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Q: Will my total hip or total knee hurt? The answer is yes. It does hurt; it's a surgery and a painful recovery process. But the good news is that even though there's no way to make your pain go away completely, our understanding of pain management has dramatically improved over the last 10 to 20 years. The use of multimodal pain medications has improved patient satisfaction significantly. Intraoperatively, you do not feel anything in your sleep throughout the operation.
Q: What kind of anesthetic will I get? It depends. From my standpoint, I like a patient to be under spinal when they can but there are multiple options from an anesthetic standpoint such as general anesthesia, epidural anesthesia, and spinal anesthesia. The anesthesiologist and you discuss which is the right, appropriate anesthesia for you. Some patients have medical reasons why they can't have a spinal and they need a general. Other patients don't like the idea of having a spinal so they have a general and that's fine. That's that dialog that needs to happen before surgery. Ultimately the decision is between you and the anesthesiologist.
Q: How long will I need pain medications? Usually about four to six weeks. These are pretty heavy duty narcotics that you go home with. For most patients, the surgical pain only lasts for a couple of days. Most patients have discontinued their narcotic pain medication by the time they see me again in four to six weeks.
Q: Will I lose a lot of blood? Not usually. Most patients only lose a small amount of blood that does not affect them clinically. Blood saving strategies are utilized intraoperatively to minimize the risk of needing a blood transfusion postoperatively.
Q: Will I need to take a blood thinner following surgery? The answer is yes. We live at altitude. Even at sea level, patients develop blood clots that can start in the legs. Those are called deep vein thrombosis or DVT and they can break off and go to your lungs. Those are called PEs or pulmonary embolisms. We recommend that you take a blood thinner such as Lovenox which is a daily injection for about two weeks. Then for the remaining four weeks after that you take oral aspirin. If you've had a blood clot in the past, our treatment depends on your primary care physician's recommendations.
Q: One of my legs feels shorter than the other. Can you lengthen my leg? I get asked this all the time. The answer is actually yes; I can lengthen your leg through a hip replacement. However, I cannot through a knee replacement. One of the biggest problems with joint replacement surgery, specifically hip replacement surgery, is residual leg length discrepancy which can sometimes be the result. Sometimes that's intentional and sometimes it's not. My goal is to provide you with a functional hip with relatively symmetric leg lengths that you won't even know there's a difference.
Q: My knee is crooked and stiff. Will you be able to straighten my knee and improve the stiffness? The answer is yes I can. Straightening the knee joint is done routinely during a total knee replacement, however stiffness can be a tougher problem to treat. From a surgical standpoint I can treat stiffness intraoperatively. But the best predictor of postoperative range of motion is your motion preoperatively. If you have a stiff knee before surgery, that typically means you've formed scars and you potentially could have residual and worsening stiffness after surgery.
The best way to combat this is being diligent with your physical therapy, working on range of motion. This is the best way to combat postoperative knee stiffness.
Q: When can I walk after surgery? I expect my patients to walk at least by postoperative day one. Most patients are out of bed by postoperative day zero at least. The development of rapid recovery to all joint protocols are encouraging patients to mobilize faster. Staying in bed too long increases your risk for blood clots. So it's important to get up and walk. Unless there is a reason to restrict weight bearing from a surgical standpoint and concern about bone quality, I usually allow all patients to weight bear as tolerated after surgery meaning you can put all of your weight on the hip.
Q: Will I need a walker? Yes. During the recovery period your muscles and coordination need to retrain. Most patients use a walker for about one or two weeks. Then they may use a cane for another two to four weeks. Typically, they return to my clinic without the use of anything at all and walking normally. Everyone is a little bit different. So these are averages. Some patients do take a little longer to return back to ambulating without the use of anything and there are a few patients who unfortunately do use a cane for life.
Q: How long will I stay in the hospital? One or two days for a primary hip and knee. The goals of going home are pain control with oral pain medications, eating, drinking, going to the bathroom normally, and ability to safely mobilize with therapy. Some patients may even be able to go home the same day of surgery depending on how well they’re doing, how motivated they are, and how tolerable their pain is. Patients who have had knees and hips replaced before and require revision surgery typically spend a few more days in the hospital before discharge.
