Hip & Knee Replacement Surgery FAQs: Ask a Surgeon
We took your questions about hip and knee replacement preparation, surgery and recovery and asked some of America’s best orthopaedic surgeons. “Click a video” to hear what top-tier surgeons have to say about your most-asked questions.
Joint Replacement PreOp & PreHab Questions: Ask a Surgeon
Lose Weight Before Joint Replacement Surgerysummary
Anterior Approach Hip Replacement: Pros and Conssummary
Cemented vs. Uncemented Joint Replacement Surgerysummary
Varicose Veins and Joint Replacement Surgerysummary
Bilateral Joint Replacement Surgerysummary
Approaches for Hip Replacement Surgerysummary
Dangers of Delaying Joint Replacement Surgerysummary
How Long Does a New Joint Last?summary
Preparing for Joint Replacement Surgery: PreHab Basicssummary
Hip Replacement Approaches: Different Types and Variationssummary
Robotic Knee Replacement Surgery: What are the benefits?summary
Time for a Joint Replacement? When You May be a Surgery Candidatesummary
What is same-day joint replacement surgery?summary
How to Choose a Knee/Hip Replacement Surgeonsummary
Allergies to Joint Replacement Implants: What to Do?summary
Multiple Joint Pain: Hip or Knee Replacement First?summary
Joint Replacement Recovery & ReHab Questions: Ask a Surgeon
Knee Manipulation Under Anesthesia: When is an MUA Recommended?summary
Sitting on the Floor After Knee Replacement Surgery. Is it Safe?summary
Trouble Sleeping After Joint Replacement Surgery?summary
IT Band Knee Pain After Surgery: How Common is It?summary
Knee Feels Heavy and Tight After Replacementsummary
Knee Joint Clicking After Replacementsummary
What Not to Do After a Joint Replacementsummary
Questions to Ask Surgeon After Total Knee Replacementsummary
Blood Thinner Dose: Why is it Hard to Get Right After Surgery?summary
Hamstring Pain After Surgery: Why it Hurts After a Joint Replacementsummary
Postoperative Stiffness & Swelling After Joint Replacementsummary
Knee manipulation under anesthesia: When Will I See Better Range of Motion?summary
Cortisone Injections After Joint Replacement Surgery: Safe or Unsafe?summary
Range of Motion Milestones After Knee Replacement Surgery?summary
Stiffness in Knee Replacement Recovery: What Causes it?summary
Driving After a Knee Replacement: When is it Safe?summary
Complications After Joint Replacement Surgery: Red Flags to Watch Forsummary
Pain After a Joint Replacement: What’s Normal?summary
Sleeping on Side After Hip Replacement Surgerysummary
How soon after surgery can you massage scar tissue?summary
Loose Total Joint Implant: Will it show up on an X-ray?summary
Avascular Necrosis of the Hip: How Common is it?summary
Pain Weight-Bearing After Hip Replacement: Is it Normal?summary
Knee Joint Clunking After Replacement: Is it Normal?summary
Drop Foot After Joint Replacement: Is it Permanent?summary
Dislocation Risk After Hip Replacement: Bending Over?summary
PreHab Q&A summaries
Lose Weight Before Joint Replacement Surgery
Lose Weight Before Joint Replacement Surgery!? Why is it important? What happens if you can’t lose weight before surgery? This is a common scenario for those preparing for knee replacement surgery or hip replacement surgery. This is especially true for patients in the age group of 65 or younger. In the younger demographic, surgeons want to maximize the longevity of the knee replacement. A decent weight range for a joint replacement is a BMI of less than 40. If you’ve got a lower BMI, your knee or hip implant will last longer.
If you have a BMI above 40 it more than doubles your risk of postoperative infection. About 1-2% of all patients develop an infection after surgery. Infections will always require more surgery. In someone who has a BMI of over 40, the infection rate goes from 1 in 50 to 1 in 25. Getting in a safe weight range minimizes your risk and lowers the odds that you will face problems after surgery. Improving your weight will significantly improve your outcome.back to video
Anterior Approach Hip Replacement: Pros and Cons
There’s the anterior approach, posterior approach, direct superior approach, anterolateral approach, direct lateral approach, among others. They’ve all come in and out of favor at some point with orthopedic surgeons. The most important thing when deciding your joint replacement approach is the relationship you have with your surgeon. If you go to somebody that does a posterior approach and not an anterior, but you really like them, this could be a great option for your hip or knee replacement.
Some benefits with the anterior hip surgery are: reduction in postoperative pain and closer to a normal gait in the first six weeks after surgery (after six weeks, the other approaches catch-up and are pretty similar).
Some downsides with the anterior approach hip replacement: A longer procedure time; potential for increased blood loss; less common surgical method so not as many expert surgeons available to perform it; a slightly more complicated surgical procedure.
The posterior approach is the tried and true method. It has been around as long as hip replacements have been around. It’s an approach that almost all hip surgeons are trained in and are very comfortable with. On the downside, after surgery you may have a slightly higher pain level and a slightly abnormal gait compared to anterior.back to video
Cemented vs. Uncemented Joint Replacement Surgery
Cemented vs. uncemented joint replacements come with a list of pros and cons. There are also some key differences between the two methods of fixation. The newer technique is called press-fit. In a press-fit, instead of having a smooth surface on the back of the implants, they have a roughened surface. With a roughened surface in a hip or knee replacements your own bone will grow to the back side of the implant. When this happens, it acts more like a lifelong bond and is less likely to loosen over time. It creates a natural “fixation” between your bone and the implant.
