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Managing Hip and Knee Replacement Surgery

Managing Hip and Knee Replacement Surgery
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By Steve Nubie

Joint replacement sounds common, but the procedure is anything but simple and not without complications.  This applies to hip replacement, knee replacements, shoulder replacements and other insertions of metal bridges and joints to repair broken collarbones and other parts of our bodies. For some of us, it’s a solution to a chronic condition.  But you need to understand and prepare for the surgery, recovery and the outcome.

The good news is that the technology and surgical procedures have advanced significantly.  The caution is that recovery can take time and leave you with limited mobility, but hopefully without pain or risk of further deterioration of bone, joints and cartilage.

The Need for Joint Replacement:

A variety of conditions can emerge to necessitate a joint replacement.  This can be due to injury, disease or a genetic pre-disposition.  Regardless of the cause, a chronically painful knee or a hip can make life miserable.   The key question you need to ask yourself is how much it hurts and how much it’s affecting your life and lifestyle.

Painkillers and physical therapy can offer some relief, but at a certain point you may need to consider a surgical solution.  Just make sure you discuss the procedure and the recovery in-depth with your doctor and surgeon.

According to the Mayo Clinic, the symptoms and the level of their affect on you tend to emerge in one of 6 ways.

  1. You can no longer complete routine daily tasks without help.
  2. You have significant pain, like pain that keeps you awake at night despite the use of medications; pain that keeps you from being able to walk or bend over, pain that isn’t relieved by rest, or pain that isn’t helped by non-surgical approaches.
  3. Your doctor says that less-complicated surgical procedures are unlikely to help.
  4. You have osteoarthritis and feel the disease is wearing you down physically, emotionally, and mentally.
  5. You are suffering severe side effects from the medications for your painful knee or hip.
  6. Tests show advanced arthritis or significant joint damage.

These are some of the common laments of people who should consider hip or knee replacement.  This surgical procedure can help but it’s not a one and done proposition.

Osteoarthritis and Your Hip:

The most common reason for hip replacement is osteoarthritis in the hip joint or a fall that has compromised the hip joint.  You have probably followed a course of prescriptions and therapy at this point, but it has not proven effective.

The ultimate test to determine the need for a surgical implant is a combination of X-rays and an MRI scan.  Implants are made from either stainless steel or plastic.  You should discuss with your doctor the benefits of each.  Your condition will often dictate the choice, but you should still understand why you are getting a certain type of implant.

What to Expect:   Hip replacement and knee replacement are typically not out-patient procedures.  You will probably have a hospital stay of two to four days depending on your age, how you respond to the surgery and your overall health.  If you are having the minimally invasive two-incision hip surgery, you will stay at least one or two days in the hospital. You may stay in the hospital up to three days if you are having a primary total hip replacement. If you are having a revision hip replacement, you may be in the hospital four to five days before you go home unless there are complications or your overall health is compromised.

The Importance of Therapy after the Procedure:

But going home is just the beginning.  You now need to engage in a fairly long program of therapy to rebuild muscle mass, improve circulation and decrease any injury to the new joint.  If you are active and generally healthy, the recovery and therapy will be shorter in duration.  If you have conditions that limit your mobility and your general health is compromised, it may take longer.  Your therapy will be a prescribed and planned program and you need to take it very seriously following a hip or knee replacement.

There are two critical types of therapists you will meet after your surgery.  One is a respiratory therapist who will teach you breathing exercises to ensure that you keep fluid out of your lungs.  This is a common affliction following most surgical procedures.

The second therapist will be your physical therapist.  They will teach the correct way to sit up, bend over and walk with your new hip while you are recovering.  They’ll also go over some simple exercises that help you to slowly resume simple activities.

Don’t Go it Alone:

You can expect a full recovery after three to six months depending on your health, the type of surgery and your dedication to your course of physical therapy.  You should also try to have someone with you when you first come home from the hospital.  A lot can happen those first few days at home and you may not want to be alone if you have a problem.

You’re also going to need help with fundamental tasks like grocery shopping, cooking, returning to the doctor or hospital for follow-up visits and therapy, and other occasions where driving or extensive walking is not yet possible.  You probably won’t be able to drive safely until at least 6 weeks after your surgery.

You should also think about stocking up on certain items and making sure your telephone or cell phone are close at hand and easy to reach or recharge.   If you can’t get help from family or friends, churches and social groups can support you, or you can discuss other options with your doctor or hospital.

Potential Problems and Side-effects:

Problems you may encounter could be a dislocation of the new hip or knee joint.  This often occurs if you pull the knees up to the chest, which is common when we squat or simply get out of bed.  As you would suspect, there is also the risk of infection although that is less common.  Blood clots can also occur and typically your doctor will prescribe certain medicines or blood thinners to lessen the chance of a clot emerging in the first days and weeks after surgery.   The good news is that the overall risk of complications after hip or knee replacement are less common than they used to be, but make sure you are aware of the symptoms of any of these occurrences.

During your first year after surgery you will have frequent follow-ups with your doctor and orthopedic surgeon.  Figure three weeks, six weeks, three months, six months and twelve months after surgery.  Usually you’ll be asked to schedule annual visits thereafter to assess your condition and progress.

Knee Replacement:

Many more people confront knee replacement.  More than 700,000 knee replacements are performed in the U.S. every year, and about 90% of people who have the surgery get major pain relief and are able to get back to their everyday life, work and lifestyle.

But knee replacement, like hip replacement, shouldn’t be taken lightly.  According to orthopedic surgeon David Lewallen, MD, at the Mayo Clinic College of Medicine in Rochester. “It’s a major procedure and isn’t something that has to be done unless your symptoms can’t be controlled with simpler measures.”

The telegram is that surgery is not the first step until other solutions have been explored.  “We always try to start with simpler things first and move to more complicated solutions,” says Lewallen.  “That means you’ve probably already tried pain killers, anti-inflammatory medication or cortisone shots for pain and swelling, physical therapy, and maybe even weight loss and dietary solutions.”

There’s also a fundamental question with regards to quality of life. If your pain limits what you can do every day, you may want to talk to a surgeon. “It’s about timing,” says Charles Nelson, MD, chief of joint replacement at Penn Orthopedics in Philadelphia. “People think surgery when symptoms are bad enough that they’re not functioning to their satisfaction.”

The procedures and recovery from knee replacement surgery are very similar to hip replacement.  There are varying degrees of surgeries and replacements and the recovery needs to be managed and disciplined to recover muscle mass, mobility and circulation.  Regular doctor visits the first year are also indicated and will be identified by your doctor or orthopedic surgeon.

If you are a candidate for hip or knee replacement surgery, do your homework.  Read about it, talk to your doctor about it, and have a plan.  You’re looking at a three to six month recovery period that can dramatically improve your quality of life, but you want to go into the procedure aware and ready to manage your recovery and return to an active lifestyle.


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