesia – You are put to sleep. Minor complications such as nausea and vomiting are common, but can usually be controlled and settled within 1-2 days.
• Epidural – You are numbed from the waist down with medicine injected into your back. (This is also used for women giving birth.)
• Spinal – Much like the epidural, you are numbed from the waist down with medicine injected into your back.

You may have any of the following inserted:

• An Intravenous Tube (IV) – This is placed in your arm and used to replace fluids lost during surgery, administer pain medicine, or deliver antibiotics and other medications.
• A Catheter Tube – This may be placed in your bladder to help your healthcare delivery team keep up with your fluid intake and output. It is most often removed the day after surgery.
• A Drain Tube – This may be inserted in your bandage site to help reduce blood and fluid buildup at the incision.

Elastic stockings will be put on your legs to help the blood flow. You may also have compression foot pumps wrapped around your feet and connected to a machine that blows them up with air to promote blood flow and decrease the possibility of blood clots.

What to Expect, What to Watch For, & How to Recover Safely

When you leave the hospital, your family will need to bring extra pillows for you to sit on in the car. It will be most comfortable to sit in the front seat. Your physical therapist will show you how best to get in and out.

All of the tubes will be out. All that should remain is a bandage on your wound site. If you have been instructed to use an abduction wedge you will still need to use this at night when you are sleeping.

You’ll need to continue taking medications as prescribed by your doctor. You may be sent home with prescriptions for preventing blood clots, some of which require monitoring through blood draws two times per week. Make sure to take pain medication 30 minutes before exercises—it’s easier to prevent pain than to chase it later.

Your surgeon may recommend taking a multi-vitamin with iron daily for a month. You may also be advised to take 1-2 enteric-coated aspirin daily for 6 weeks and non-steroid anti-inflammatory medication for pain and swelling unless you are on blood thinners such as Coumadin or Lovenox. Check with your doctor about special precautions while on these bloodthinning medications.

Hip Precautions

After hip replacement, you will need to observe some important safety rules to help prevent dislocation. Here are some of the most frequently advised precautions. Review them with your surgeon and discuss how many months you will need to follow these, or any other safety rules prescribed after surgery:

• Don’t bend your hip past 90º
• Don’t cross your legs; keep knees 12-18 inches apart
• Don’t lean forward while sitting in a chair
• Don’t sit on a chair that does not have arms
• Don’t lean forward while sitting in bed
• Don’t sit more than 60 minutes at a time; get up and walk frequently
• Don’t sit on a toilet or commode that does not have handles or side arms
• Don’t let your knee move inward past your navel
• Don’t turn your feet in or out
• Do use pillows between your legs at night to keep your hips properly aligned

Special Equipment

Ask your occupational therapist about special equipment to help you do routine things for yourself without placing your hip in danger of dislocation. These tools include:

• Dressing sticks – to help you put on and take off your pants or underwear
• Long shoe horns – to help you put on your shoes
• Elastic shoe laces – to make your laced shoes into slip-ons
• Grabber – to help you pick up things without bending over, reach items from high and low shelves, get clothes in an out of front loading washers and dryers, etc.
• Long-handled sponge – to help reach without stretching inappropriately
• Soap on a rope – to prevent bending to retrieve items in the shower
• Extender for woman’s razor – for shaving legs safely
• Raised commode seat – to put your knees in proper position below hips
• Bathtub benches and handrails – to improve bathroom safety
• Handheld shower – for washing while seated
• Long-handled feather duster – for dusting low and high items
• Long handled Johnny Mop – for cleaning out the tub or shower

1. Is joint replacement the best option for me now, or should I wait?
2. If I have joint replacement surgery, how much of my pain will be relieved?
3. How physically active can I be with a new joint?
4. How do joint replacements compare?
5. What are the risks or complications of joint replacement surgery?
6. How long will I be in the hospital, and how soon after having the procedure can I get back to normal daily activities?
7. Is joint replacement covered by my health insurance?
8. After the procedure, will I see you or my regular doctor for follow-up care?
9. How many of these procedures have you performed?