There are some “gray zones” for press-fit technology in knee replacements and hip replacements. There are still some people who have early failures that require revision surgery after a press-fit--it’s not bulletproof. Within the first couple of years after surgery, your bone must actually grow into that implant. If this process does not occur naturally, you may run into loosening issues.
However, the same goes for the traditional, cemented option. Like cement grouting on a tile floor, cemented implants are also susceptible to cracking and breaking down over time. There are pros and cons to both cement and cementless joint replacement implants. Your surgeon will determine if you’re a candidate for an uncemented hip replacement or uncemented knee replacement.back to video
Varicose Veins and Joint Replacement Surgery
Varicose veins, also known as spider veins, does not make it any more difficult to perform a hip or knee replacement surgery. Varicose veins and hip replacement surgery or knee replacement surgery are generally not linked together, causing procedure risks. It’s more common for the knee to have varicosities, but varicose veins themselves do not put you at any increased risk during surgery. In all likelihood, your surgeon will see varicose veins as a non-issue and move forward with your hip or knee replacement, business as usual.
Your medical team may exercise more caution when it comes to deep vein thrombosis (DVT). DVT is when blood clots form in the deep veins of your body. Having varicose veins, or any vein disease, before joint replacement surgery may indicate that you have a greater risk of blood clots. Varicose veins are an indicator that you may have any issue with blood flow.back to video
Bilateral Joint Replacement Surgery
Bilateral joint replacement surgery means a replacement of either both hips or both knees in the same surgical setting. Some factors should be considered before getting a bilateral joint replacement done. One consideration is how bad the deformity is. Other things to look at are: how bad the pain is and how poor mobility has gotten. If both sides are badly deformed and you think that you’re going to have a difficult time rehabilitating with the support of your non-surgical side, that’s one reason to get both done together.
With a double hip replacement or double knee replacement you should be cognizant of your overall health and physical shape. Patients who have bilateral knee replacements or bilateral hip replacements need to be in great overall shape since they are essentially doubling their risk of surgery complications. If you have other medical comorbidities your surgeon will not likely recommend a bilateral joint replacement.
Doing both joints at the same time (although a little bit counterintuitive) is reserved for healthier patients who can recover more easily. A surgeon will not recommend a bilateral or double replacement to a patient who is not in optimal health.back to video
Approaches for Hip Replacement Surgery
Approaches for hip replacement surgery vary. There have been different approaches throughout the decades and every new hip replacement approach has been considered the “new best thing”. What’s important to keep in mind is that hip restrictions (restrictions after a hip replacement) are very surgeon-dependent. For instance, there are surgeons who do the anterior approach and ask their patients to follow a certain set of restrictions after surgery. On the other side of the coin, there are many surgeons that do not have strict restrictions after surgery. Different rules apply with different approaches and surgeons. The posterior approach (lateral approach), the anterolateral approach, the direct superior, and minimally invasive superior approach may all come with slightly different precautions and these precautions will vary by surgeon.
Each surgeon is different. Instead of picking an approach, pick the best surgeon for you. You need to be comfortable with their skills and knowledge. If you trust them, you are trusting that they are going to do the best thing for you, regardless of the approach they take for your hip replacement procedure.back to video
Dangers of Delaying Joint Replacement Surgery
Dangers of delaying joint replacement surgery are a common discussion point amongst patients and surgeons. In health systems outside the US, like Canada, sometimes you will wait for 18 months for a total hip or a total knee replacement due to wait times. As such, waiting 18 months to 2 years for a joint replacement probably is not going to significantly change your recovery or what the surgeon does during the surgery itself.
Patients often postpone their joint surgery by a year or two because they’re close to retirement or are waiting for “the right time”. Two years is going to hurt you significantly, but you may have an increased deformity or maybe some increased pain as a result of the progression of your arthritis. This is not likely to impact your recovery. Putting off hip replacement surgery or timing knee replacement surgery for when you’re prepared is the most important factor. If you need to wait a few months in order to be more comfortable and prepared for your joint replacement, you should do so. Waiting until you’re mentally, physically and emotionally optimized for surgery will have the most impact on your surgery outcome and recovery.back to video
How Long Does a New Joint Last?
How long does a new joint last? Like a lot of things, the answer depends on a lot of key factors. BMI is a factor that determines the longevity of a hip or knee replacement but age may be the top factor. Younger joint replacement patients are a little bit harder on their replacements. They get back to higher levels of strenuous activities and put more stress on their joints. The more active you are on your joint, the more wear and tear on your prosthetic replacement. People who are under the age of 65, can expect their total knee to last anywhere from 10 to 15 years. Patients over the age of 65, can aim to get 15 to 20 years out of their joint replacement.
Not everybody will need a new replacement or require a revision joint replacement in their lifetime. However, the younger and more active you are, the higher the chances are that you will have to get another replacement. In saying this, joint replacements are lasting longer than ever. There isn’t the data to show how long these new replacements will last as joint technology is constantly updating itself. Some replacements claim to last around 25 to 30 years.back to video
Preparing for Joint Replacement Surgery: PreHab Basics
Preparing for joint replacement surgery means getting your mind, body and environment ready for surgery. Number one, getting mentally prepared is very important. This means really understanding what you’re going to be going through before and after surgery. Two is preparing your environment (home, family, friends). You will need to have a support network in place during your recovery. Third, is to optimize and improve your physical health for surgery. All of these things fall under the “PreHab umbrella” and all influence how prepared you are for surgery and recovery.
