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FAQ’s about Joint Replacement Surgery

Joint replacements are one of the greatest success stories in the history of medical science. Almost all human joints have been replaced. The most successful of these are those of hips and knees. Generally joint replacements are done for severe pain and restriction of mobility secondary to arthritis. Patients are often not sure when to opt for a joint replacement. Here we try to answer some of the frequently asked questions about joint replacements.

1. I have heard that an artificial joint should be done only after 60 years of age. Is that correct?

In knee replacement the damaged/worn surfaces of the knee are removed and resurfaced using a metal joint. A highly specialized liner made of polyethylene is inserted between the two metallic surfaces to replace the worn meniscus. There are broadly two types of knee replacements- unicompartmental (partial) and total knee replacement.
Knee joint is divided into three compartments If the arthritis is limited to only one compartment (medial compartment is the one most commonly affected) then a unicompartmental replacement is possible. The advantage is that this is done through a small incision removing only a small amount of bone making potential revision operations in future easier. Hence in younger patients I prefer a unicompartmental replacement to preserve more bone stock.

2. Am I too old for a joint replacement surgery?

Joint replacements are one of the greatest success stories in the history of medical science. Almost all human joints have been replaced. The most successful of these are those of hips and knees. Generally joint replacements are done for severe pain and restriction of mobility secondary to arthritis. Patients are often not sure when to opt for a joint replacement. Here we try to answer some of the frequently asked questions about joint replacements.

3. I have pain. When should I opt for joint replacement?

Your orthopaedic surgeon will decide if you are a candidate for the surgery. This is based on your history, an examination and X-rays. If your answer to any of the three following questions is yes then you should consult an orthopaedic surgeon.

1. Is your walking distance restricted due to pain?
2. Do you suffer from pain at rest?
3. Do you get woken up at night due to pain?
If you answer yes to any of these questions, this indicates that your symptoms are severe. If your orthopaedic surgeon confirms that your examination findings and X-rays correlate with your symptoms then you are a candidate for joint replacement.

4. Which hospital/ Which doctor?

This is probably the most important question you need to consider once you are advised that you need a new joint. Surgeons who have had special training in joint replacements (such as fellowships) and those who do larger numbers have better results.Even though the surgery is very successful there is a small risk that things could go wrong. Hence the hospital should have good ICU facilities. It is preferable to choose a hospital where all medical and surgical specialties are available on site, should you develop a complication.

5. What type of a hip or knee replacement should I choose?

The market is flooded with a plethora of joint replacements each claiming to be superior to the other. Once you have chosen your surgeon he/she will help you choose the replacement best suited for your type of disease and bone quality. I would choose a replacement that has established long term results as published in medical journals. Actually there are only a handful of hip and knee replacements which have published 10 or preferably 20 year results. I would insist on using one of these tried and tested designs rather than a new one. Generally I would not go for the Indian designs presently as none of these – to my knowledge- has published long term results.

6. How long will my new hip or knee last?

We expect most joint replacements to last more than 20 years. The longevity depends on a number of factors including how the surgery was performed, which implant was used and how you use it. This once again underlines the importance of choosing the right surgeon as he/she will help you reach these decisions.

7. What type of anesthesia?

The anesthetist will help you choose the method of anesthesia best suited for you. In most of the patients I prefer a spinal or an epidural anesthesia, as this is very safe. This has none of the side effects like vomiting and respiratory problems associated with a general anesthetic. Patients are often worried there they will hear the “sawing” or “hammering” during the operations if they are under a spinal/epidural. This is not the case. The patient is is given a light sedation where by he/she would be asleep through the surgery.

8. How long is the surgery and the hospital stay?

The surgery takes around 1 to 2 hours to complete. In my practice, since I introduced minimally invasive surgery and an enhanced recovery programme, I have managed to reduce the the average hospital stay to 5 days. This varies from hospital to hospital as surgeon preference to mobilization and discharge is variable. There are some surgeons who prefer to keep their patients till suture removal.br>

9. When will my pain get better after the surgery?

If one compareship and knee replacements, generally hip replacements are less painful immediately after the operation.Hence immediate recovery is quicker following a hip replacement. However, in both hip and knee replacements by around 3 months most of the pain would have settled. Most patients have a variable degree of swelling after the surgery that often takes up to a year to resolve.

10. Is physiotherapy needed after surgery?

Yes. Physiotherapy is very important to regain the strength in your muscles which may have been weakened by arthritis. Physiotherapy will also help to get the joint mobile early on. This is particularly important in knee replacement as patients with knee movements less than 100 degrees are not entirely satisfied with the replacement.

11. What can I do? What should I avoid after surgery?

Generally after hip replacements it is better to avoid squatting position to prevent the ball coming out of socket. For the first three months or so I advise patients to resume all activities including swimming, sports, climbing stairs etc. In knee replacements I do not insist on any special precautions. I encourage my patients to kneel and squat as studies have shown that these will improve the movements.

12. What things could go wrong with the surgery?

This is a major surgery and so one could have all the medical complications associated with such surgeries like heart attacks, deep vein thrombosis and stroke. Fortunately these are rather rare. In knee replacements the main problems after surgery are infection, pain and stiffness. In hip replacements infection, dislocation , fractures and nerve injuries are the major problems. Choosing an experienced well-trained surgeon is probably the single most important factor in considering complication free longevity of a joint replacement. Having the surgery performed in major centres performing larger volumes and early mobilization also could minimize all these risks.

13. What things could go wrong with the surgery?

Revision of a joint replacement is needed when something has gone wrong with the initial joint replacement. Overall, revision surgery has good results when done for indications like loosening. In infection often the revision surgery will have to be done in two stages. In the first stage a temporary knee replacement will need to be inserted. The patient will need to be on long-termantibiotics afterwards. Once the infection has settled one could proceed with a definitive joint replacement. These cases often have significant bone loss and may require special type of implants (i.e more expensive ones) for reconstruction.