If you're thinking about having hip replacement, knee replacement or shoulder replacement surgery at Great Plains Health, you may wonder what to expect. Here are answers to some of the most common questions we hear.
All surgeries carry a certain amount of risk. But we take steps to prevent complications. Most of our joint patients are ready to leave the hospital in a few days.
To help prevent infection, you'll be given antibiotics both before and after surgery. And we've streamlined our surgical procedures to take less time. The less time your joint is open, the less chance of infection.
After surgery, blood clots can sometimes be a problem. So you'll be given medication to reduce the risk of blood clot formation. Getting you up and walking soon after surgery is another way to reduce the risk of blood clots.
About 90 to 95 percent of patients report good to excellent results in terms of pain relief. Most people are able to significantly increase their activity and mobility. And most return to the low-impact activities they participated in before the onset of arthritis pain.
Your overall health is more important than your age. Before surgery, you'll be asked to see your family doctor to assess any health risks. And we'll take steps to prepare you for a good outcome.
The better condition your muscles are in before surgery, the easier and faster your recuperation may be. Starting to exercise now will build muscle tone and pave the way to a quick recovery. See Preparing for Orthopaedic Surgery to learn more.
The artificial ball and socket are referred to as the prosthesis or implant. Some are made totally of metal, with plastic liners in the socket, while others may include ceramic parts. Your surgeon will help decide which type of prosthesis is right for you.
A cemented prosthesis is an artificial joint with a smooth surface. It is held in place by a type of cement that attaches metal to bone.
An uncemented prosthesis is an artificial joint that has a fine mesh of holes on the surface. It allows bone to grow into the mesh and secure the prosthesis to the bone.
You should talk with your surgeon about which is right for you. Cemented prostheses are typically used for less active people and people with weak bones or osteoporosis. Uncemented prostheses are rarely used for total knee replacements, but they may be right for younger, more active people. Both types of joints have similar success rates.
It is possible but not recommended. During the recovery process, it will be easier to walk and exercise if only one joint is healing. Usually, the second joint can be scheduled within three to four months of the original surgery. This gives the first joint enough time to heal.
The surgery itself takes one to two hours. After surgery, you'll be closely monitored in the Post Anesthesia Care Unit (PACU) until the anesthesia wears off. Once you're awake and stable, you'll be transferred to your room.
Your orthopaedic surgeon will perform the actual surgery. The surgeon often has an assistant who helps with the procedure. In addition, there is a surgical team that provides care before, during and after the surgery. Other team members include an anesthesiologist and nursing staff.
During surgery, an anesthesiologist will give you an anesthetic that provides pain relief. There are different types: A general anesthetic will put you into a deep sleep, while a regional anesthetic will numb specific areas only. You and your anesthesiologist will discuss which method is best for you.
For hip and knee replacements, we normally use regional anesthetics along with another medication to make you very relaxed and put you in a light, dreamlike state. You won't remember the surgery once you're awake.
For shoulder replacements, we typically use a general anesthetic.
As with any surgery, there will be some pain associated with your joint replacement. But there are several pain control methods that can keep you comfortable and allow you to be up and moving shortly after surgery. Your doctor will help choose the method right for you. It may include:
- Oral medications. These may be started before surgery and continue throughout your hospital stay and recovery at home.
- IV pain medications. These are given through a vein in the arm. They may be used for severe pain or before oral medication has taken effect.
- A nerve block. This is a regional anesthetic injected in the thigh or neck area. Nerve blocks prevent the pain signals from reaching the brain.
There is a possibility that you may need a blood transfusion after surgery. You can rely on blood from the blood bank or you can donate your own blood before surgery. Your donated blood will be stored for your use only. There may be a charge for the service. For more information, call your local American Red Cross center.
Your care team will let you know when it's safe to get up after surgery. If you've had a hip or knee replacement, don't expect to get out of bed until the morning after your surgery. Early that morning, you will be up in a recliner chair for breakfast. Usually, most patients are walking in the halls with a walker by the afternoon.
Before leaving, you must meet certain goals. You'll learn more about these goals from the medical staff after surgery.
For hip or knee replacements, the average length of stay is three days. But depending on how you are progressing, you may be able to leave in two days.
For shoulder replacements, the average length of stay is two days.
Some patients require a short stay in a nursing home or rehab center first, but this is the exception rather than the rule. Your care team will monitor your progress daily and will let you know when you're ready to go home.
Although you'll be well on your way to recovery when you leave the hospital, arrange to have someone help you with meals, medications, dressing, etc., for at least one or two weeks. If you go directly home from the hospital, the joint care team can arrange a home health nurse to visit you if needed.
To make the transition to home easier, plan ahead. Before coming to the hospital, take care of things like:
- Getting prescriptions filled.
- Changing the beds.
- Doing the laundry.
- Washing the floors.
- Arranging for someone to cut the grass or walk the dog.
- Stocking up on groceries.
Your job after surgery is to focus on recovering, not household tasks. See Preparing for Orthopaedic Surgery to learn more.
You'll have follow-up appointments about two weeks and four weeks after surgery. During the first appointment, your staples will be removed. At the second appointment, your surgeon will evaluate your progress.
People progress at their own rate. Most hip and knee replacement patients use a walker for about four to six weeks. Your doctor will tell you when you can retire the walker.
Most patients do physical therapy after they leave the hospital. The joint care team will make arrangements for you with our physical therapy department or the facility of your choice. If you can't attend physical therapy, an in-home therapist can be arranged.