Before knee replacement or hip replacement surgery, it’s important to be as active as you can be. The better your range of motion before surgery, the better it will be after. The greater thigh strength, hamstring, quadricep and calf strength that you have on surgery day, the more support your hip joint will have in recovery.
All of these physical, mental and environmental factors help speed up your recovery after surgery. Being an active participant in your health by taking part in Prehab before surgery will have a significant impact on what you can expect out of your hip or knee replacement and how quickly and seamlessly you recover.back to video
Hip Replacement Approaches: Different Types and Variations
Hip replacement approaches for replacement surgery are a hot topic. There are a handful of different approaches and variations like minimally invasive hip surgery. However, there are three common approaches that suit most patients: posterior approach (hip “being done” from the back) a direct anterior approach (hip being done from the front) and the anterolateral approach (hip is done from the front but slightly different from a direct anterior approach). There are many other approaches plus variations on each approach, but these are the most popular.
All hip replacement approaches can achieve really good results. That being said, there are definitely pros and cons to the different approaches and a different set of .total hip replacement precautions that go with each. When working with your surgeon to select an approach, the most important thing to focus on is that all approaches do well and patients do well. Different surgeons will have different reasons for using the approach that they choose. If you trust in your surgeon, you can trust that they’re choosing the best approach for you.back to video
Robotic Knee Replacement Surgery: What are the benefits?
Robotic knee replacement surgery for total knee replacement surgery (also called a Mako robotic knee replacement) leverages a technology that’s been around for a long time. Initially used for partial knee replacement surgery, the application became available for hip replacement surgery, and most recently is being used for total knee replacement surgery.
When you think about a knee replacement, there are kind of two parts to the surgery. There’s placing the implants in the right position and there’s also the management of soft tissues. “Soft tissues” means everything that makes up your joint besides bone (ligaments, tendons etc.). It’s important to get the soft tissues working as normally as possible. Most people with arthritis have soft tissues that are different, distorted, and deformed.
The most important part of performing a knee replacement is getting those soft tissues as close to normal as possible. The robot assistance (robotic-assisted arm) helps the surgeon be able to measure how tight or how loose those ligaments are. It helps get ligaments in a point where they’re as close to normal anatomy as possible. A robotic knee replacement offers great support in surgery to get things more correct and aligned.back to video
Time for a Joint Replacement? When You May be a Surgery Candidate.
Time for a joint replacement? If you have hip or knee arthritis, there are basically three types of things you can do. The first two types of things are ways to manage your symptoms. These two types of things do not change anything about your actual hip or your knee. The first category is medication. The second thing you can do is put less force (impact) on your joint and avoid certain activities.
The third and final thing is a hip or knee replacement. This is the only category that will actually change the problem in the joint. Barring any rare medical conditions or other things that would preclude a patient from being a candidate, joint replacements are recommended if there is pain from loss of cartilage and that pain is not adequately addressed by any of the non-surgical treatments. Ultimately, the patients are the only ones that can decide when the right time for a joint replacement is. After all, joint replacements are elective, so timing is up to the patient and their physician.back to video
What is same-day joint replacement surgery?
Same-day joint replacement surgery: what is it? A same-day (outpatient) joint replacement is just like any other outpatient surgery. In short, it’s having a surgery but not staying overnight in the hospital. There are some different definitions for outpatient total joint surgery. Sometimes it’s defined as being in a hospital or a facility for less than 24 hours, and other times it’s leaving before midnight that day. Outpatient surgery is increasing in popularity across the country for a few reasons.
The most important reason is that for healthy patients, the lower duration of time that the patient is exposed to any medical facility (surgery center or a hospital), the lower the risk of infection. Infection risk is much lower in groups that spend a day or less in hospital.
Not everyone’s a candidate for outpatient surgery. There is no uniformly accepted criteria about who is and who isn’t a candidate. However, it has to do with the medical risks for that particular patient based on their medical history. Having a secondary disease or condition, being overweight, older, have no caretaking support at home may make outpatient surgery too risky. A an outpatient patient should always participate in a preoperative preparation. This is another massive factor that determines outcome. To be successful in a same-day surgery, patients must be as prepared as possible (PreHab).back to video
How to Choose a Knee/Hip Replacement Surgeon
How to choose a knee/hip replacement surgeon? A patient needs to be comfortable with two things when choosing their hip replacement surgeon or knee replacement surgeon. The first thing is: who’s doing it. The second is the particulars of the surgery. You want to find out what is important to you like: types of implant, types of materials, any number of things. If you are comfortable with your surgeon and they tick the boxes for the particulars you are looking for, this could be a good surgeon match.
Irrespective of many of the technical aspects of the surgeries, there’s a huge mental component for patients undergoing a total joint replacement. If you’re not completely comfortable who is doing it and that they meet the particulars of your surgery, then you’re making your recovery more difficult. Choosing the right surgeon is a matter of being comfortable. Let yourself get as many second, third, fourth opinions as you need before you find that comfort zone. It’s also important to look at the orthopedic surgeons reviews, the surgeon’s case load, the surgeon’s complication rate, the surgeon’s satisfaction rate by other patients etc. The data doesn’t lie, so it’s always worth digging a little deeper into a prospective orthopedic surgeon.back to video
Allergies to Joint Replacement Implants: What to Do?
