Joint Replacement: Your Questions Answered

I get this question all the time, and what I tell people is that nobody needs a joint replacement. This is an elective procedure that is meant to restore function and alleviate pain. There are many non-surgical modalities that we can do to treat said pain. However, if these fail and you still have continued, debilitating pain and decreased function, a joint replacement may be indicated.

This depends on whether or not it’s a total hip or a total knee. Total hips usually recover a little bit faster. But generally speaking, for the first two weeks after surgery, you’re walking around with a walker working on gentle range of motion exercises. More important for the knee that the hip. Two to six weeks, you’re walking farther. You’re weaning from the assisted devices. You’re getting stronger. Six weeks to three months, you’re walking around the grocery store, starting to go out and get back to more normal Three months to a year, that’s when we really start to see return to a more normal lifestyle.

We really don't know the answer to this. Data that we have from twenty to twenty-five years ago says that around seventy-five to eighty percent of hip and knee replacements that were placed at that time are still in patients that have not been revised. That being said, we have made significant advances and the reasons for failure are changing. So we think that around eighty percent will last twenty years for both hips and knees.

Arthritis is any destruction of the cartilage surface at the end of bones that allows for smooth, painless, gliding range of motion. There are multiple causes for this, mainly wear and tear arthritis, but also rheumatoid arthritis, post traumatic arthritis, infection arthritis. When the joint surface is destroyed and the underlying bone surface is now exposed that was usually covered by cartilage, there are nerve endings in these bone surfaces that get irritated and that is what causes the pain of arthritis.

There are many non-surgical ways to do this that consist mainly of physical therapy to help increase the range of motion and strength of the joints, weight loss to put less pressure across the joint, anti-inflammatory medications to decrease the inflammation that is going on, which is causing some of the pain, and injections that include both corticosteroid and gel injections. And these are all interventions that we can attempt prior to surgery.

So what are the risks of a hip and knee replacement? There are many. Fortunately, they are all low, and many of the modalities that we do prior to surgery decrease these risk factors. However, the main things that we worry about are the implants coming loose, dislocation, infection, breaking, damage to surrounding structures, mainly nerves. And all of these, again, are low, but they are real.

The answer is maybe. It depends on the sensitivity of the metal detector. Sometimes it'll go off, sometimes it won't. If it does, tell the TSA agent that you have a total hip or a total knee replacement. They will wand you and usually send you right through.

The answer is we used to do this. And mainly because of physical therapy and pain control, we have gotten a lot better at this and now a majority of the patients, barring any unforeseen complications go home the same day of surgery.

Physical therapy increases your strength and your range of motion or your mobility around the joint. If we have muscles that are weak, whenever they fire, they put too much pressure or more pressure than they need to on the joint, which increases the joint reactive forces. If we have muscles that are too tight, you’re having to work harder to pull against them. Both of these can cause pain. There are also generators of pain that come from outside the joint, particularly where the tendons insert into the bone. These can cause pain around the joints but are not necessarily caused by the arthritis itself. So it’s very important to treat both pain generators from the joint itself and outside of the joint.

Weight loss is important for multiple reasons. Pressure across the joint is related to body weight. It is measured in multiples of body weight based on different activities. For example, going up and downstairs can be three to four times your body weight. Therefore, if you decrease your body weight by a few pounds, that's multiple pounds of pressure that is not placed across the joint whenever you're doing these activities. It is also important in the surgery setting because with an elevated weight or a elevated body mass index, which is a ratio of your height to your weight, the risk of surgical complications follow and go up directly with an increased BMI.