Fact or Fiction? Debunking 10 Myths About Joint Replacement Surgery
This article was reviewed by our team of medical advisors. All physician quotes were taken from board-certified orthopaedic surgeons.
The popular TV show, MythBusters, is where a group of scientists try to prove or disprove commonly held urban legends and myths. Whether it’s figuring out once and for all if cooking a lasagne in a dishwasher is possible or to finding out if a muddy car gets better gas mileage, these nerds seek truths. After watching an episode (the dishwasher-lasagne one), we thought “hey, we’re healthcare nerds” and “hey, our medical advisors squash tall tales about joint replacements” and “bam!”: the rest is history.
We’re putting myths about joint replacement preparation, surgery and recovery to the test to see if they’re fact or fiction.
MythBusters Joint Replacement Edition: Fact or Fiction
1. A Dental Cleaning Before Surgery Can Cause Complications
True. You’ve probably heard this one before and thought, “what does dental work have to do with a joint replacement?” The idea that dental work before surgery could have any lasting implications, seems a bit far fetched. However, it’s true. Although a routine cleaning is less risky, all dental work, including extractions or more invasive procedures can increase the risk of infection or complications. As such, dental work should be put on hold for several weeks leading up to surgery and for several weeks after.
The Reason: Because you’ve had a replacement, your risk or complications from a blood-borne infection is higher. As such, you want to avoid getting extra bacteria in your bloodstream. Having dental work done increased the amount of bacteria in your bloodstream, which can cause infection and complications for a new, artificial joint.
A Doc Weighs in: “A procedure that causes significant bleeding can cause bacteria in the blood. If bacteria is released into a microvessel in the mouth, it can travel through to the blood vessels of the knee or hip. Since the replacement is a foreign object, bacteria will have a greater adherence. This can lead to an infection. Always check with your surgeon and dentist to see if you should take antibiotics before a dental procedure.”
2. I Should Be 60+ Before a Knee or Hip Replacement.
Myth. In the ideal world, a patient will have one, complication-free replacement that will last their lifetime. However, as we all know, sometimes life has other plans for us. Patients who are born with degenerative conditions, had adolescent diseases that affect the joints, were super athletes, or were dealt a different set of cards, may need replacements sooner to live a full life. Age is only one factor that your orthopedist and care team will use in weighing whether or not a replacement, right now, is the best choice for you.
As technology progresses and the artificial replacements themselves become more durable, we’re seeing younger and younger patients go all-in to cure their joint pain and mobility issues. After all, you are an individual and going through with a total knee or hip replacement surgery is a very individual decision.
A Doc Weighs in: “The reason people said “60” is because the average lifespan is around 80 years old and knee replacement were thought to last about 20 years. The goal is to do one replacement that lasts a patient’s lifetime. But the bottom line is quality of life. If you have bad arthritis and your knee is preventing you from leading a normal life, don’t wait until you’re 60. People are getting replacements when they’re younger and younger. This just means that they’re more likely to need a second surgery in their lifetime. It’s not the end of the world.”
3. The Longer You Wait to Have a Replacement, the Greater the Consequences.
Myth? True? This one is up for debate and really depends who you ask. We’ll have our doctor’s weigh in on this one for kicks, but the answer is a little more complex. There are some studies that suggest that sooner rather than later is better to avoid further degradation of the bone and cartilage and to prevent further deformities. In saying this, the right time for you to have a joint replacement, depends on numerous factors.
In determining if now is the right time you should ask: Have I exhausted all less-invasive treatments? Is this what my trusted care team recommends? Is it a good time financially? Do I have the support of family and friends for my recovery? Can I afford to take a “time-out” from my personal and professional life? Am I at my wits end? Here’s a detailed post with a quiz to help determine if now is the right time for your joint arthroplasty.
A Doc Weighs in: “Patients always ask this. It’s not chronological age that you should focus. Rather, it’s health. If you have a deformity, like being bow-legged, and it is getting worse, it’s worth doing earlier. Or if someone has medical problems that will get worse with age, it may be worthwhile to optimize and do it sooner. It’s not age, it’s medical health.”
4. Hip and Knee Replacements Only Last 10 years.
Myth. Although this was once the case, it is no longer true. As technology improves and the artificial components themselves get better and better, the life expectancy of your new joint extends into the 15-20 year mark and beyond. Almost year-on-year, we’re seeing leaps being made in the implants themselves and techniques being used on patients. This means, that banking on your replacement to last longer than those of your predecessors, is a positive outlook to take. With this being said, the replacements that last the longest without revision, belong to those who worked hard to ReHab their joint, followed doctor's orders, avoided high-impact activities, and live well-rounded, healthy and happy lives.
A Doc Weighs in: “That’s not true. It’s hard to say because we don’t have the data for how long newer implants will last. The actual implants have improved significantly but the lifestyle of the patient is most important. A replacement is built for normal, daily activities. It’s not meant for marathons. If you’re putting a lot of impact on it, it will have more wear and won’t last as long.”
5. Sex After a Joint Replacement is Dangerous
Myth. First, we need to start by saying that there are numerous positions that are safe for men and women after a hip or knee replacement. Also, it should be noted that it’s best to avoid intercourse for 2-3 weeks after surgery. Your body will let you know when you’re feeling well enough to “get busy” and which positions feel right and which don’t. Listen to your body, and don’t push yourself too much. Use towels or pillows to prop yourself up to a comfortable height, relax, and let this fun fact soak in: after joint replacement surgery “90% of patients had improved overall sexual function”.