Allergies to joint replacement implants are a common concern for patients. There isn’t a lot known about how allergies to metals or plastics or even cement that are used in the materials are handled by the body. If you’re the type of person who has a reaction when you wear metal jewelry, you may have a metal or nickel allergy. This doesn’t always mean that you will react to a joint prosthesis that has metal components, but this isn’t clear. Simply, the medical community does not have a definitive answer for what may cause allergies or how metal hypersensitivity in a joint replacement works. If allergies are proven to be caused by specific materials the impact that they may have on the recovery of that patient is also relatively unknown.
There are some reactions that are extremely rare that can occur inside of a joint. Surgeons are still trying to determine if those those are true allergies or if they could be caused by something different? If you have metal allergies or wish to be tested, let your surgeon know. There are nickel free hip replacements/ hypoallergenic knee replacement as well as nickle-free hip replacements. There are also some non-metal alternatives or some implants. Generally, nickel is a metal that more people can have a reaction to.back to video
Multiple Joint Pain: Hip or Knee Replacement First?
Multiple joint pain is something you wouldn’t wish for anyone. To add to the pain, it can be tough to decide on having a hip or knee replacement first? If you have osteoarthritis affecting your hips and knees, which order should you get a replacement done in? For patients who have back issues, hip issues, knee issues, how should they think about the sequence in which to get joints replaced?
If you have multiple bad joints in your body, there are joints in the body that can cause pain that may be referred to other locations in the body. There are also joints that typically cause pain just around the joint. Knees tend to cause pain right around the knee. This pain tends not to refer up or down the leg.
The hip can cause pain around the hip (most common in the front of the hip) but it can also cause pain that goes down the thigh and to the knee. If someone has a really bad hip and a really bad knee, I usually will recommend that the hip be done first. There’s a good chance that fixing the hip might help address some of the knee pain. The other benefit is that hip replacement recovery is easier than knee replacement recovery.
Some patients have a bad hip and a bad knee. If the knee is much worse than the hip, it could still be done first. Through exams, testing and history-taking, your doctor may feel confident that the knee itself is the predominant cause of the knee pain. In this case, they may elect to have the knee done first.back to video
ReHab Q&A summaries
Knee Manipulation Under Anesthesia: When is an MUA Recommended?
Knee manipulation under anesthesia is a second surgery after a knee replacement. Stiffness after knee replacement surgery is a fairly common complication. If the stiffness remains a problem, manipulation under anesthesia may be necessary to improve range of motion (extension and flexion). The timeline for a Manipulation Under Anesthesia (MUA) for knee surgery is not recommended for someone recovering from surgery before the 6 week mark. If pain and stiffness after a knee replacement surgery persists months or years after the procedure, an adjunct procedure to break-up scar tissue may be suggested. This is known as a knee manipulation procedure.
Knee replacement manipulation is something that your orthopedic surgeon may consider in the 6-12 week mark (and beyond) if stiffness is a major factor and you are not hitting expected range of motion milestones. Knee manipulation under anesthesia will set your recovery back, but in the long-run an MUA to gain knee flexion and for knee pain relief may be required.back to video
Sitting on the Floor After Knee Replacement Surgery. Is it Safe?
Sitting on floor after knee replacement: is it safe? For a total knee replacement, getting on and off the floor is safe at any point. Getting on and off the floor isn’t an issue if you have a range of motion greater than 100 degrees. If your range of motion after a knee replacement isn’t above 100 degrees, you may have difficulty getting on and off the floor. The chances of you harming your knee joint while following knee replacement protocol and getting up from the floor after a knee replacement is unlikely.
For hip replacements, you must abide by hip precautions after surgery when sitting on the floor after recovery. You can get up and down off the floor after a hip replacement if you follow the hip replacement precautions laid out by your orthopedic surgeon.back to video
Trouble Sleeping After Joint Replacement Surgery?
Trouble sleeping after joint replacement surgery? Is it safe to sleep on your side after surgery? Can't sleep after hip replacement surgery at all? After hip replacement surgery lying on your surgical side is uncomfortable and isn’t good for your incision. It can cause fluid collection around the incision site. Avoid lying on incision until after the 6 week mark or later. Your body will let you know when it becomes more comfortable. Laying on your side after the 6 week mark in small increments may be okay. Sleeping positions after a hip replacement should follow your hip protocols outlined by your surgeon.
To maximize sleep after joint replacement surgery, it’s important to keep busy and to avoid napping during the day. Try to get out of the house and get back into a “normal” routine. Also, it’s important to time your anti-inflammatory and narcotic medications properly after surgery. You want to take your last dose right before you go to bed at night for a sound sleep. Try and develop a normal bedtime routine. Remove electronics, don’t play with your phone, and try to relax without stimulation.back to video
IT Band Knee Pain After Surgery: How Common is It?
IT band knee pain (also known as iliotibial band) feels like pain on the outside part of knee. After a total or partial knee replacement, knee IT band pain isn’t the most common complaint. However, about 5% of total knee replacement patients will report some outer pain or IT band issues. The reason for IT band pain is because arthritis is a bone and cartilage losing disease. As bone and cartilage degrades, the muscles and tendons tighten up to keep the knee stable. Once the knee is replaced, the ligaments in the knee are stretched to a point that they haven’t been stretched to in a very long time (prior to having significant arthritis).
