5 things to know about joint replacement surgery

5 Things Everyone Should Know About Joint Replacement Surgery

1. What are the most common joints being replaced?

Knees, hips and shoulders are commonly replaced joints. In 2022, almost 900,000 joint replacement surgeries were performed in the United States. This is expected to increase approximately 20% next year. Knee and hip replacement are more common, but shoulder replacement surgery is having significant increase due to improved technology and training.

The most common reason for joint replacement surgery is typically osteoarthritis in which the cartilage or smooth surfaces that make up the joint wear out and become rough. This leads to destructive inflammation, pain and loss of function. Other common causes are traumatic arthritis, rheumatoid arthritis, instability or deformity such as knock knees or bowlegged deformities. Joints that are affected typically experience worsening pain, limited strength, limited motion, inability to perform activities of pleasure or of work, swelling, grinding catching, symptoms of giving way or instability, and limited response to nonsurgical treatment over time.  With over 30 million Americans suffering from osteoarthritis it is important for you to know that you are not alone and that joint replacement surgery of the knee and hip are the third and fourth most common surgeries in United States hospitals.

2. When to consider joint replacement surgery?

If you have osteoarthritis of the hip, knee or shoulder or severe rotator cuff problems of the shoulder, we will typically recommend conservative treatment for as long as reasonably possible. This may include exercises, physical therapy, nonsteroidal anti-inflammatory medications, acupuncture, massage therapy, weight loss and injection treatments. These types of treatments may provide a good quality of life for many patients but may not last.

It is important to exhaust conservative treatment prior to joint replacement surgery.  Should symptoms continue to worsen with pain, mobility and enjoyment of quality of life despite conservative treatment then joint replacement surgery needs to be discussed.  With improved technology, joint replacements are lasting longer so most orthopedic surgeons are not taking age as much into account.  The goal of joint replacement surgery is to decrease the amount of pain while increasing the function of the affected joint.  I tell patients that joint replacement surgery is not a time machine and it is not expected that the new joint will be like it was when there was full function and no pain prior to arthritis, but we can expect a significant improvement in pain and function.

3. What is new in joint replacement surgery?

We definitely have newer technologies and ways of doing surgery that may improve early outcomes and get you back to a good quality of life sooner. Outpatient, or same-day joint replacement surgery is on significant rise. We see that many patients end up not being admitted to the hospital following surgery and often recover at home. Currently, most insurance companies and Medicare support outpatient or same-day joint replacement surgery. This also typically limits your costs as a patient. With shorter stays in the hospital or outpatient surgery there is also less infection risk. Even if your surgery is done at the hospital, we are making every attempt to get you home in a shorter period of time, often resulting in improved outcomes and decrease complications.

The utilization of knee replacements that do not rely on cement or adhesive to bond the knee has led to also decrease infections and fewer knee replacement loosening. Utilization of computer or robotic surgery for knee replacement is on the rise to improve alignment of knee replacement.  We are also utilizing different pain and anesthesia strategies to allow patients to feel better after surgery and utilize fewer narcotic medicines. Hip replacement surgery has advanced with the utilization of less invasive hip replacement approaches such as anterior muscle sparing hip replacement surgery.

In addition, the utilization of computer navigation and hip replacement leads to less problems with limb length inequality after surgery. Typically hip replacement surgery postoperative physical therapy is no longer warranted as there are fewer precautions and surgery as much friendlier to the surrounding muscles.

Shoulder replacement surgery, percentagewise, is the largest growing field of joint replacement surgery. For patients with good rotator cuff muscles around the shoulder, we have the ability to do outpatient shoulder replacements and utilizing much smaller implants than before preserving your bone.  For those with poor rotator cuff muscles, one of the newest devices in orthopedics called the reverse shoulder replacement has been a real game changer in improving pain and most significantly function in patients who did not have a good option prior to this replacement. Bearing surfaces have also significantly improved and studies on how these bearings wear show that joint replacements now may last over 20 or even 30 years.

4. How do I prepare myself for joint replacement surgery?

Several things can lead you down a road to successful replacement surgery, such as:

• Staying as mobile as possible and avoiding stiffness or reduced range of motion in the joints can make gaining that motion after surgery easier.
• It is important to stay close to your ideal body weight and maintaining a healthy diet has shown to improve your postoperative outcomes as well.
• Smoking cessation is also led to improved outcomes.
• Reduction in  narcotic pain medicines will make your postoperative pain control much easier.
• Have all dental work done prior to surgery and have a clean bill of dental health as this also decreases risk of infection.
• Our center will also do a comprehensive medical screening including blood work and EKG to make sure you are medically in good condition for surgery.
• You will also want to familiarize yourself with your insurance benefits regarding joint replacement.  Most insurance companies including Medicare and Medicaid will cover the majority of joint replacement costs but you should contact your carrier to see exactly what your benefits are.  Again, many insurance plans urged their patients to consider outpatient joint replacement as long as you are a good candidate.
• Seek out surgeons that have significant joint replacement experience and consider a hospital setting that has a center of excellence designation.  This typically means a very high rate of success with a very low complication rate.

5. How long does it take to heal and what does recovery typically look like?

       Each person is different and how they heal but there are some general guidelines.

Knee replacement surgery is definitely a tougher recovery and typically carries a little bit more early pain than hip or shoulder replacement surgery. There is more aggressive physical therapy with knee replacement to gain motion, strength and stability. It is important to participate in therapy very early in your recovery. We recommend starting formalized physical therapy immediately with knee replacement. Typically, you will be on a walker for a few weeks then a cane for a few weeks, then typically no assistive device by 6 to 8 weeks. Range of motion is the most important aspect of knee replacement surgery and that the goal is 0 to 120 degrees 6 weeks after surgery.  By 6 weeks after surgery typically pain is very reasonable and function is returning nicely.  By 3 months after surgery patients are typically doing very well and very pleased with how they are doing and see consistent improvement in strength and mobility and endurance.  We tell every patient it takes 1 full year for healing for all joint replacement surgery. 

Hip replacement surgery goes a bit quicker and there is typically minimal therapy in the first 6 weeks just some gentle exercises. Usually there is a walker for a few weeks then a cane for a few weeks and typically no assistive device by 6 weeks after surgery.  Again, it takes 1 full year for healing but hip replacement patients are typically feeling good at 6 weeks and patients are able to resume normal activities by 6 weeks. 

Shoulder replacements, have a 6-week period of time where there is a sling on after surgery and there is gentle motion done on their own and physical therapy starts around 2 weeks after surgery. After 6 weeks, the sling comes off and we started increasing motion and early strength.  Then at 3 months we really encouraged a strengthening program.  Most patients are feeling very good at 3 months and then by 6 months and one year are feeling great with excellent motion and strength.