For patients whose joint pain does not improve with medication or physical therapy, “joint grease” injections may provide temporary relief. The joint is injected with a joint fluid supplement that acts as a lubricant for the damaged joint. Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient. However, these injections do not cure the diseased joint and joint replacement may be needed as the joint worsens with time.
Various medications are used to treat the pain and stiffness of arthritis. One of the most commonly prescribed types of drugs are the non-steroidal anti-inflammatory agents, or NSAIDs, which can be taken long-term to reduce both the pain and swelling caused by arthritis.
Another type of medication prescribed to reduce severe pain and swelling are corticosteroids. Corticosteroid injections offer quick, effective pain relief. However, they can be used only a few times a year because they weaken bone and cartilage. Also, corticosteroids may cause other potentially serious side effects; their use must be monitored by a physician.
Every hospital has its own particular procedures, however, they often follow the basic routine outlined below. Your surgeon and hospital where the surgery will be performed will provide you with information detailing their specific procedures.
- Arrive at the hospital at the appointed time
- Complete the admission process
- Final pre-surgery assessment of vital signs and general health
- Final meeting with anesthesiologist and operating room nurse
- Start IV (intravenous) catheter for administration of fluids and antibiotics
- Transportation to the operating room
- Joint replacement surgery—generally lasts 1 to 2 hours
- Transportation to a recovery room
- Ongoing monitoring of vital signs until condition is stabilized
- Transportation to individual hospital room
- Ongoing monitoring of vital signs and surgical dressing
- Orientation to hospital routine
- Evaluation by physical therapist
- Diet of clear liquids or soft foods, as tolerated
- Begin post-op activities taught during pre-op visit
In the days following surgery, your condition and progress will continue to be closely monitored by your orthopaedic surgeon, nurses, and physical therapists. Much time will be given to exercising the new joint, as well as deep breathing exercises to prevent lung congestion. Gradually, pain medication will be reduced, the IV will be removed, diet will progress to solid food, and you will become increasingly mobile.
Joint replacement patients are generally discharged from the hospital when they are able to achieve certain rehabilitative milestones, such as getting in and out of bed unassisted or walking 100 feet. Whether you are sent directly home or to a facility that assists in rehabilitation will depend on your physician’s assessment of your abilities.
You may be wondering how long you’ll need to be in the hospital after joint replacement. Every individual is different, and insurance coverage will differ as well. Generally speaking, a total of 4 days (including the day of the surgery) is typical. It is important to note that each patient experience differs and you will be discharged when you have achieved the goals outlined by your orthopaedic surgeon.
On the first day after your surgery, you may get out of bed and begin physical and occupational therapy, typically several brief sessions a day. These are first steps on your way to getting back into the routines of your life!
During your hospital stay, your orthopaedic surgeon works closely with nurses, physical therapists, and other healthcare professionals to ensure the success of your surgery and rehabilitation. Usually a case manager is assigned to work with you as you move through your rehabilitation routines. As the days progress, you should become more independent using two crutches or a walker.
If you need to work with a physical therapist after your joint replacement, the therapist may begin an exercise program to be performed in bed and in the therapy department. The physical therapist will work with you to help you:
- Regain muscle strength
- Increase range of motion
The physical therapist (or nurses) will also show you:
- How to get out of bed
- How to use the bathroom
- How to get dressed
Discharge from the hospital will depend, to some extent, on your progress in physical therapy. The physical therapist will likely give you a list of activities, exercises, and “do’s and don’ts” when you leave the hospital, and you may also have the assistance of an occupational therapist or nurse to help with special needs.
When you’re ready for discharge, your surgeon will determine whether you can best continue to recover at home (the usual procedure) or in a facility where you can receive specialized rehabilitation help. If you do go to another facility, the goal will be to return you to your home, able to move about with a safe level of independence, within 3 to 5 days.
You shouldn’t be surprised if you feel a little shaky and uncertain for the first day or two after you’re discharged. However, you should soon get a routine going and gain confidence in your new joint—the start of a new life with less pain. (As with many surgeries, pain medication may be prescribed while you are healing.)
You may need a walker and/or crutches for about 6 weeks, then use a cane for another 6 weeks or so. You’ll be in touch with your doctor or orthopaedic surgeon as well as your case manager, so you’ll have plenty of opportunities to ask questions or discuss concerns as well as to report your progress.Be aware that there are some things you should not do after joint surgery. It’s important to have realistic expectations. For example, artificial joints have limitations:
- Excessive joint “loading” because of the patient being overweight or strenuous activity, such as running and hiking, may injure the artificial joint.
- The artificial joint will not restore function to the same level as normal, healthy bone.
- The life span of the artificial joint is not infinite.
- Adverse effects may result in a need for additional surgery, including revision or removal of the artificial joint.
Your healthcare provider will instruct you about limiting your activities following the surgery. Remember: It is very important to follow these instructions!
The decision to resume a normal daily routine is one that only you and your doctor or orthopaedic surgeon can make. However, there are some general guidelines that your doctor may give you:
- You may practice stair-climbing in the hospital and should be able to do this by the time you leave.
- You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don’t tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength.
- When to resume driving a car, going to work and/or participate in sports activities are all highly individualized decisions. Be sure to follow your doctor’s or orthopaedic surgeon’s advice and recommendations.
