Hip & Knee Replacement FAQs: Orthopedic Surgeon Video Answers
Thinking about a hip or knee replacement? If so, you’re probably filled with questions. At first, you’ll have questions like “What will the surgery look like?” or “How much pain will I be in?”. Once your surgery is on the books, your questions will become more specific. You will ask things like “Should I have a cemented or uncemented joint replacement?” or “What are the benefits to robotic-assisted joint replacement surgery”? Wherever you are in your research about joint replacement surgery, these frequently asked questions will give you the information you need to move forward in your journey.
We spoke with two leading orthopedic surgeons: Dr. Trevor North, MD from Cleveland Clinic Michigan and Dr. John Tiberi of Kerlan Jobe in the Los Angeles area. Both surgeons took the most frequently asked questions by real patients (like you) about joint replacement surgery and submitted video replies.
DISCLAIMER: The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for informational purposes only.”
10 FAQs About Joint Replacement Surgery
(Video Answers by Top Surgeons)
Why Am I Told to Lose Weight Before Joint Replacement Surgery?
Told to lose weight before joint replacement surgery? Why is your surgeon recommending you lose weight before surgery? Simply, the closer you are to a healthy body weight, the better. If you have an average body weight, there will be less impact on your joint and the implant will last longer.
Your surgeon will likely want you to have a BMI (body max index) that is less than 40. If you have a BMI greater than 40 it more than doubles your risk of postoperative infection. In someone who has a BMI over 40, the infection rate after surgery is 1 in 25 (instead of 1 in 50). Losing extra weight will significantly lower your surgical risk and will allow your implant to function better and last longer. Watch the video for the full answer!
Why a Bilateral (Double) Joint Replacement Surgery?
Bilateral joint replacement surgery (double joint replacement surgery) is a replacement of either both hips or both knees at the same time. A double replacement is not for everybody. Questions to ask while considering a bilateral replacement are: How bad is the deformity?; How much pain are you in?; How good is your mobility on the “better” side?
If both joint sides are badly deformed, going with a double replacement can make the most sense. In saying this, you need to be in solid medical shape to have a double replacement.
Essentially, in a bilateral replacement you are doubling your risk for surgery complications. If you have any heightened medical risk (like existing medical conditions, are overweight, a smoker etc.) a double replacement won’t likely be an option. Having a double replacement is only for healthier patients who can recover safely from the stress of two replacements during a single surgery.Watch the video for the full answer!
Read the story of Jim, former college professor who had a robotic-arm assisted, staggered double knee replacement.
Dangers of Delaying Joint Replacement Surgery
What are the dangers of delaying hip or knee replacement surgery? In short, delaying for a few months likely won’t impact your outcome. Patients often postpone their joint surgery by a year or two for personal reasons like retirement, insurance coverage, obligations etc.
Waiting several months (even a couple of years) probably won’t hurt you significantly. However, there may be increased deformity, pain, and immobility issues that you will have to endure. All of the above are unlikely to impact surgery results or your recovery.
The most important thing is that you are mentally, physically and environmentally prepared for your hip or knee surgery when you decide to move forward. There is a major mental component to joint replacement surgery, so if the timing isn’t right for you, it’s better to get your “ducks in a row” than to have the procedure when you are ill-prepared. Watch the video for the full answer!
How Long Will My New Joint Last?
How long should a hip or knee replacement last? First and foremost, the ideal situation is that each patient only has one replacement done in their lifetime. Patients over the age of 65 can aim to get 15-20 years out of their implant. Younger patients tend to “abuse” their replacements more by doing high-impact exercises and putting them through more wear and tear.
The younger and more physically active you are, the higher the chances that you will need a revision surgery. In saying this, replacements are lasting longer than ever before. Technology has improved the technique, implant materials are better, and there is more knowledge about how to extend the lifetime of a prosthetic joint. Some of the latest replacements claim to last 30+ years.Watch the video for the full answer!
Read about the top 10 myths about joint replacement surgery!
Cemented vs. Uncemented Joint Replacements: What is Better?
Cemented or uncemented joint replacement? The latest technique is called “press-fit” (uncemented) where the replacement prosthesis naturally attaches to roughened surface on your bone. Over time, your bone will grow into the replacement, securing it organically. This forms a lifelong bond and is less likely to shift or loosen. However, there is a chance that your bone may not bond with the implant and this can cause loosening that could require surgery.
