What you Need to Know About Joint Replacement
GETTING MOVING AGAIN
It may come as a surprise to you that total joint replacement patients are usually encouraged to get up and start moving around as soon as possible after surgery—as early as the day of 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, the more likely he or she will regain independence. 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.
LIFE AFTER TOTAL JOINT REPLACEMENT
The vast majority of individuals who have joint replacement surgery experience a dramatic reduction in joint pain and a significant improvement in their ability to participate in the activities of daily living. However, joint replacement surgery will not allow you to do more than you could before joint problems developed. Your physician will recommend the most appropriate level of activity following joint replacement surgery. In the weeks following total joint replacement, certain limitations are placed on every patient’s activities. 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, as happens with running or jumping
- Not place the joint in the extremes of its range of motion
- Be pleasurable
WHAT IS JOINT REPLACEMENT SURGERY?
Hip replacement involves replacing the femur (head of the thigh bone) 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 (durable, wear-resistant plastic).
In total knee replacement, the artificial joint is composed of metal and polyethylene 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 1960’s. While the expected life of conventional joint replacement is difficult to estimate, it is not infinite.
PREPARING FOR JOINT REPLACEMENT SURGERY
Preparing for a total joint replacement begins weeks before the actual surgery date. In general, your doctor may discuss the following with you:
Antilogous Blood Donation
While some total joint procedures do not require a blood transfusion, it is possible that you may need blood during or after surgery.
Exercising Under a Physician’s Supervision
It is important to be in the best overall health to help promote the best possible surgical experience. Increasing upper body strength is important because of the need to use a walker or crutches after hip or knee replacement. Strengthening the lower body is also key because increasing leg strength before surgery can reduce recovery time.
General Physical Examination
Patients who are considering total joint replacement should be evaluated by their primary care physician, and obtain surgical clearance a week prior to surgery.
Dental procedures such as extractions and periodontal work should be completed before joint replacement surgery to reduce the potential of infection.
Your doctor can advise you which over-the-counter and prescription medications should not be taken before surgery.
To help reduce the risk of post-operative lung problems and improve healing.
Arrange a Pre-Op Visit
An important opportunity to meet with healthcare professionals at the hopsital to discuss your personal hospital care plan.
Blood tests, urine tests, an EKG or cardiogram, and chest X-ray may be prescribed to confirm that you are fit for surgery.
Evaluate Post-Surgical Rehabilitation Needs
Every patient who undergoes total joint replacement will need help once surgery is completed. Consider your sub-acute options prior to your surgery. Visit local sub-acute facilities to ensure the best possible outcome.
WHAT YOU MAY EXPERIENCE THE DAY OF SURGERY
Every hospital has its own particular procedures, but total joint replacement patients can expect their day-of-surgery experience to follow this basic routine:
- 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 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 of 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.
Whether you are sent directly home or to a facility that assists in rehabilitation will depend on your physician’s assessment of your abilities. Remember, it’s your choice to begin the rehabilitation process in a sub-acute facility or at home.
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 — the vast majority of which can be successfully avoided and/or treated.
Infection may occur in the wound or within the area around the new joint. Following surgery you will receive antibiotics to help prevent infection. You may also need to take antibiotics before undergoing even minor medical procedures to reduce the chance of infection spreading to the artificial joint. 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
Pneumonia is always a risk following major surgery.
Ask your doctor for a complete list of risks.
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