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: *

1. Find an experienced surgeon – Your orthopaedic surgeon will become an important person in your life for years to come. Make sure you are comfortable with your doctor’s approach, level of experience and personality.
2. Educate yourself about your surgery – Learn as much as possible about pre-op preparations, the procedure, post-op care, precautions and possible complications. Ask your doctor to go over your surgical plan, outcomes and long-term care in detail.
3. Seek a second opinion – Your surgeon should honor your right to confer with another, well-respected orthopedist if you have any doubts.
4. Plan ahead – Schedule surgery when you can afford to take time off from work, and when it will be least disruptive to your family.
5. Weigh risks versus benefits – Reconcile the big picture in your mind so you don’t go into surgery dwelling on risks or potential complications.
6. Have a positive attitude – Be encouraged and focus on the high rate of success for total joint procedures.
7. Talk with past patients – Hearing about other’s successes can help you gain perspective and ease your mind.
8. Visualize getting your life back – The pain and deterioration of your joint severely diminished your quality of life. Think about how much things will improve after surgery.
9. Realize feeling tense or anxious is normal – Don’t fight it!
10. Actively participate – Make a commitment to do your part to ensure a positive outcome and assume responsibility for your own care (i.e., follow precautions, do exercises daily, etc.). Consult with your orthopaedic surgeon with questions or concerns.
11. Practice on crutches – If you have spent time on crutches before, reacquaint yourself with them so the awkwardness won’t be overwhelming after surgery.
12. Don’t view the recovery process as time lost – This is time to rest and recuperate. Time invested in rehabilitation is necessary for better health.
13. Prioritize physical therapy – Realize your physical therapy and postop exercise regimen are critical for a successful outcome. Think of each exercise as a stepping-stone toward improved strength, range of motion and function.
14. Prepare for downtime – Remember you will be laid up for about 6 weeks. Organize, schedule appointments and take care of as much business as possible before surgery.
15. Take multi-vitamins and eat well-balanced meals – Be particularly health conscious during the weeks and months leading up to surgery to promote better healing.
16. Be conscious of infection – If you have any sign of any kind of infection anywhere in your body you must postpone surgery.
17. Donate autologous units of blood – You can donate your own blood in the weeks prior to surgery to be held for your operation.
18. Ask about current medications – Find out if you need to stop taking any prescription, over-the-counter or herbal remedies before surgery.
19. Adapt your environment – Get ready for homecoming before you go to the hospital by having a raised toilet seat, reachers and other adaptive equipment already available.
20. Arrange for help – Plan for someone to be with you, especially for the first week or two at home. If no one is available, make arrangements to enter a post-op inpatient rehabilitation facility until you are independent enough to care for yourself at home.

Never Lose Sight of Your Goals

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.

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.

Before Surgery

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.

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.

Possible complications include:

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:

• Blood thinning medications (anticoagulants)
• Elastic support stockings that improve blood circulation in the legs
• Plastic boots that inflate with air to promote blood flow in the legs
• Elevating the feet and legs to keep blood from pooling
• Walking hourly

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

Every hospital has its own particular procedures, however, they often follow the basic routine outlined below. Your surgeon and hospital where the surgery will be performed will provide you with information detailing their specific procedures.

• Arrive at the hospital at the appointed time
• Complete the admission process
• Final pre-surgery assessment of vital signs and general health
• Final meeting with anesthesiologist and operating room nurse
• Start IV (intravenous) catheter for administration of fluids and antibiotics
• Transportation to the operating room
• Joint replacement surgery — generally lasts 1 to 2 hours
• Transportation to a recovery room
• Ongoing monitoring of vital signs until condition is stabilized
• Transportation to individual hospital room
• Ongoing monitoring of vital signs and surgical dressing
• Orientation to hospital routine
• Evaluation by physical therapist
• Diet of clear liquids or soft foods, as tolerated
• Begin post-op activities taught during pre-op visit

In the days following surgery, your condition and progress will continue to be closely monitored by your orthopaedic surgeon, nurses, and physical therapists. Much 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.

