• Dan Kao

What should I ask my surgeon about my upcoming joint replacement?

Reviewed by: Daniel Kao, AGACNP-BC

Joint replacement is a surgical procedure in which you supplant the joint injured by a prosthesis. This type of intervention can relieve the patient's pain and help him move more easily, feel better and recover his quality of life. The hips and knees are the joints that are most frequently replaced, but can also be done on shoulders, ankles, and elbows.

This type of operation is becoming more common. According to estimates by the United States Institutes of Health (NIH), more than one million people undergo hip or knee replacement surgery in that country each year. Research has shown that this procedure can help even elderly patients recover mobility and feel better.

Here are some of the questions you should ask your surgeon for your surgery (we have provided some general answers, but your case may differ slightly):

1. How to know if I need joint replacement surgery?

Through a physical examination and appropriate x-rays, the doctor will determine if you are a candidate for this type of surgery. In general, when joint pain is intense, constant, it limits walking or other daily activities and is not relieved with medications and general measures, the best option for the patient is surgery.

2. What does the surgery consist of?

The operation consists in replacing the damaged parts of the joint with two metal or ceramic components that are fixed to the patient's bone with cement loaded with antibiotics. Among them, a high-density polyethylene is placed that gives congruence to the components, favors sliding and allows the physiological absorption and distribution of loads.

Although the prosthesis can also be fixed by using some ultra-porous metals such as tantalum, studies suggest that the best fixation and the best results are obtained with cementation. The cementing technique is always essential to achieve a good long-term result. This also has the advantage of adding cement loaded with antibiotics, in what is known as the double antibiotic prophylaxis (intravenous antibiotics and local antibiotics in the cement) which has been shown to reduce infection rates.

The components of the prosthesis are usually chromocobalt, titanium or other materials such as oxinium that is both hard as metal and low friction as ceramic. In patients allergic to metals, hypoallergenic or titanized prostheses are used.

See videos of a hip and knee replacement below!

Knee replacement

Hip replacement

3. What anesthesia is used for hip or knee joint replacement surgery and how will postoperative pain be relieved?

Generally, the anesthesiologist performs a regional block through a catheter placed in the back in combination with sedatives through an IV, so that the patient will not experience any pain during surgery.

An anesthesiologist will speak with you prior to surgery to determine which type of anesthesia will be best for you.

In the postoperative period, a combination of oral and IV pain medications will be available to help control the pain. Oral pain regimens consist of an anti-inflammatory, acetaminophen as well as an opiate if needed. Upon discharge you will receive a prescription for a short course of pain medications like ones you may have received in the hospital.

4. How long is a hip or knee joint replacement surgery and how will my surgical wound be?

The operation to replace hip or knee lasts approximately 90 minutes. The intervention is performed through an incision in the lateral part of the hip of about 10 cm. and in the case of the knee in the anterior part of it of approximately 12 cm. stitches or staples are removed after approximately 14 days.

5. How long will my new joint last?

Prostheses placed during joint replacement surgery have a life expectancy based on their materials. However, this may vary according to the patient's age, weight, daily activity and co-morbidities. Like any medical device, joint prostheses are prone to wear, which could lead to mechanical failure. In order to prolong the functionality of the prosthesis, the patient should follow the surgeon's recommendations after surgery.

6. What are the major risks?

All surgical interventions have their benefits and risks, joint replacements are major surgical procedures and can, therefore, present complications in some patients. Some complications that may arise may be:

Infection of the wound, dislocation of the components, blood clots in the legs or lungs (deep vein thrombosis or pulmonary embolism) among others. To avoid these complications, you may receive post-operative antibiotics and may be prescribed a blood thinner for a short time.

7. What care should I take after a hip or knee joint replacement surgery?

Although each case is different, in general the care is as follows:

- Use of dynamic compression stockings on both legs for three weeks

- Wound care as instructed by your surgeon

- Maintain a healthy diet

- Taking medications prescribed by the doctor and as instructed

- Follow range of motion precautions instructed by your surgeon and physical therapist

- Perform exercises prescribed by the doctor and physical therapist

- Avoid high impact or high-risk fall activities

- Go to your appointments after surgery

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