Orthopedics

Joint cartilage is a tough, smooth tissue that covers the ends of bones where joints are located. It helps cushion the bones during movement, and because it is smooth and slippery, it allows for motion with minimal friction.

Osteoarthritis, the most common form of arthritis, is a wear and tear condition that destroys joint cartilage. Sometimes, as the result of trauma, repetitive movement, or for no apparent reason, the cartilage wears down, exposing the bone ends. Over time, cartilage destruction can result in painful bone-on-bone contact, along with swelling and loss of motion. Osteoarthritis usually occurs later in life and may affect only one joint or many joints.

The term total hip replacement is somewhat misleading. The hip itself is not replaced, as is commonly thought, but rather an implant is used to recap the worn bone ends. The head of the femur is removed. A metal stem is then inserted into the femur shaft and topped with a metal or ceramic ball.

The worn socket (acetabulum) is smoothed and lined with a metal cup and either a plastic, metal, or ceramic liner. No longer does bone rub on bone, causing pain and stiffness.

The term total knee replacement is also misleading. The knee itself is not replaced, as is commonly thought, but rather an implant is used to recap the worn bone ends. This is done with a metal alloy on the femur and a plastic spacer on the tibia and patella (knee cap). This creates a new, smooth cushion and a functional joint that can reduce or eliminate pain.

Knee or hip replacement surgery may be considered for those suffering from arthritic pain that severely limits the activities of daily living.

It is only recommended after careful examination and diagnosis of your particular joint problem, and only after more conservative measures such as exercise, physical therapy and medications have proven ineffective.

All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition(s). A total joint implant’s longevity will vary in every patient.

It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specified length of time.

Most surgeries go well, without any complications. Infection and blood clots are two serious complications. To avoid these complications, your surgeon may use antibiotics, blood thinners or compression devices. Surgeons also take special precautions in the operating room to reduce the risk of infection.

Our goal is that all patients get out of bed and walk the same day as their surgery. The next morning patients get dressed in their own clothing, get up to a recliner chair for breakfast and participate in physical and occupational therapy. Most patients leave the hospital the day after their surgery.

You can still return directly home from the hospital if you have someone to help you at home. Talk to your coach, relatives, or friends and determine if someone or different people can stay with you after your surgery to help out until you become more independent. Generally, we recommend you have assistance the first two weeks after surgery.

If you do not think you will be able to go directly home from the hospital, visit local skilled nursing facilities to determine where you want to go for rehabilitation until you become independent enough to return home alone. Keep in mind that you must meet certain criteria for your insurance to pay for a skilled nursing facility stay.

After your surgeon has scheduled surgery, you will receive a letter in the mail outlining your pre-operative appointments and surgery date and time. A member of the JRIO team will also contact you to schedule your pre-operative class and Hospitalist consultation. They will guide you through the program, answer your questions and help determine any equipment or discharge planning needs you may have.

The hospital reserves approximately 2-3 hours for surgery. Some of this time will be taken by the operating room staff to prepare for surgery.

Most patients have spinal anesthetic for surgery, which numbs your legs but does not require you to be asleep. You will discuss your anesthesia options further when you meet with an anesthesia provider prior to surgery.

You will have some discomfort following surgery, but our goal is to keep your pain level at a 4/10 or less. This pain level will allow you to eat, sleep, walk and do your exercises so that you can recover comfortably.

Pain after surgery is quite variable from person to person, and not entirely predictable, but advancement in medication and improved anesthetic techniques greatly enhance our ability to control pain and discomfort after surgery. Expect pain to be at its worst the first two weeks after surgery.

If you have a knee replacement, surgical scars vary in length, but most surgeons will make it as short as possible. It will be straight down the center of your knee, unless you have previous scars, in which case your surgeon may use an existing scar. There may be lasting numbness around the scar.

If you have a hip replacement, There are a number of different techniques used for hip replacement surgery. The type of technique will determine the exact location and length of the scar.

Please note that there may be some numbness around the scar after it is healed. This is perfectly normal and should not cause any concern. The numbness usually disappears with time.

We recommend all patients begin by using a front wheeled walker immediately following surgery. Patients generally progress from a walker to a cane then to no assistive device.

Patients progress at their own rate and wide variability exists for how long a patient will use an assistive device. This determination will be made on an individual basis based on each patient’s progress.

You may ask your surgeon or program manager about this for more specifics. The program manager can help you obtain these assistive devices if necessary.

Most patients are able to go home directly after their hospital stay. In fact, more than 96% of our patients go directly home after their hospital stay. A very small percentage of patients transfer to a sub-acute rehab facility, where they will stay until they are safe to discharge home.

Yes. We recommend that all patients have someone available to assist them all of the time for the first 2 weeks after surgery. Depending on your progress, you will need someone to assist you with meal preparation, household chores and possibly daily activities and medication management.

Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and frozen meals prepared will help reduce the need for extra help.

Talk to your coach, relatives, friends and even neighbors, to determine who can help you and in what capacity when you return home.

For patients with a total knee replacement: Yes, you will be scheduled for outpatient therapy.

The length of time spent with physical therapy varies widely and is dependent on patient progress and long-term goals. In general, expect to participate with outpatient physical therapy for approximately 4-6 weeks after total knee replacement.

For patients with a total hip replacement: You will need to discuss this with your surgeon. If you do not have formalized outpatient therapy, you will still be expected to complete your daily home exercise program two times/day.

Your joint replacement is made of a metal alloy and may or may not be detected when going through some security devices. Inform the security agent you have a metal implant. The agent will direct you on the security screening procedure.