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. Whether you are sent directly home or to a facility that assists in rehabilitation will depend on your physician’s assessment of your abilities.

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:

• How to get out of bed
• How to use the bathroom
• How to get dressed

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.

• You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don’t tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.
• You may need to take antibiotics before dental work (including dental cleaning) and any surgical procedure that could allow bacteria to enter the bloodstream. Ask your healthcare provider whether you will need to take antibiotics at certain times to prevent infection.
• When to resume driving a car, going back to work, and/or participating in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopaedic specialist’s advice and recommendations.

Call your doctor if you experience any of the following symptoms:

• Redness, burning, swelling, or drainage from your operated area
• Fever of 100 degrees or higher
• Pain that does not lessen with rest
• Acute, severe pain in the hip associated with twisting, turning or injury

Consult your doctor regarding considerations before surgery, rehabilitation after surgery, and expectations for surgery. It is important to begin planning for your return home from the hospital before your surgical procedure. Your surgeon may suggest tips to prepare your home for after surgery. For example, get an apron or belt with pockets to carry things while you are on crutches, buy or borrow a cordless phone, remove scatter rugs and other obstacles, safe transport using crutches, have high chair and commode accessories available. Above all, during this time, treat yourself well, eat balanced meals, get plenty of rest, and if requested by your surgeon, donate your own blood in advance so it can be transfused during and after surgery.

After surgery you will need to rest your hip to allow proper healing. Your activity will be restricted during this healing period. During the first weeks after surgery, you may be advised to put a pillow between your legs when turning over in bed, wear elastic stockings, use raised toilet seat, take showers rather than baths, restrict activities such as sudden twisting or turning, crossing legs, exposing the scar to sunlight, and driving. Carefully follow your doctor’s instructions regarding progression to normal weight bearing and resumption of normal physical activity. Individual results will vary and all patients will experience different activity levels post-surgery.

Even after the healing period, excessive loads placed on the implants through sudden trauma or high impact activities, such as running and jumping, can damage the artificial joint. While the expected life of an artificial hip replacement system is difficult to estimate, it is finite. The components are made of foreign materials that will not indefinitely withstand the activity level and loads of normal, healthy bone. The hip joint may have to be replaced at some time in the future.

You may be wondering how long you’ll need to be in the hospital after joint replacement. Every individual is different, and insurance coverage will differ as well. Generally speaking, a total of 4 days (including the day of the surgery) is typical. It is important to note that each patient experience differs and you will be discharged when you have achieved the goals outlined by your orthopaedic surgeon.

On the first day after your surgery, you may get out of bed and begin physical and occupational therapy, typically several brief sessions a day. These are first steps on your way to getting back into the routines of your life!

During your hospital stay, your orthopaedic surgeon works closely with nurses, physical therapists, and other healthcare professionals to ensure the success of your surgery and rehabilitation. Usually a case manager is assigned to work with you as you move through your rehabilitation routines. As the days progress, you should become more independent using two crutches or a walker.

If you need to work with a physical therapist after your joint replacement, the therapist may begin an exercise program to be performed in bed and in the therapy department. The physical therapist will work with you to help you:

• Regain muscle strength
• Increase range of motion

The physical therapist (or nurses) will also show you:

• How to get out of bed
• How to use the bathroom
• How to get dressed

Discharge from the hospital will depend, to some extent, on your progress in physical therapy. The physical therapist will likely give you a list of activities, exercises, and “do’s and don’ts” when you leave the hospital, and you may also have the assistance of an occupational therapist or nurse to help with special needs.

When you’re ready for discharge, your surgeon will determine whether you can best continue to recover at home (the usual procedure) or in a facility where you can receive specialized rehabilitation help. If you do go to another facility, the goal will be to return you to your home, able to move about with a safe level of independence, within 3 to 5 days.

