Atlantic Medical Group Center for Orthopedics and Sports Medicine - Basking Ridge

What is a hip replacement?

Hip replacement involves the removal of arthritic bone ends and damaged cartilage and replaces them with prosthetic implants that replicate the hip joint. Hip replacement can help relieve pain and get you back to enjoying normal, everyday activities.

What are the reasons for total hip replacement?

Total hip replacement is often reserved for patients who:

• Have a painful, disabling joint disease of the hip resulting from a severe form of arthritis.
• Are not likely to achieve satisfactory results from less invasive procedures, such as arthrodesis (artificial stiffening or fixation of the joint).
• Have bone stock that is of poor quality or inadequate for other reconstructive techniques.

How is a total hip replacement performed?

In a total hip replacement operation, the surgeon replaces the worn surfaces of the hip joint with an artificial hip joint. The worn head of the femur (thighbone) is replaced with a metal or ceramic ball mounted on a stem; the stem is placed firmly into the canal of the thighbone at its upper end. The acetabulum (hip socket) is prepared and implanted with a metal cup and plastic or ceramic insert. The ball and insert glide together to replicate the hip joint.

Who should have a hip replacement?

Hip replacement surgery may be considered when arthritis limits your everyday activities such as walking and bending, when pain continues while resting, or stiffness in your hip limits your ability to move or lift your leg. Hip replacement may be recommended only after careful diagnosis of your joint problem. It may be time to consider surgery if you have little pain relief from anti-inflammatory drugs, or if other treatments, such as physical therapy, do not relieve hip pain.

How long is the hospital stay?

After hip replacement surgery, you will probably spend no more than three to five days in the hospital. Most hip replacement patients begin standing and walking with the help of a walker and a physical therapist the day after surgery. However, everyone is different, and you should discuss what you can expect with your doctor.

How long is recuperation?

Recovery varies with each person. It is essential that you follow your orthopedic surgeon’s instructions regarding home care during the first few weeks after surgery; especially concerning the exercise program you are prescribed. You should be able to resume most normal light activities of daily living within three to six weeks following surgery. Some discomfort during activity and at night is common for several weeks. Complete recovery can take from about three to six months.

While most people will gradually increase their activities and return to doing things like playing golf, doubles tennis, shuffleboard, or bowling, you will be advised to avoid more active sports, such as jogging, singles tennis, and other high-impact activities.

Are there complications?

As with any surgery, there is a risk of complications after hip replacement surgery. However, they are relatively rare. Blood clots are the most common complication after surgery. Your orthopedic surgeon may prescribe one or more measures to prevent a clot from forming in your leg veins. These measures may include a special support hose, inflatable leg coverings, and blood thinners.

What is the success rate?

Hip replacement is one of the most important surgical advances of this century. This surgery helps more than 300,000 Americans each year to relieve their pain and get back to enjoying normal, everyday activities.

How long does a hip replacement last?

The conventional arrangement of a metal ball into a special plastic (polyethylene) cup has been shown to have positive results over the years. How long it will last depends not only on age, but also on a patient’s activity level. Newer hip replacement materials using more durable alumina ceramic and titanium have made major advances in hip replacement technology.

Demand and activity levels are generally considered when the surgeon works with you to decide which type of hip replacement materials are best for you.

What is knee replacement?

Knee joint replacement is a surgical procedure in which certain parts of an arthritic or damaged knee joint are removed and replaced with a prosthesis, or artificial joint. The artificial joint is designed to move just like a normal, healthy joint and allows you to get back to enjoying normal, everyday activities without pain.

How “bad” does my joint pain have to get before I should consider having a joint replacement?

This is a very personal decision that only you can make with the help of an orthopedic specialist’s evaluation of your pain and its effects on your daily life. For example, experiencing knee pain day after day without relief can lead to “staying off” the joint, which often weakens the muscles around it, so it becomes even more difficult to move.

When other, more conservative treatment options — including medication and physical therapy — no longer provide pain relief, joint replacement may be recommended.

What is minimally invasive (MIS) knee joint replacement?

With a minimally invasive knee surgery, specialized techniques and instrumentation enable the physician to perform major surgery without as large an incision. In this respect, it is indeed “minimally invasive,” requiring a smaller incision and causing less trauma to the soft tissues. MIS knee replacement is considered a step forward in total knee replacement for a number of reasons, which include the following: potential for a shorter hospital stay, faster recovery, and less scarring. However, MIS surgery is not the right procedure for everyone. Only your orthopedic specialist can determine its benefits for you.

Are there risks associated with MIS surgery?

The MIS knee replacement technique is significantly less invasive than conventional knee replacement surgery, but it is still a major surgery.

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.

What will I need to know about postoperative recovery in the hospital?

Following joint replacement surgery, hospital stays vary depending on insurance coverage and individual medical status. A total of four days (including the day of the surgery) is typical. On the first day after your surgery, you will likely get out of bed and begin physical and occupational therapy, typically several brief sessions a day.

Usually, a case manager is assigned to work with you as you move through your rehabilitation routines. When you’re ready for discharge, the decision will be made concerning whether you can best continue to recover at home (the usual procedure) or in another facility where you may receive specialized rehabilitative 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 three to five days.

What can I expect in the first days after I’m discharged?

You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. But soon you may get a routine going and gain confidence in your new joint — the start of a new life with less pain. (As with any surgery, you’ll probably take pain medication for a few days while you are healing.) Be aware that you’ll probably need a walker and/or crutches for about six weeks, then use a cane for another six weeks or so. You’ll be in touch with your doctor or orthopedic specialist 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.