The number of sessions you need will be based on your progress. In many cases, the more effort you put into your exercise routines, the quicker your recovery. See Exercise After Surgery for sample exercises you may be asked to do.
Exercise helps your whole body stay healthy. It's especially good for your new joint. Ask your doctor when it's safe to add low-impact activities—such as dancing, golf, hiking, swimming, bowling and gardening—back into your normal routine.
Keeping your new joint moving will help your recovery. But you should return to normal activities gradually. You may have to work your way up to a particular activity.
If you've had a hip or knee replacement, talk with your surgeon before participating in high-impact or injury-prone sports, such as:
- Downhill skiing.
If you've had a shoulder replacement, you should not jar your joint or push it to its most extreme range of motion. Talk with your surgeon before:
- Lifting or pushing heavy objects.
- Making hammering or forceful movements.
- Boxing or doing any other arm/shoulder impact sports.
That depends on the physical demands of your job, as well as your progress. Most people plan on taking a one-month leave of absence. Your surgeon will tell you when you can return to work.
It can be as little as four weeks or as long as six weeks or more. It depends on the progress you make during your recovery.
The type of car you drive also matters. For instance, if you had a left hip or knee replaced, you may be able to drive an automatic transmission in as little as four weeks. If your surgery was on your right hip or knee or you drive a manual transmission, then you may not be ready to drive for six or more weeks.
You should not drive if you are still taking prescription pain medication or muscle relaxers. Your surgeon will let you know when it's OK to drive.
After surgery it will take time to regain your strength. Most people feel able to have sex about four to six weeks after surgery. Although healing times can vary, by that point the incisions, muscles and ligaments are usually sufficiently healed. Talk to your surgeon if you have any questions.
Some medications can affect your performance or enjoyment during sex. Narcotic pain relievers and cortisone medications can decrease performance. Other common medication-related side effects may include:
- Decreased interest in sex.
- Abnormal erections.
- Vaginal dryness.
- Delayed orgasms.
If you think your medication is causing side effects like these, try having sex in the morning before taking your first dose or in the evening before your last dose. Don't adjust the dose or stop taking your prescribed medicine without talking to your surgeon first. You may be able to try a different medication to eliminate unwanted side effects.
After a hip replacement, it's important to avoid positions that could cause your hip to pop out of place or dislocate. Take these precautions:
- Don't bend your hip more than 90 degrees.
- Don't bring your knee higher than your hip.
- When lying on your back, don't roll your affected leg toward the other leg. Keep the affected leg relatively straight, in line with the hip.
- When lying on your side, don't cross the affected leg over the unaffected leg.
- When lying on your side, place pillows between your legs to keep your legs parallel to each other.
Usually the most comfortable position for both men and women immediately after hip replacement is the bottom position. Women should keep the affected leg out to the side with one or two pillows under the thigh and knee for support. Move the affected leg as little as possible.
Later in recovery, as hip swelling goes down and range of motion improves, you may want to experiment with other positions. But stop if you experience discomfort. In case of severe pain, don't move. Call your surgeon right away for instructions.
After a knee replacement, avoid positions that involve kneeling on your new joint. It is best to use a side-lying position early in recovery. You may place pillows under the knee to provide support and comfort.
As your healing progresses, lying on your back with a pillow or two under the knee to create a comfortable bend is a good alternative to the side-lying position.
Later in recovery, as knee swelling goes down and range of motion improves, you can try a top position. But don't use this position until your knee is comfortable and the incision is totally healed.
Remember, you're still healing. Just like other activities you used to enjoy, it may take some time to regain your former stamina. These changes to your sex life are temporary and are needed to protect your new joint. But in time, you'll be back to your old self.
It depends on the technique your surgeon uses. The type of surgery you have will determine the number, location and length of your scars. Your surgeon will discuss which technique is right for you.
There may be some numbness around the scar after it heals. This is perfectly normal. The numbness usually resolves over time.
After a hip replacement, the new joint normally feels natural. Some people may notice that the leg with the new hip seems slightly longer than it was before. That's usually because years of slow degeneration of the hip joint caused a shortening effect the body compensated for. Once the joint is replaced, the leg feels longer.
In other instances, the surgeon intentionally lengthens the leg at the joint during the surgery. This is done to prevent the joint from dislocating or popping out of the socket. Over time, the new leg length becomes less noticeable. Sometimes a small lift placed inside the opposite shoe can help correct the length difference. Talk with your surgeon if you encounter this problem.
A few patients report aching in the thigh when standing or bearing weight. This pain normally goes away after a few months.
After a knee replacement, kneeling may be uncomfortable during the first year. But it should become less noticeable over time. Some people also notice a minor clicking sound when they bend their knees. This is normal. It's the result of the artificial parts of the knee coming in contact with each other.
Various factors—such as your weight, activity types and activity level—can affect the life of your new joint. Current studies suggest that the average hip or knee prosthesis lasts 15 to 20 years. As new materials and procedures come along, this expectation may change.
Some people have hip or knee replacements that last their entire lives. Other people need to have the procedure repeated. For example, if the bone doesn't bond properly to the first replacement, the prosthesis may become unstable and need to be replaced. Or if the plastic spacer that cushions the joint becomes extremely worn, it may also need replacing.
Don't see your question here?
Call Great Plains Health Orthopaedics in North Platte at 308.568.3800 to speak with one of our experienced staff members.