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 many surgeries, pain medication may be prescribed while you are healing.)

You may need a walker and/or crutches for about 6 weeks, then use a cane for another 6 weeks or so. You’ll be in touch with your doctor or orthopaedic surgeon as well as your case manager, so you’ll have plenty of opportunities to ask questions or discuss concerns as well as to report your progress.

Be aware that there are some things you should not do after joint surgery. It’s important to have realistic expectations. For example, artificial joints have limitations:

• Excessive joint “loading” because of the patient being overweight or strenuous activity, such as running and hiking, may injure the artificial joint.
• The artificial joint will not restore function to the same level as normal, healthy bone.
• The life span of the artificial joint is not infinite.
• Adverse effects may result in a need for additional surgery, including revision or removal of the artificial joint.

Your healthcare provider will instruct you about limiting your activities following the surgery. Remember: It is very important to follow these instructions!

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:

• You may practice stair-climbing in the hospital and should be able to do this by the time you leave.
• You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don’t tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.
• When to resume driving a car, going to work and/or participate in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopaedic surgeon’s advice and recommendations.
• You may need to take antibiotics before dental work (including dental cleaning) and any surgical procedure that could allow bacteria to enter the bloodstream. Ask your healthcare provider whether you will need to take antibiotics at certain times to prevent infection.

When fully recovered, most patients can expect to return to work — unless your type of work is not advisable for people with artificial joints. Examples of these include construction work, certain types of carpentry, and occupations that involve repeated high climbing or lifting. You should discuss your situation with your doctor.

You may also be advised to avoid certain activities, including some athletics, as they may place excessive stress your new joint. Examples of these activities include:

Hip/Knee

• Skiing (snow or water)
• Basketball
• Baseball
• Contact sports
• Distance running
• Frequent jumping

Shoulder

• Any activity involving lifting or pushing heavy objects
• Any activity that places excessive stress on your shoulder joint
• Hammering and other forceful arm/shoulder movements
• Boxing and other arm/shoulder impact sports

After Joint Replacement, a Good Rule of Thumb is that Acceptable Physical Activities Should:

• Not cause pain, including pain felt later
• Not jar the joint
• Not place the joint in the extremes of its range of motion
• Be pleasurable

The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you will potentially experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems.

It’s important to have realistic expectations. For example, artificial joints have limitations:

• Excessive joint “loading” because of the patient being overweight or strenuous activity, such as running and hiking, may injure the artificial joint.
• The artificial joint will not restore function to the same level as normal, healthy bone.
• The life span of the artificial joint is not infinite. It cannot be expected to equal that of normal, healthy bone.
• Adverse effects may result in a need for additional surgery, including revision or removal of the artificial joint.

It may come as a surprise to you that total joint replacement patients are encouraged to get up and start moving around as soon as possible after surgery.

When you are medically stable, the physical therapist will recommend certain exercises for the affected joint. Physical therapy is a key part of recovery. The more quickly a joint replacement patient gets moving again, it is more likely that he or she will regain independence just as quickly. To ease the discomfort the activity will initially cause, pain medication is recommended prior to therapy. In addition, the physical therapist will discuss plans for rehabilitation following hospital discharge. Depending on your limitations, an occupational therapist may provide instruction on how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing. A case manager will discuss plans for your return home and will ensure that you have all the necessary help to support a successful recovery. If needed, the case manager can help arrange for you to have a home therapist.

The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you will potentially experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems!