When will I be able to go back to a normal daily routine, such as going to work or driving a car?

This is a decision that only you and your doctor or orthopedic specialist can make. Be sure to follow your doctor’s or orthopedic surgeon’s advice and recommendations. Individual results may vary.

How long does a knee replacement last?

As successful as most of these procedures are, over the years the artificial joint can become loose or wear out, requiring a revision (repeat) surgery. How long it will last depends not only on a person’s age, but also on a patient’s activity level. These issues — together with the fact that increasing numbers of younger and more active people are receiving total joint replacement — have challenged the orthopedic industry to try to extend the life cycle of total joint replacements.

What happens during knee replacement surgery?

In surgery, the knee is flexed and the leg suspended. One muscle is separated to expose the femur (thighbone); later, the tibia (shinbone) is exposed. The damaged surfaces at the end of the thighbone are trimmed to shape it to fit inside the total knee prosthesis. The shinbone is cut flat across the top and a hole is created in the center to hold the stem of the tibial component. If needed, the kneecap is trimmed and the patellar component attached.

At various points during surgery, the alignment, function, and stability of the knee joint are evaluated and required adjustments are made. The prosthesis components are cemented into place, any contracted ligaments are released, the midvastus muscle is reconstructed, and the incision is closed.

What is a shoulder replacement?

Also called arthroplasty, shoulder replacement is a surgical procedure in which the damaged or diseased joint is removed and replaced by an artificial shoulder implant (prosthesis) that is designed move like a normal, healthy joint.

How “bad” does my joint pain have to get before I should consider having joint replacement?

This is a very personal decision that only you can make, with the help of an orthopedic surgeon’s evaluation of your pain and its effect on your daily life.

Why do some people need joint replacement?

When other treatment options no longer provide relief, joint replacement may be recommended — not only to relieve pain but also to prevent the disability it can cause. For example, experiencing joint pain day after day without relief can lead to “staying off” the joint, which often weakens the muscles around it so it becomes even more difficult to move. Your orthopedic surgeon will tell you whether you might benefit from joint replacement and explain the reasons why it may or may not be right for you at this time.

What happens during shoulder replacement surgery?

Certain parts of your shoulder joint are removed and replaced with a plastic or metal device called a prosthesis, or artificial joint. The artificial shoulder joint can have either two or three parts, depending on the type of surgery required.

• The humeral component (metal) is implanted in the humerus, or upper arm bone.
• The humeral head component (metal) replaces the humeral head at the top of the humerus.
• The glenoid component (plastic) replaces the surface of the glenoid socket, or shoulder socket.

If I decide to have a joint replacement, what will I need to do before the surgery?

You’ll need routine blood tests, urinalysis, a physical examination, and, if you’re over 50 or your doctor thinks they’re advisable, an electrocardiogram (EKG) and chest X-ray as well. Your own doctor or the hospital where you’ll have the surgery may perform these preoperative tests and evaluations. You may also be asked to donate blood preoperatively or to have a designated donor — usually a family member or relative — do this. Your doctor or orthopedic surgeon will specify exactly which tests and evaluations you will need and when you should have them. He or she may also recommend that you take an iron supplement before your surgery, and you may be asked to stop taking certain medications — for example, aspirin and other medications that thin the blood. Your doctor or orthopedic surgeon will also specify how these and any other medication concerns apply to you. Finally, your doctor may advise you not to eat or drink after midnight on the day your surgery takes place.

What will I need to know about postoperative recovery in the hospital?

Following joint replacement surgery, hospital stays vary depending on insurance coverage and individual medical status — a total of four days (including the day of the surgery) is typical. The surgery may take from two to three hours, and you’ll spend about the same amount of time in the recovery room.

On the first day after your surgery, you may be able to get out of bed and begin physical and occupational therapy, typically several brief sessions a day. Usually, a case manager is assigned to work with you as you move through your rehabilitation routines. When you’re ready for discharge, the decision will be made concerning whether you can best continue to recover at home or in another facility where you may receive specialized rehabilitative 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 three to five days.*

What can I expect in the first days after I’m discharged?

You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. But soon you will likely get a routine going and gain confidence in your new joint — the start of a new life with less pain. (As with any surgery, you’ll probably take pain medication for a few days while you are healing.) You’ll also be in touch with your doctor or orthopedic surgeon, as well as your case manager, so take advantage of opportunities to ask questions or discuss concerns as well as to report on your progress. (Individual results vary.)

When will I be able to go back to a normal daily routine, such as going to work or driving a car?

This is a decision that only you and your doctor or orthopedic surgeon can make. However, there are some general guidelines that your doctor may give you:

• You should have no restrictions on leaving your home as long as your safety and comfort are assured.
• Don’t tire yourself out — a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.

When to resume driving a car, going to work, and/or participating in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopedic surgeon’s advice and recommendations.

Are there activities I cannot do after shoulder replacement surgery?

When fully recovered, most people with artificial shoulders can return to work and normal daily activities without any problems. Keep in mind, however, that certain activities could affect how long your artificial shoulder will last and how well it will perform. A good rule of thumb is that your physical activities should not cause pain, including pain felt later. You should also not jar your joint or push it to its most extreme range of motion. If, for example, you are considering doing any of the following activities, you should discuss them first with your doctor or orthopedic surgeon:

• Any activity involving lifting or pushing heavy objects
• Any activity that places excessive stress on your shoulder joint
• Hammering and other forceful arm/shoulder movements
• Boxing and other arm/shoulder impact sports