Joint replacements of the knee and hip are some of the most commonly performed surgeries in the US today. They are generally recommended when the joint is worn out to the extent that mobility is restricted, and you experience pain in your joint even when at rest.
We see a lot of people come into our office after being told they have “bone-on-bone arthritis”. A large percentage of those people don’t have any pain or deformity. Remember that our job as surgeons is to treat you, the patient…not your x-rays. The time to consider surgery is when you are having pain on a daily basis that is limiting your quality of life and preventing you from doing the things you enjoy. For some people that may be walking, golfing, skiing or gardening for example. If you have exhausted conservative treatment such as anti-inflammatory medication, a reasonable therapy program, perhaps even tried injections without lasting success…that is the time to schedule an appointment and discuss surgical options.
Today, advances in surgical procedures, implants, and instrumentation have made it possible for almost anyone to undergo joint replacement surgery, it is not just restricted to the elderly population.
Here are some important questions to ask your doctor before undergoing knee or hip surgery:
How do I prepare for the procedure?
Preparation is critical to success and there is a growing body of evidence suggesting that better preparation before surgery can result in improved outcomes after surgery. Inform your doctor about your regular prescription medications as some of them may have to be stopped before the procedure. Cancel any dental appointment prior to and inquire about a safe time to schedule dental work after surgery. You must also avoid injections into the joint 3 months before surgery. Preoperative physical therapy exercises to strengthen the muscles around your joint may help you recover faster after surgery. These have historically been performed in a formal therapy setting but ask your surgeon about home routines. With the growth in digital health there are a number of resources available that afford you the opportunity to have directed therapy in the comfort of your home.
What are the risks associated with the procedure?
Even with advanced surgical techniques, state-of-the-art facilities, and a thorough presurgical evaluation, there may still be complications from surgery. Infection, injury to surrounding healthy tissue, blood clots and delayed healing are a few of the risks associated with any surgical procedure. Discuss the risks involved in your case and how they can be minimized. Each person is different and it’s important to be up front with your surgeon about any medical conditions you have so that you can work together to tailor your protocol specifically for you. This is also important because a big part of our job is to make sure that you are optimized prior to surgery to reduce specific risk factors.
We take optimization seriously and there are a few examples that come up regularly. If you have a pre-existing heart condition you may be sent to your cardiologist for pre-operative clearance and additional testing. If you have sleep apnea and use a CPAP machine at night you may be sent to a sleep specialist or see the anesthesiologist in advance to limit your risks with anesthesia. Another example is patients with rheumatoid arthritis. We will commonly have you see your rheumatologist and schedule surgery around your medication schedule. The over arching theme here is that by working together we can reduce risk and improve your overall outcome.
When can I return home after surgery?
As the surgery is usually performed minimally invasively, you may be discharged on the same day or after an overnight stay. Not everyone is a candidate for outpatient or rapid recovery. The right time to go home is different for everyone and some people will require longer length of stay to ensure that they are medically safe to go home. Another important aspect of returning home is your home environment and support system. Putting together a support network before surgery and preparing your home in advance can improve your chances of returning home sooner.
What precautions should be taken after surgery?
You must keep the surgical bandage intact and as dry as possible for the first week. This means you may shower, but no baths. Pain medications should be taken only as recommended and no driving when on narcotic pain medications. You will have to restrict certain activities and may require walking aids for a period of time. Everyone is different so it is important not to try to compare yourself with others. That being said, the process of getting back to your normal routine starts immediately and progresses over the first few weeks.
When can I return to work?
How soon you can return to work will vary depending on your specific condition, your overall health, and the type of work you do. In general, in 3-5 days to a sedentary job, 2-4 weeks to a job that involves some amount of standing, and about 1-1/2 to 2 months to a job that involves manual labor.
Discussing these questions with your surgeon will help you set realist expectations and plan ahead for positive outcome from surgery.
Dr. Frisch is a specialist orthopedic surgeon focusing on minimally invasive hip and knee joint replacement as well as complex primary and revision surgery. He believes in creating a very personalized experience with the highest level of service. For all appointments & inquiries, please contact our offices located in Rochester, River District, or Tawas City, MI.