I have heard that people should postpone joint replacement surgery as long as possible. Is that right?
The decision about when a patient should have a total joint replacement is dependent on how symptomatic and painful the joint arthritis is. The main indication for joint replacement surgery is pain relief, so if a patient is functioning well with conservative (non-operative) treatment, then I would recommend the patient continue with the non-operative treatment. On the other hand, if a patient struggles with the joint pain and is unable to perform the activities they like to do, then they should consider surgery.
What can I expect during recovery and rehabilitation from joint replacement?
Each patient recovers differently. After surgery, you will work with a physical therapist to gradually increase your strength and mobility. You may experience some pain during physical therapy. The good news is that medications can help you manage this pain, and it should be temporary. The hard work you do in the early weeks of rehab will pay off with improved strength and motion, which will help reduce stiffness in your joint.
Am I going to have much pain after surgery?
Many patients find that the pain after surgery is tolerable, treatable, and subsides gradually over a few weeks. I strongly believe that post-operative pain must be properly managed so that the patient is able to perform the necessary physical therapy. Therefore, multiple modalities are incorporated into the post-operative pain regiment including nerve blocks, numbing injections, long and short acting oral pain medicines, IV pain medication, and anti-inflammatory medications.
How long will I be in the hospital?
The typical hospital stay is two to four days.
Should I be concerned about anesthesia during surgery?
There are two common types of anesthesia used during joint replacement surgery: general anesthesia where the patient is put to sleep, and regional anesthesia, where the patient is numbed below the waist, typically with an epidural. Most patient have general anesthesia, but I do not mind if the patient prefers regional anesthesia.
Will I recover at home or at a rehabilitation facility?
Many people are able to go home soon after surgery. Others choose to recover at a rehabilitation center. This decision depends on the availability of family or friends to help you with daily activities; home environment and safety considerations; and your overall evaluation after surgery. Dr Kurtz, the Baptist case worker, and you will decide together which course of treatment is best for you. Often times, the decision about going home or to a rehab facility is addressed during your pre-operative joint class.
When can I resume normal activities, such as working or driving?
Many patients are able to drive again in about 6 weeks, so long as you can tolerate not taking narcotic medications. If your job is not physically demanding, you may be able to return to work after about 6 weeks, however some patient require up to 3 months to return to work.
What about minimally invasive knee replacement surgery?
I do perform minimally invasive knee replacements on most patients. There are some early studies of minimally invasive surgery (MIS) that have shown benefits such as less blood loss, shorter hospital stays, and better motion.7 Other studies, however, have shown more complications, poor implant positioning, and no difference in the length of recovery.7 Because MIS is still relatively new, it won't be known for 10 to 15 years if these new techniques affect the long-term function and durability of the implant.7 I personally perform minimally invasive knee replacements because I feel comfortable with it and it might benefit some patients, but I do not think whether a surgeon performs the knee replacement through a small or large incision should influence your decision on where to have your surgery done.
How long will the implant last?
The success of your knee replacement is measured by whether or not you're satisfied with the decrease in pain and the increase in mobility you should have, as well as the durability of your implant over time. Knee replacement in general is a very successful operation. In fact, according to an Arthritis Foundation study, outcomes for total knee replacement generally have 90% to 95% patient satisfaction and an implant lifespan greater than 95% at 10 and 15 years with many designs.
How can I pay for my knee replacement?
Knee replacement surgery is considered medically necessary and is typically covered by both private insurance and Medicare. Your out-of-pocket expenses may be impacted by either your co-pay or deductible, so you should check with your insurance company for complete information.
If you do not have private insurance or Medicare, you may want to visit the website www.covertheuninsured.org to research resources in your area.
How can I prepare my family and myself before surgery?
Baptist Hospital offers a pre-operative free educational joint replacement class that I strongly recommend all my patients and family members participate in. Speak with your family members and/or friends about the role they will play in your recovery. Explain the recovery process to them and the care you will need after surgery.
What else should I be aware of?
The way a knee replacement will perform depends on your age, weight, activity level and other factors. There are potential risks and recovery takes time. If you have conditions that limit rehabilitation you should not have this surgery.