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Make the most
of your recovery
When you get home from the hos-
pital after having a joint replaced,
there’s still work to be done—
and you’re in charge of it. How
much function, range of motion
and strength you gain depends a
lot on how you manage the first
months of your recovery.
To make the most of that
recovery, follow these sugges-
tions from the American Acad-
emy of Orthopaedic Surgeons
and the American College of
Rheumatology:
Take medications as di-
rected.
These may include
blood thinners to prevent life-
threatening blood clots and pain
medication to keep you moti-
vated to move and stretch.
Follow medical instructions.
Keep stitches and wounds clean
and dry, avoid bending and reach-
ing as you mend, and follow other
advice from your doctor, such as
wearing compression stockings
to prevent blood clots.
Don’t rush recovery.
Doing
too much too soon can jeopardize
healing.
Watch your weight.
Too
many extra pounds put stress on
new joints.
Be careful of infections.
This is a priority for the rest of
your life, because infections
can enter the blood stream and
infect the artificial joint. Because
some infections start after dental
work, your dentist may prescribe
an antibiotic before dental
procedures.
Stay active.
Continue doing
joint-specific, post-surgery exer-
cises for at least two months.
Working with a physical therapist
helps with motivation. A lifelong
commitment to exercise is best
to help protect joint health.
Know (and follow) specific
limitations after surgery.
Most
orthopedic surgeons recommend
that patients with artificial joints
avoid high-impact activities (ten-
nis, football, running, basket-
ball, heavy lifting). Swimming,
walking, biking, playing golf or
doubles tennis, and doing other
low-impact activities are typically
OK—even encouraged.
after joint surgery
D
Knees are the most commonly replaced joints in the
United States—doctors do more than 500,000 of the
surgeries a year, according to the American Academy of
Orthopaedic Surgeons (AAOS). In the No. 2 spot: hips,
with nearly 200,000 replaced every year.
Other joints can be replaced, too, including those in
the ankle, foot, shoulder, elbow and fingers.
Why joints fail
Healthy joints are cushioned by a
smooth layer of cartilage that allows the joint bones to
move without much friction or pain. Bones themselves
are living tissue and need a constant supply of blood to
grow, remain healthy and make repairs.
When joints are damaged—by injury, arthritis, or
simple wear and tear, for example—cartilage can dis-
appear. Bones can lose some of their blood supply, and
inflammation can trigger fluid that overfills the joint.
The result? Pain, stiffness and swelling that can affect
walking, standing, sitting and sleeping. Muscles around
the joint start to decline as using the joint becomes in-
creasingly painful.
What’s involved?
Replacement joints are designed
to mimic how a normal joint moves. They generally have
two or more parts that fit together, and the parts are made
of various materials—including stainless steel, chrome,
titanium, ceramic and wear-resistant plastics.
Surgery to replace a hip or knee usually takes two
hours or less. The surgery team removes the damaged
joint and replaces it with an artificial one, called a pros-
thesis. Artificial joints come in many forms and sizes.
Surgeons decide which one to use based on a number of
factors, including a patient’s size, health and lifestyle and
the amount of damage to the joint.
Rehabilitation begins right after surgery. Patients
usually are walking, standing and using their new joint
within a day—sometimes the same day as their surgery.
They may need to use a walker, crutches or a cane until
their muscles grow stronger.
Total joint replacement for hips and knees typically
involves a three- to five-day stay in the hospital. After
that, patients are released to go home or to a temporary
rehabilitation center.
Most people are back to work and driving again after
six to eight weeks, but recovery times can vary depending
on the joint replaced, according to the AAOS.
Risks of surgery
More than 90 percent of people
who have a joint replaced consider the surgery a success,
according to Victor Goldberg, MD, a spokesperson for the
AAOS and an orthopedic surgeon for more than 40 years.
Although complications from the surgery are rare,
they can include:
●
Blood clots.
●
Infection in the
wound or deep around the prosthesis.
●
Loosening of
the prosthesis within the bone.
●
Dislocation of the ball
from the socket after total hip replacement.
●
Nerve and
blood vessel damage near the replaced joint.
●
Breakage
of the new joint.
Sometimes another surgery—called a revision—must
be done to correct problems.
Is it time?
Having a joint replaced is a big decision,
Dr. Goldberg says. Doctors can tell a lot about the me-
chanics of a joint by looking at x-rays and studying the
results of other tests. But these don’t measure how a
patient feels or how willing he or she is to go through
surgery and the hard work involved in recuperating.
“As a surgeon, I’m interested in a patient’s level of
pain, when they have pain, the characteristics of the
pain and what impairment they have with daily living—
such as getting up from a chair, walking, and going up
and down stairs,” he says. “Usually they decide to have
a joint replaced when pain is interfering with how they
function every day.”
Most people who get new hips, knees or other joints
are over 65 years old, Dr. Goldberg says. But a trend over
the past decade is for people in their 40s and 50s to have
joint replacement surgery.
“These surgeries have been around a long time, people
know they’re available, and they know that they’re suc-
cessful,” he says. “Young patients have active lifestyles.
They don’t want to give them up, and they don’t want to
live with pain.”
Replacement joints usually last 10 to 15 years. People
who have the surgery at a young age may face need-
ing a second one later on. Many are willing to accept
that possibility in order to enjoy a more active life now,
Dr. Goldberg says.
Today vs. tomorrow
If you’re considering joint
replacement surgery, check with your primary care
doctor to make sure you’re healthy enough to undergo
anesthesia and the operation, advises the American Col-
lege of Rheumatology. An orthopedic surgeon can then
help you sort through the maze of options available for
replacing your joint.
Joint surgery is always improving, Dr. Goldberg says.
The next decade should bring longer-lasting materials,
more smart tools—such as robotics—into the operating
room and more implants tailored to fit a patient’s anatomy,
he says.
“We’re already seeing much of this now,” Dr. Goldberg
says. “Joint replacement designs are already sophisticated
and precise. They’ll only improve.”
But, “if I were 50 years old and I needed a joint re-
placement now, I wouldn’t wait 10 years,” he advises. “If
I’m already having functional issues at 50, I’m not going
to wait on the chance that there might be something
better down the road.”
You can learn more about joint replacement surgery—
including information about replacing specific
joints—at
www.orthoinfo.aaos.org
.
ave Guffey’s pain started a decade ago. It began in one knee but soon affected
both. He’d always been active—football in college, racquetball and basketball for
recreation—and he had a job that required hiking across university stadiums
and climbing arena stairs to see athletes and coaches.
✦
He knew his knees were
wearing out; cortisone shots, braces and pain pills no longer helped ease the pain.
“Both knees were bone-to-bone,” he recalls. “I couldn’t walk 10 minutes without
feeling pain.”
✦
At 59, Guffey decided to trade in his old knees for new ones.
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