What you can do after surgery to for IT band pain relief, is stretching during physical therapy or at home. Seeing a physical therapist several times a week can be very helpful to encourage IT band stretches after a TKR. Deep massage and ultrasound on the IT band itself can also help speed up the healing process. IT band issues can be painful, but they can be resolved.back to video
Knee Feels Heavy and Tight After Replacement
Knee feels Heavy and tight after a total or partial knee replacement? If you ask 100 people that have had total knee replacement surgery (knee arthroplasty) about 70% will say that they’re aware of their knee. Whether it’s stiffness, pain or swelling, patients say their knee is noticeable on the average day. Majority of patients after knee surgery will perceive some difference from their “natural knee” to their prosthetic knee.
However, if you ask patients if they are in significantly less pain or if they’d recommend a total knee replacement to others, they’ll almost certainly say “yes”. Patients should see gains made to the feeling of their prosthetic knee up to 12-18 months after surgery. In this time patients will notice their artificial knee prosthesis less and less. In saying this, most patients will have times of the day or week when they will notice their knee replacement. Heaviness and tightness, although not anything a patient looks forward to, is a part of recovery from joint replacement surgery. Keeping up with PreHab and ReHab exercises is a way to help regain movement and to help your knee feel more “normal”.back to video
Knee Joint Clicking After Replacement
Knee joint clicking after replacement surgery can be very uncomfortable. Clicking and popping sounds as you walk can be stressful and even scary. However, the truth of the matter is that knee replacement prostheses are made metal and plastic parts. These parts can make a little bit of noise. Now, that noise tends to lessen with time because of the scar tissue that forms around the knee. This quiets it down.
There are a couple of specific designs of knee replacement parts by certain manufacturers that are more prone to having a “popping” sound. It’s a syndrome called “patellar clunk” or “kneecap clunk” and that often does settle down with time. However, in certain situations if patellar clunk persists it can require surgery. If popping or clicking as you walk continues more than 12 weeks after surgery, let your surgeon know. Before the 12 week mark, your thigh muscle and your quadricep function has not fully returned. It takes about 10 to 12 weeks for that thigh muscle to fully strengthen back up and this is when “clicking” and “popping” usually goes away.
If the knee popping or knee clicking continues, contact your care team. They can offer some non-surgical solutions and advice.back to video
What Not to Do After a Joint Replacement
“What not to do after a joint replacement” is a very common concern. This is especially true around the 6 month mark once pain has drastically reduced and patients are getting back to the activities they loved before arthritis. Hip or knee replacements are sensitive to high-impact activities. This means, if you were a marathoner before you had your joint replacement perhaps shifting to low-impact sports like swimming, biking, walking or golf is in your best interest. However, one main reason for surgery is to get back to doing what you love. If reducing the longevity of your implant in exchange for doing higher impact activities you love is worth it to you, then this is something to consider.
If you’re aware that marathon running will reduce the longevity of your implant but still want to pursue it, then just be careful when you get back out there and be mindful of your new joint. High-impact activities may knock a year or two off of the longevity of your implant but your life is meant to be enjoyed!back to video
Questions to Ask Surgeon After Total Knee Replacement
Questions to ask surgeons after total knee replacements vary from patient to patient. However, patients generally want to know about their recovery timeline. For instance, “when can I return to work?”, “when can I drive again?” and “what should I ask during my follow up appointments after knee replacement surgery?”. Other important things that patients often bring up are about their medications. Sometimes people are lucky enough to have a pretty short list of medications, but often joint replacements are being performed in patients who are older and have more medical comorbidities. This means that patients are often on more medication than just those prescribed after hip or knee replacement surgery. Patients often want to know about their narcotic medications, when to anticipate no longer needing narcotics, how these meds may interact with other prescriptions etc.
In your follow-up appointments after surgery, ask your surgeon about anticoagulants or the blood thinners you were put on after surgery. Blood thinners, like any medications, have side effects. You want to be on the right dose for as short a period as needed.
After a total joint replacement, make sure to ask about recovery, medications, any symptoms you are having, and always ask your surgeon, “how do you think my recovery is going”. Don’t be afraid to ask your surgeon how your recovery compares to the average patient. You want to know if you are doing very well or if you are behind. Having greater insight lets you know just how hard you need to work in your recovery.back to video
Blood Thinner Dose: Why is it Hard to Get Right After Surgery?
Blood thinner doses are hard to get correct for patients. Blood clots after surgery, like blood clots in your knee, can cause serious, life-threatening problems after surgery. Blood thinners drastically cut the risk. Common blood thinner medications like Warfarin or Coumadin are common, great blood thinners. Warfarin does a good job at preventing blood clots after surgery, which is why you’re on blood thinners after a hip or knee replacement in the first place. The problem with Warfarin or Coumadin is that it can be really finicky and difficult to get the dose right after surgery. Blood thinners interact with a lot of different medications and foods, making it more difficult to find the correct dose for each individual.