Q: When can I shower? Usually you're able to shower in about two days. The plastic dressing that you'll go home with is waterproof. Once that dressing is on, you can shower. You’ll leave that dressing on until you come back to the clinic in about one or two weeks. Even though it's waterproof, the dressing can dissolve if you soak in water. So while you can shower, you can't sit in a hot tub or soak in a bathtub.
Q: How long will my incision be? I get asked this quite a bit. The answer is about ten centimeters or about four inches. The incision length is determined by multiple factors. Depending on a patient’s size, some patients require larger incisions. The incision is made to the appropriate length so that I can do the right job for the patient. The length of the incision doesn't necessarily effect healing time.
Q: How long will it take for my incision to heal? Usually about two to six weeks. Skin heals in about one or two weeks. The deeper layers may take a little longer. Once the scar forms, it can remodel for about one or two years. And while it does fade and smooth over to the point where it's hard to notice, it rarely goes away.
Q: Will I need physical therapy? The answer is yes. Most patients will require physical therapy for at least a few weeks following surgery. Outpatient physical therapy starts at your first postoperative appointment around the two-week mark. For the first two weeks, we typically do home health for patients who need it. If a patient is very motivated and doing very well, we can start therapy much sooner. It usually lasts for about two to six weeks following surgery.
Q: When can I drive? This is a question that most people are very interested in. The answer is usually about six weeks. Remember after surgery, the muscles have been traumatized. It takes a while for your reaction time to return after the surgery. But when you can drive really depends on which leg you had surgery on. If you have a right leg surgery, you have to be off narcotics altogether including oral narcotics. And you have to be able to put full weight on that leg for at least six weeks prior to driving. That's why I want you to walk on it right after surgery so you can start that clock and get you back to driving as soon as you can. Left leg surgeries are dependent on what kind of transmission your vehicle has. If you have automatic transmission, you just have to be off your narcotics before you can return to driving, assuming you're driving with your right leg. If it's a manual transmission, it still takes about six weeks. The same rules apply as your right leg surgery.
Q: When can I return to work? It depends on the job that you do. Typically, you should request about three months off from work to recover appropriately following hip and knee replacement surgery. For patients who do more of a sedentary computer or desk type job, they actually can return to work in about a couple of weeks, as long as their pain is controlled and they're able to get around safely.
For patients who do more heavy labor work such as construction, it typically takes somewhere between 6 to 12 weeks before they're able to return. No matter what time you return back to work, you have to be able to devote the appropriate amount of time to the therapy that gets you back to strengthening your muscles and getting you back to walking normally.
Q: How long will it take to recover? Three months is a good rule of thumb. Most patients are able to perform the majority of daily activities in about two or four weeks. However, it can take about three months before most patients have regained the endurance and strength needed to enjoy their usual activities. Some patients may take a little longer.
Q: Will I have any restrictions following surgery? What can't I do after surgery? It depends on what you had. For knee surgery, you really don't have any restrictions. I want you to be able to get up and walk, with your knee as straight as possible and as bent as possible.
Q: When can I return to sports? Usually about three months. For the most part, if you did it before surgery, it means you can likely do it after surgery, including golfing, skiing, hiking and biking. Some patients find it hard to kneel after a total knee replacement. The things we do limit are heavy impact exercises such as running and jumping. Remember these are mechanical devices and they do wear out. The more you use it, the more likely it may wear out. I say it may wear out because the newer technologies are improving how long these joints last.
Q: When should I have surgery? This is the final question that I get asked quite a bit. Really the answer is when you're ready. You're the only person who can make the decision to have a hip or knee replaced. The good news is having a total joint replacement is not an emergency. You can take your time with your decision and it can certainly be done anytime. Whether you have surgery tomorrow or two years from now, it doesn't necessarily change what I do intraoperatively or what you have to do postoperatively. The most important thing is to schedule this at a time in your life, in the season of your life that allows you to recover appropriately.
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