Hip and Knee Pain
|The Hip Joint||The Knee Joint|
Did you know?
Did you know?
Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery.
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 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:
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.
Preparing for total joint replacement begins weeks before the actual surgery. In general, you may be told to:
Your hospital stay will progress something like this:
Many people will be with you in the operating room during your one to three-hour surgery, including:
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:
You may have any of the following inserted:
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.
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.
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:
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:
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.
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.
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
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.
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:
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.
Call your doctor if you experience any of the following symptoms:
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:
The physical therapist (or nurses) will also show you:
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:
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:
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:
After Joint Replacement, a Good Rule of Thumb is that Acceptable Physical Activities Should:
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:
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!
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.
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.
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.
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.
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.
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