To help get your blood thinner dose right, a relatively consistent diet is beneficial. Not changing your other list of medications too much after surgery can help stabilize your blood level. Getting your blood thinner dose right can require some adjusting after surgery. Follow-up with your care team after a surgery like a joint replacement if your blood thinner dose is not right for you in your recovery.back to video
Hamstring Pain After Surgery: Why it Hurts After a Joint Replacement
Hamstring pain after surgery: why does it hurt after a joint replacement? If you think about arthritis in the knee, you can understand the loss of cartilage and loss of “volume” in the knee. Before a knee replacement you will have lost cartilage with a joint that shrinks down or becomes much more narrow. The only way your body knows how to stabilize the joint is by tightening up the ligaments, tendons and muscles. As a result, your hamstrings tighten up with the arthritis.
Once your joint is replaced, your body shifts back to where it was before you had arthritis (or near when you had the early arthritis). It can take months and months for the ache or sensation of stiffness to go away. Good aggressive physical therapy that involves slow, gradual stretching gets you further than shorter, more repetitive stretches. Having persistent issues with tendons and muscles after joint replacement surgery is common and something that can be worked at with time. It is not a quick fix, but involved consistent physical therapy and stretching to relax the tendons and muscles that surround your new artificial joint.back to video
Postoperative Stiffness & Swelling After Joint Replacement
Postoperative stiffness and swelling after a knee replacement: What are the best ways to manage it? First off, stiffness and swelling are not always related. When it comes to stiffness, the single most important thing is to exercises in order to encourage range of motion (ROM). This is true for both hip and knee replacements. Although, exercise and ReHab to decrease stiffness is generally more critical for knee replacement patients. For all joint replacements, physical therapy or self-range of motion exercise are extremely important. At-home ReHab with exercises should always be done to compliment physical therapy. After all, you can’t be in the physical therapist’s office 7 days a week.
For swelling, there are two important things to do to reduce the effects. There are a bunch of things you can do to minimize your swelling like elevating the extremity above your heart, using compression stockings, icing etc. The next thing to reduce swelling is time. Sometimes you just need time for that swelling to get better. In some patients, swelling can take longer than anything else to improve. So, how long does the swelling last after surgery? Swelling will last for some time and is normal after these surgeries. If you’re worried about swelling, bring it to your doctor’s attention.back to video
Knee manipulation under anesthesia: When Will I See Better Range of Motion?
Knee manipulation under anesthesia is sometimes called a manipulation under anaesthesia (MUA). It is done to gain better range of motion. It’s needed pretty rarely but on occasion, if a patient is having a tough time with stiffness after surgery, the patient will go under anaesthesia and the joint is manipulated. This is typically done without making any incisions on the joint itself, so it’s a closed procedure.
If the knee replacement manipulation is successful, the surgeon will see an immediate improvement. The patient will see improvement once the anesthesia has worn off. However, how quickly the patient will notice an improvement is variable. Some patients almost immediately will notice a big change to their range of motion. Others patients despite progressing quite a bit during the procedure, will see their range of motion function return more slowly. The timing varies for full improvement, but most often there will be an initial improvement and then a delayed continued improvement as you continue physical therapy.back to video
Cortisone Injections After Joint Replacement Surgery: Safe or Unsafe?
Cortisone injections after joint replacement surgery is uncommon. However, are cortisone injections in a replaced hip or knee unsafe? This is something that there isn’t a lot of raw data on. However, most physician aren’t likely to recommend frequent injections in a replaced joint. The concern would be that once you have a joint prosthesis, there is a higher risk of inducing an infection into that joint.
The skin has bacteria that lives on it. Even when we use skin cleansers and prep the skin before placing the needle, there’s always a risk that bacteria can enter the joint. Although it is rare, patients can have an induced infection. If for some reason the physician wants to use the injection to help diagnose a problem, there’s a good reason to do it. However, if it’s not diagnostic in nature, it’s generally not recommended for pain relief.back to video
Range of Motion Milestones After Knee Replacement Surgery?
Range of motion milestones after knee replacement surgery is one of the most talked about topics. Patients wonder what a good range of motion should be after a knee replacement surgery. Unfortunately, it’s fairly arbitrary. There are no such specific, fixed range of motion requirements to hit by any certain time. Also, patients reach the point of maximum improvement at different times. Some patients will max out their flexion and extension in a few months. Others will improve their range of motion for up to a year.
A goal for most patients is to be as close as possible to full extension of the knee and at least 90 degrees or more of flexion one month after surgery. People are usually at this point much earlier than four weeks. Often time, two weeks out from surgery patients are hitting this milestone. As long as you are improving, staying active, and your medical team is happy with your progress, you are likely on target for total knee replacement ROM. If you’re not exercising at home and with a physical therapist and your knee is stiffening up, this is cause for concern. Knee flexion and extension is earned and must be worked toward.back to video
Stiffness in Knee Replacement Recovery: What Causes it?
Stiffness in knee replacement recovery can be a red flag for patients. Sometimes someone who is a couple months into their recovery can have good flexion but can describe “feeling stiff”. Can stiffness be a reaction to something in the implant?
Stiffness can be caused for many reasons. Also, according to patients themselves, there can be many definitions of what “stiffness” actually feels like or looks like. The sensation of joint stiffness can be caused by a number of things. Probably the most common thing is scar tissue. Just like you get a scar on your skin when you have an injury or a cut, the same thing happens underneath the skin after a knee replacement.