- You may need to take antibiotics before dental work (including dental cleaning) and any surgical procedure that could allow bacteria to enter the bloodstream. Ask your healthcare provider whether you will need to take antibiotics at certain times to prevent infection.
Getting Moving Again
It may come as a surprise to you that total joint replacement patients are encouraged to get up and start moving around as soon as possible after surgery.
When you are medically stable, the physical therapist will recommend certain exercises for the affected joint. Physical therapy is a key part of recovery. The more quickly a joint replacement patient gets moving again, it is more likely that he or she will regain independence just as quickly. To ease the discomfort the activity will initially cause, pain medication is recommended prior to therapy. In addition, the physical therapist will discuss plans for rehabilitation following hospital discharge. Depending on your limitations, an occupational therapist may provide instruction on how to use certain devices that assist in performing daily activities, such as putting on socks, reaching for household items, and bathing. A case manager will discuss plans for your return home and will ensure that you have all the necessary help to support a successful recovery. If needed, the case manager can help arrange for you to have a home therapist.
The success of your joint replacement will strongly depend on how well you follow your orthopaedic surgeon’s instructions. As time passes, you will potentially experience a dramatic reduction in joint pain and a significant improvement in your ability to participate in daily activities. Remember, however, that joint replacement surgery will not allow you to do more than you could before you developed your joint problems!
Life After Total Joint Replacement
Total joint replacements of the hip, knee, and shoulder have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients. However, joint replacement surgery will not allow patients to do more than they could before joint problems developed. Each patient’s physician will recommend the most appropriate level of activity for the patient following joint replacement surgery.
In the weeks following total joint replacement, certain limitations are placed on every patient’s activities. Using a cane or walker may be necessary for several weeks. Kneeling, bending, and jumping will likely be forbidden for the first month. It may be 6 weeks before driving is permitted. The orthopaedic surgeon and physical therapist will provide specific recommendations.
When fully recovered, most patients can return to work, although some types of work—such as construction work, certain types of carpentry, and occupations that involve repeated or high climbing—may not be advisable for individuals with a joint replacement. Also, athletic activities that place excessive stress on the joint replacement, such as skiing, basketball, baseball, contact sports, distance running, and frequent jumping, should be avoided.
After joint replacement, a good rule of thumb is that acceptable physical activities should:
- Not cause pain, including pain felt later
- Not jar the joint, as happens with running or jumping
- Not place the joint in the extremes of its range of motion
- Be pleasurable
It is also important for an individual with a joint replacement to keep his or her body weight as close to normal as possible. Joint wear and loosening increases with weight increase.
Talk to Your Doctor
You don’t have to live with severe joint pain and the functional limitations it causes! Even if you have not experienced adequate results with medication and other conservative treatments, total joint replacement may provide the pain relief you long for—and the resulting return to your favorite activities.
Remember, even if your orthopaedic surgeon determines that joint replacement is a good medical option for you, it is still up to you to make the final decision. The ultimate goal is for you to be as comfortable as possible� and that always means making the best decision for you based on your own individual needs.
As with any major surgical procedure, patients who undergo total joint replacement may be at risk for certain complications; however, many risks can be avoided and/or treated. In fact, the complication rate following joint replacement surgery is very low: Serious complications, such as joint infection, occur in less than 2% of patients.
Besides infection, possible complications include blood clots (the most common complication) and lung congestion, or pneumonia. Complications may require medical intervention such as additional surgery. In rare instances, complications may lead to death. Your doctor should discuss these potential complications with you. Fortunately, the vast majority of surgical complications associated with joint replacement can be successfully avoided and/or treated.
Preventing Possible Complications of Surgery
The complication rate following joint replacement surgery is very low. Serious complications, such as joint infection, occur in less than 2% of patients. Nevertheless, as with any major surgical procedure, patients who undergo total joint replacement are at risk for certain complications—many of which can be successfully avoided and/or treated.
Possible complications include:
Infection: Infection may occur in the wound or within the area around the new joint. It can occur in the hospital, after the patient returns home, or years later. Following surgery, joint replacement patients receive antibiotics to help prevent infection. Joint replacement patients may also need to take antibiotics before undergoing any medical procedures to reduce the chance of infection spreading to the artificial joint.
Blood Clots: Blood clots can result from several factors, including the patient’s decreased mobility following surgery, which slows the movement of the blood. There are a number of ways to reduce the possibility of blood clots, including:
- Blood thinning medications (anticoagulants)
- Elastic support stockings that improve blood circulation in the legs
- Plastic boots that inflate with air to promote blood flow in the legs
- Elevating the feet and legs to keep blood from pooling
- Walking hourly
Lung Congestion: Pneumonia is always a risk following major surgery. To help keep the lungs clear of congestion, patients are assigned a series of deep breathing exercises.
- Is joint replacement the best option for me now, or should I wait?
- If I have joint replacement surgery, how much of my pain will be relieved?
- How physically active can I be with a new joint?
- How do joint replacements compare?
- Would you recommend minimally invasive surgery (MIS) for me?
- What are the risks or complications of joint replacement surgery?
- How long will I be in the hospital, and how soon after having the procedure can I get back to normal daily activities?
- Is joint replacement covered by my health insurance?
- After the procedure, will I see you or my regular doctor for follow-up care?
- How many of these procedures have you performed?