Regaining Mobility Safely, Slowly, Securely At first

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:

• Expect to use a cane or walker for several weeks
• No kneeling, bending or jumping for the first month
• Don’t drive until ok with your doctor (usually 4-6 weeks)
• No alcohol with pain medication
• Don’t smoke – it slows healing
• You may hear some clicking in your knee as it heals; it’s normal
• Avoid sexual activity until after six-week check-up
• Continue wearing elastic stockings until your return appointment

In general, physical activities should:

• Not cause pain, either during activity or later
• Not jar the joint, such as when running or jumping
• Not place the joint in extreme ranges of motion
• Be pleasurable

Additional tips for living with your new joint:

• Ask for help – while your goal is to eventually do things for yourself, don’t take unnecessary risks by trying to do too much too soon.
• Recuperation takes approximately 6-12 weeks – you may feel weak during this time. Use ice for swelling and discomfort. Ice your knee for 15-20 minutes after each exercise period to reduce pain.
• Keep your appointments with your doctor – it’s important to monitor healing and function on a regular basis. You may need to check in with your doctor two to three times during the first two years, and at intervals of two to three years thereafter. During those visits, your surgeon will take X-rays and monitor wear.
• Under optimal conditions, your artificial joint may last for many active years. You should always consult your orthopaedic surgeon if you begin to have pain in your artificial joint or if you suspect something is not working correctly.
• Watch for infection – your new joint is a foreign substance to your body. Germs from other infections can move to your new joint and cause infection. Call your family doctor immediately if you have any signs of infection, e.g., skin infection, urinary tract infection, abscessed teeth, etc. Early treatment is crucial.
• Alert your dentist or family physician – tell them about your joint replacement before any dental work or procedure, such as a cardiac catheter, bladder exam, or surgery. You may always need to take antibiotics first to prevent infection.
• Your new joint may set off metal detectors in airports and other secured buildings. Your doctor can give you an identification card to carry in your wallet.

Long Term

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.

Your doctor has provided this information to answer some of the questions you may have about the importance of preventing infection after your joint replacement. It will also help you better understand what to do if you develop an infection and require medical treatment.

Recovering From Joint Replacement

After your joint replacement, your orthopaedic physician will likely give you specific instructions on movement, exercising and wound care. Most people are encouraged to stand, even walk, the day after surgery. Your doctor may provide you with a walker, cane or crutch. Depending on the joint replaced, and your overall health, your doctor may also prescribe a course of physical therapy, so that a trained healthcare provider can guide you through specific therapeutic movements.

Joint replacement surgery has a 90% success rate across the board.¹ But, as with any surgery, there are possible complications associated with joint replacement. Among them, infection may occur in the wound, or even around the joint implant itself (prosthesis). Infection can set in while you’re in the hospital or after you go home. Minor infections of the wound are often treated successfully with antibiotics. A deeper infection may cause the implant to loosen, become painful and require additional surgery and, eventually, another joint replacement. The good news is that most infections are preventable.

Helping to Prevent Infection

Before and during your joint replacement surgery, your doctor will take measures to reduce the risk of bacterial infection. You may be given a preventative antibiotic right before, and for a short time after, your surgery. Your doctor will also recommend that you take antibiotics before you have any invasive procedure or test (like a colonoscopy or dental work).² Because you now have an implant, it may give bacteria a place to hide from your body’s natural immune response, increasing your risk of infection.² A preventative course of antibiotics will help to reduce that risk.

Treating a Joint Replacement Infection

People who develop infections within the first few months of joint replacement surgery are often treated successfully with intravenous antibiotics and a surgical technique that washes the infected implant. People who develop infections months or years after joint replacement appear to face more challenging treatment. Often these infections require surgical removal of the infected implant, use of a spacer impregnated with antibiotics to stabilize and treat the joint space, and longer-term intravenous antibiotics.² Careful blood monitoring helps to determine when the infection is thoroughly cleared. A new joint replacement may be considered at that time.

If you have any questions about caring for your wound site or preventing infection in your joint replacement, be sure to talk with your doctor.

Total Joint Replacement AAOS Links

Total Hip Replacement
Total Hip Replacement Exercise Guide
Total Joint Replacement
Total Joint Replacement: Questions Patients Should Ask Their Surgeon
Total Knee Replacement

Total Joint Replacement AAHKS Links

Considering Joint Replacement Surgery