There is trauma to the joint when you have surgery, and this causes some scar tissue form. Moving your joint after surgery so that the scar tissue does not form as extensively is very important. But sometimes if you have a soft tissue problem, the joint is unstable, there’s an implant problem, the implant becomes loose, or there’s an infection – stiffness can become more prominent. Any of those things can cause delayed stiffness, either directly or due to abnormal amounts of fluid being present in the joint.back to video
Driving After a Knee Replacement: When is it Safe?
Driving after a knee replacement: when is it safe? When is it safe to drive after a knee replacement? The timing until your doctor says it is safe ranges. There is no proven length of time before it is safe to drive again as all joint replacement patients are very different and each surgery is very different.
Somebody who’s younger, in good physical shape, has their left hip done and drives a automatic car is very different from another patient who is unfit and is recovering from their right knee replacement. This patient is using a different joint to drive. A such, there isn’t a firm catch-all timeframe for when it is safe to return to driving. However, there are two criteria that you can follow: 1) You cannot drive if you’ve been taking any narcotic pain medication. You cannot operate a vehicle under the influence of narcotics. 2) You have to be ready to react and slam on the brakes with your recovery. This is largely based on how the patient feels but also with what the medical team has to say.back to video
Complications After Joint Replacement Surgery: Red Flags to Watch For
Complications after joint replacement surgery can often be detected by knowing which red flags to watch out for. Signs of infection after surgery is the most important thing to look out for. A knee replacement infection or hip replacement infection will seriously affect your recovery time. As a rule of thumb, if you’re worried about something in your recovery, let your surgeon know. From your surgeon’s perspective, they’d rather know if something is concerning you and have the opportunity to treat you, then have you go into the ER or into an after-hours clinic. Your surgeon knows you and your case the best and will likely have the best handle on treating you.
It’s very normal to have things like swelling and redness. However, there are some signs that things may not be normal. PeerWell has a list of red flags to watch out for after surgery by following the acronym “WORST”. Worsening, discolored or foul smelling discharge from your wound/ excessive bleeding; Out of breath, chest pain or difficulty breathing; Red streaking down the leg from your incision; Sharp pain in the back of your surgical leg calf; Temperature of 100.5 degrees fahrenheit or greater. If you’re experiencing any of the above, contact your physician or care team immediately.back to video
Pain After a Joint Replacement: What’s Normal?
Pain after a joint replacement: what’s normal? How long do you have pain after knee replacement surgery? How long does your knee hurt after knee replacement? How much pain should a patient expect after a hip replacement?
The good news is that pain management following these procedures has improved quite a bit. Most surgeons will use a tactic that is called “multimodal pain management”, which basically means that several different types of medications are used to treat pain. This also limits the amount of each medication that is needed. The aim is to reduce the amount of narcotic pain medication that a patient may need because those medicines have the most side effects.
Pain is much better controlled than it was historically. It is typical to have pain after these surgeries, but it’s usually managed quite well. Also, just like if you go to the gym and work out really hard, you’re going to feel most sore a few days after--the same thing is true with surgery. The day of surgery because it’s so new (and you potentially still have some effects of anaesthesia) you will not have as much pain. A few days later, things will become more painful. If pain increases days after surgery, this is normal. Also, you may notice a spike in pain after your pain medications wear off in the weeks that follow surgery and as your physical therapy becomes more vigorous. However, the general trend should be less pain as you move further into your recovery.back to video
Sleeping on Side After Hip Replacement Surgery
Sleeping on side after joint replacement surgery: when is it safe? Patients often ask: “When can I sleep on my side after a hip replacement?” or “How long do you have to follow hip precautions?”. These are important questions to ask your specific surgeon because everyone’s got a different preference. It has a little bit to do with the approach that was used for the hip replacement, whether it was done from the “front” or the “back”. While it’s possible to have a dislocation (even though that’s extremely rare) the position that could cause a dislocation differs by approach. The approach that you had your hip replacement done comes with it’s own set of hip replacement precautions. It’s important to follow these.
Generally, if your surgeon signs-off, it is usually safe to sleep on your surgical side when it feels comfortable. This will likely be a few weeks after surgery. If you self-regulate, you’re unlikely to push it too early in the healing process. A patient is probably not going to put too much pressure on the incision site too soon because it would be painful.back to video
How soon after surgery can you massage scar tissue?
How soon after surgery can you massage scar tissue? There is really no known proven technique to eliminate or reduce scars. Scarring is mostly genetic. Even your surgeon cannot take credit for a good-looking scar. Most of the time, it’s either body location or genetics. If you’re a person who forms bad scars, chances are you will form a bad scar from your hip or knee replacement incision.
Patients often want to know about applying topical cream or medication on their incision. It’s recommend to wait about a month after surgery to apply any creams. As far as massaging the scar, it’s usually about the same. Any earlier than that and there could be a disruption of the tissue underneath the skin. Even after a month, you’re probably not fully healed. It takes at least three months to fully heal the soft tissue. Gently massaging your incision to break up tissue and applying vitamin oil and other creams should be introduced lightly at the one month mark. If your scar is reacting well, continue to do so.back to video
Loose Total Joint Implant: Will it show up on an X-ray?
Loose total joint replacement implant? It’s a fear for most patients. Often times you can see if a joint implant has become loose on an X-ray. On the other side of the coin, you may not be able to see it. The only time that you know an implant is loose is if you have two X-rays at different points in time done and they show a change in the implant position. If you can map a change in implant position, then things have loosened.