There are pros and cons to both cement and uncemented. Cemented implants have been around longer, but like cement cracks on the sidewalk, it ages inside your joint as well. This could lead to a revision. Depending on the quality of your bone, your surgeon’s preference, and your replacement type, cementless may or may not be an option. Your surgeon will work to determine your options. Watch the video for the full answer!
When is it Time for a Joint Replacement?
Is it time for a joint replacement? As an elective surgery, it’s largely up to the patient to determine when they want to have the surgery. If you have hip or knee arthritis, there are a few things that you can do. Most of these things are only managing symptoms—they don’t actually fix or address your joint arthritis. Medication and putting less impact on your joint or avoiding impacts that are high-impact and create pain are all “managing” symptoms.
A hip or knee replacement is the only tried and true solution to the problem. Joint replacements are recommended to people who have a loss of cartilage and pain that cannot be fixed by non-surgical treatments. A patient also has to be mentally and physically healthy enough to withstand surgery and recover safely.
Patients are the only ones that can decide when the right time for a joint replacement is. Orthopedic surgeon’s can give the green light or recommend the surgery, but unlike an emergency surgery, it’s not enforced. Watch the video for the full answer!
Allergies to Joint Replacement Implants: What to Do?
Allergies to joint replacement implants, whether proven or unproven, is an increasingly popular concern for patients. Despite there not being a lot known about how metals in the implant affect the body, it is something that more patients and surgeons are taking into account. If you have an allergy to metal in jewellery, you could be affected by certain metals in your hip or knee replacement prosthesis.
The medical community does not have a definitive answer for what may cause allergies or how metal hypersensitivity can aid in infection or other complications. If you think you may have a metal allergy, get tested by a medical professional. Reactions in replacements are rare, but knowing if you are sensitive to metals can save you from future complications. Most implant manufacturers have non-metal, non-nickel and ceramic options. Watch the video for the full answer!
Learn about the knee replacement manufacturers and materials OR read about the different brand and materials for hip replacement prostheses.
How to Choose a Knee/Hip Replacement Surgeon
How to choose the best orthopedic surgeon for your joint replacement? When picking the right surgeon for your surgery you should take a few things into account. Firstly, take into account the fact that you do have a choice. You don’t need to go to the surgeon who was recommended by your primary care provider. Above anything else, you need to be comfortable with your hip or knee replacement surgeon. Him/her should be able to answer your questions and meet the particulars of the surgery that you’ve laid out.
There’s a huge mental component and mental preparation required for joint replacement patients. If you’re not completely comfortable with your surgeon then you are adding undue stress and anxiety. When selecting a surgeon ask for patient reviews, ask about their caseload (how many replacements they do each year), and dig deeper into their complication rate. Watch the video for the full answer!
What are the Pros and Cons to an Anterior Approach Hip Replacement?
There are a few different approaches for hip replacement surgery. The anterior approach, posterior approach, direct superior approach, anterolateral approach, and direct lateral approach have all been favored by orthopedic surgeons at some point. When working with your surgeon to decide your hip replacement approach one thing is most important: to fully trust and be comfortable with your surgeon. If your choice surgeon prefers the posterior approach and you trust him/her, go with that approach. Being a highly technical surgery, if there is one particular approach your surgeon favors and does most often, this should be the approach you have that surgeon perform.
The anterior approach has some benefits including less post-op pain and a better gait immediately after surgery. However, after the six week mark of recovery, the results of the various approaches look similar. The anterior hip replacement approach also comes with some risks like a longer surgical procedure and more blood loss during surgery.
The posterior approach is more common and therefore has more skilled surgeons practicing this approach. Once you have found the best man/woman for the job, go with the approach they know best.Watch the video for the full answer!
Can Varicose Veins Interfere with Knee Replacement Surgery?
Varicose veins, also known as spider veins, don’t make either hip or knee replacement surgery more difficult for your surgeon to perform. Varicose veins will not interfere with your replacement surgery at all.
However, having varicose veins (or any vein disease) may indicate that you have a higher risk of blood clots. Blood clots are a very serious complication after joint replacement surgery. This is why most hip or knee replacement patients are placed on blood thinners.Varicose veins can indicate that you may have poor blood flow and poor blood flow contributes to blood clots. Watch the video for the full answer!
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