To be more scientific, there are some positions that should be avoided--depending on your gender and replacement type and approach. Here is a detailed read on “sex after joint replacement surgery” with a simple chart of the best positions for your specific replacement type.
A Doc Weighs in: “No, not at all. After a total knee replacement, there is no real risk. It is more about pain and pain tolerance. After a hip, you can run the risk of dislocation if you’re in risky positions. Safe sex positions are based on what approach you had. Safe positions for posterior approach hip replacements and anterior approach replacements are different. There are some great online studies or discuss with your physician.”
6. Joint Replacement Surgery Causes Hair Loss
Myth. This is a bit of trick answer. Although nothing directly links a joint replacement to hair loss, some patients do report excessive hair shedding in recovery. A better way to put it is: joint replacement surgery can create the perfect storm for hair loss. To explain, a traumatic event (like surgery), plus medications prescribed after surgery, plus added stress, all trigger hair loss. Hair loss cannot be caused from a joint replacement directly, rather it is triggered by surgery and other factors in recovery. Also, for the record, any hair loss you notice in recovery is temporary and totally reversible. To read up more on the science behind post-op hair loss, check out this article.
A Doc Weighs in: “I’ve never heard of this at all. Whether it’s true or not, it hasn’t been proven. There’s no data supporting this claim at this time.”
7. Not Everyone Needs to PreHab Before Surgery
Myth. This is a falsie. It may come as no surprise, but we firmly believe in the importance of physical, emotional, and environmental preparation before surgery. The more someone puts into getting in the best mental and physical shape before surgery, the better the outcome and easier their recovery. In the same way that ReHab in recovery is a given, we think PreHab is set to become as more and more patients learn about the role it plays in steering how well a procedure goes. After all, using the weeks leading up to surgery to prepare as much as possible is something that professional athletes and world-class physical therapists and clinicians have been doing for years. Read more about why it’s important to PreHab and ReHab here.
A Doc Weighs in: “Everyone, no matter who they are, should optimize their physical, mental and emotional health before a procedure. Whether this means controlling weight or diabetes or becoming more mentally ready, that patient is going to do better than someone who is unprepared.”
8. Artificial Joints Leach Harmful Metals into the Body
Myth. Although it is true that joint replacement components are made of metal and some of this metal will be absorbed into the bloodstream, it is not harmful per se. In other words, the artificial components today are made of metals, plastic, and even ceramic, which are all biocompatible. Of course, for those with metal and nickel allergies, this question should be approached differently. For those with a tested and proven allergy to metals (usually nickel), the added requirement of selecting a joint replacement brand and material that is low in nickel is a must. If you think you may have a metal allergy, get tested by an allergist, and work with a surgeon who used component manufacturers that are nickel-free (for knee replacements, these are BioMet and Smith & Nephew). For more on knee replacement component materials and types, study up!
A Doc Weighs in: “It has been shown that people with replacements have higher ions of metal in their blood. However, the metal found in the body are still lower than harmful levels.”
9. I Can Become Addicted to my Prescribed Pain Medication
True. A lot of the pain medications patients are prescribed after surgery fall under the “opioid” class of medications. Unlike most over-the-counter pain medications, like Advil or Tylenol, opioid prescription pain medications are highly addictive. Although taking them after surgery is scary for many patients, these medications can be very helpful in recovery when taken as prescribed. Narcotics taken in recovery can help patients keep pain at bay after surgery, get through important (and painful) physical therapy, and sleep better at night. Opioid narcotics become dangerous when patients take more than the prescribed amount, take them for a prolonged period, mix them with alcohol, mix them with other narcotics or over-the-counter medications, or have a history of alcohol or drug abuse. It’s up to you and your care provider to determine the best pain management plan before your surgery date.
Following the instructions of your care team and integrating drug-free pain management tips, are surefire ways to keep your pain in check, and not overdo it on the riskier, stronger meds. This informative article details everything you need to know about opioids after joint surgery, the dangers, the benefits, and the alternatives.
A Doc Weighs in: “Is it possible? Yes. It is probable? No. It’s uncommon but is something that should considered--especially for those with past addiction problems. The average patient will get rid of narcotics within a couple weeks of surgery.”
10. I Can't Wear High Heels After a Joint Replacement
Myth. Although this question won’t be relevant for everyone, you’d be surprised how frequently it comes up. Who knew you joint replacement folks were so glamorous! In all seriousness, high heels should be eased back into your regular footwear once you are far long in your recovery. Also, the higher the heel, quite literally the closer you may be to God. That was a morbid joke. But really, you don’t want to risk falling and putting yourself at risk for a revision surgery or other complications. A pretty shoe simply is not worth it. Wearing practical footwear until you’re well into your knee replacement or hip replacement recovery (let’s say a few months in) is the best way to avoid causing damage.
A Doc Weighs in: “False. But I definitely would not wear heels until you’ve completed therapy. I would suggest starting with shorter ones and base it on comfort. Ask: ‘Is it painful for my hip or knee?’”
Are you planning a hip or knee replacement surgery? If you’ve got a surgery on the books, let PeerWell’s PreHab smartphone app help prepare. Sign-up today. The more you do today, the better your tomorrow will be!