If an X-Ray shows a change in position, you know that something moved and something is loose. There are other findings that can make your surgeon concerned about an implant being loose. Some implants that look loose on X-ray, that go into a surgery end up not being loose at all. On the reverse, implants that don’t look loose on X-ray can be loose once a surgery is performed There is no perfect test, other than a surgery to look directly at the implant itself or two X-rays that show movement.back to video
Avascular Necrosis of the Hip: How Common is it?
Avascular necrosis of the hip: how common is it and when it does occur is there a common reason? Avascular necrosis of the hip or femoral head is not all that rare. Avascular necrosis refers to a process where the bone undergoes cell death due to a lack of bloodflow. There are a few different theories as to how that actually occurs, but there’s no definite mechanism established for it.
Probably the most common causes for avascular necrosis of the hip would be “idiopathic”. This is a fancy way for saying, “we don’t know why it happens”. Second, probably at some point in time there was the use of oral steroids. These are steroids taken for a medical reason. These have been linked to the development of osteonecrosis or avascular necrosis. Another predicting factor is a history of excessive alcohol use. Avascular necrosis of the hip or avascular necrosis of the femoral head has also been linked to some blood clotting disorders, viruses like HIV and medications used to treat HIV.back to video
Pain Weight-Bearing After Hip Replacement: Is it Normal?
Pain weight-bearing after hip replacement: is it normal? Is it normal to have pain three weeks after a hip replacement when bearing weight? In short, it can be. People will have a different rate of recovery after surgery. Sometimes even if everything is okay, you will have pain when using your joint after surgery. That can last for a variable amount of time. Some patients will never use assistance for walking (including a walker, cane or crutches). Others that have needed walking assistance for many weeks. Both patient groups can go on to recovery very well after their hip replacement.
Pain is quite variable after joint surgery. Feeling pain after 3 weeks can be normal but it could also be abnormal. If you are concerned, always discuss with your physician as he can properly assess you. After all, extreme pain after total hip replacement is a sign that something may not be right with your recovery.back to video
Knee Joint Clunking After Replacement: Is it Normal?
Knee joint clunking after replacement surgery is a common complaint. It’s often described as a “clicking” or “clunking” sound. It is sometimes called “the “patellar clunk” or “kneecap clunk”. It can be both normal and abnormal. If you take a normal knee that is non-arthritic and move it around, there’s some motion. It is not rigidly stiff and that’s the way a knee should be. A normal knee is made up of soft cartilage with normal joint fluid. A normal knee probably won’t feel much of the clicking or clunking sensation. A knee replacement is made from metal and plastic pieces. As a result of these materials, there could be some normal or physiologic clicking that occurs in certain positions.
However, there are also many abnormal reasons for a knee replacement to click. If there is an excessive amount of clicking or clunking, this can be cause for concern. If there is clunking in knee when walking or your total knee replacement is clicking while cycling, it could be more than just “annoying”. An examination by a joint replacement surgeon to try to determine whether it’s normal or abnormal, but it could be either. After the 12 week mark, if the clunking or popping continues frequently, talk to your physician.back to video
Drop Foot After Joint Replacement: Is it Permanent?
Drop foot after joint replacement: is it Permanent? Drop foot, although rare, can occur after hip or knee replacement surgery. If it does occur, is permanent? Drop foot is when a patient is unable to “dorsiflex the ankle” which means bring the toes and foot up towards the direction of their head.
What are drop foot causes? Drop foot is a result of an injury to a nerve. It could be a direct traumatic injury to a nerve, which is really rare, or it can be more of a stretch injury to the nerve. A stretch injury means that during the surgery – sometimes part of the normal correction of the patient’s deformity – the nerve was stretched. For example, if a patient has a really short leg because of hip arthritis, when you put the leg back to its normal spot, you may stretch out some of the nerves. As well as when you do a knee replacement, if someone has a really crooked leg, by straightening that knee out, which is a normal goal of surgery, everything gets a little bit stretch.
There’s no real definition as to how much stretch is okay and how much isn’t, so unfortunately sometimes patients will have a drop foot. It’s extremely rare, probably less than 1% as far as a complication rate. There are cases where it is temporary but it can also be permanent. If it is permanent, there may be other treatments that are available. If the nerve doesn’t heal on its own braces or surgery can be used to help fix the problem.back to video
Dislocation Risk After Hip Replacement: Bending Over?
Dislocation risk after hip replacement: bending over? Is it true that after hip replacement a patient should not bend over at the waist and/or touch their toes? When you have a hip replaced, it is a known risk of the procedure that the hip could dislocate or come out of socket. Fortunately, dislocation is very low risk. As far as bending over at the waist being a risk, it depends on how soon after surgery you are bending and the hip replacement approach.
Surgeries that are done through a posterior approach (from the back) have a higher risk of dislocating from the back. And surgeries that are done from an anterior approach (from the front) have a higher risk of dislocating from the front. Bending over at the waist could place you at risk for a posterior dislocation. Different surgeons (based on their surgery approach, patient variables, and other factors) will have different feelings about hip precautions after surgery. This is something that each patient should talk to their surgeon about.
While you’re healing from surgery, which generally takes about three months, the risk of a dislocation is going to be highest. After this 3 month healing period, risk goes down and you can resume more normal movements. At this point, it’s safer to bend more than 90 degrees after hip replacement with less of a dislocation risk.back to video