FAQs

General :: Medical :: Total Hip Replacement :: Total Knee Replacement

General

How do I make an appointment?

Simply call us at during our working hours or you can request an appointment online using this form.

Do I need a referral to make an appointment?

Most medical specialists will accept only referred patients. This is mainly to try to ensure that the specialist you are seeing is appropriate for you and your condition. Check with your insurance company to see if a referral is necessary.

What to bring for your initial consultation?

For your initial consultation you will need to bring a referral letter from your physician if required.

Here is check list for your initial consultation:

  • Drivers License or a valid ID
  • Insurance information
  • Referral Letter (if required)
  • Reports, X-rays, MRIs, CT scans, etc. and any other relevant information
  • List of medications (if any)

We encourage you to come to your initial consultation with a written list of questions to ensure you don’t forget to ask them when you visit the doctor.

Are my medical records kept private and confidential?

Your medical file is handled with the utmost respect for your privacy. Our staff is bound by strict confidentiality requirements as a condition of employment regarding your medical records. We will not release the contents of your medical file without your consent.

How long do I need time off work after the surgery?

The post-operative recovery period varies based on the surgery. Generally, it is recommended patients take two weeks off work to recover from any surgery and to resume light duty following resumption of work. Your surgeon will give you specific instructions to follow for a successful recovery.

How long before I can resume driving?

You should wait at least one week before driving after surgery. The effects of anesthetic and surgery can affect judgment and reflexes during the first week following your surgery. Your surgeon will provide more specifics after considering your condition.

When can I resume exercise?

Your doctor will instruct you about post-treatment exercises – the type and the duration to be followed. You may be referred to a physical therapist to help with strengthening and range of motion exercises following surgery.

How do I contact after hours?

There will be a point of contact 24 hours a day for any concerns you may have. You will be provided with contact details following your treatment.

Medical

What are the non-surgical treatment options?

The non-surgical treatment options include rest, medications including analgesics and antibiotics, injections, and physical/occupational therapy.

Will physical therapy be required after surgery?

Getting full range of motion, strength, and flexibility back after surgery usually takes time. That is where pre-operative exercise, education, and post -operative physical therapy programs come in – to ensure you are physically and emotionally prepared for surgery and to maximize your recovery after surgery.

What are the risks associated with surgery?

As with any surgery, risks include reactions to anesthesia, bleeding, infection, stiffness and nerve damage. Your doctor will discuss the risks associated with your specific procedure.

When can I return to daily activities?

This varies depending on the type of procedure undergone, and can range from a few days to a few months. Return to all activities, sports and exercise can take up to four to six months. Your doctor will advise you depending on your health condition.

What can happen if surgery is avoided?

Some complications of not undergoing an orthopaedic surgery for your condition include pain, loss of joint motion, joint weakness, numbness and an early onset of arthritis.

What are the most common injuries?

The most common orthopaedic injuries are sprains and strains, fractures and dislocations. Injuries can occur when playing indoor or outdoor sports or while exercising. Sports injuries can result from accidents, inadequate training, improper use of protective devices, or insufficient stretching or warm-up exercises.

Traditional Total Hip Replacement

How long does a THR last?

A common reply to this question is that total joint replacement lasts 15-20 years. A more accurate way to think about longevity is via the annual failure rates. Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years. With improvements in technology, these numbers may improve.

Are all hip replacement implants the same?

Most implants today have become more similar than different as surgeons and manufacturers have determined which designs work best. One variable that still remains is the bearing surface. The bearing surface is the ball and liner that attach to the stem and cup that fix to the bone. The ball can be composed of either metal (cobalt chromium alloy) or ceramic, and the liner can be made of plastic (polyethylene), metal, or ceramic. The ball and liner can then be used in different combinations and are named for the respective ball liner combination (metal on poly, ceramic on poly, ceramic on ceramic, etc.). In 2013, a vast majority of bearings utilize a polyethylene liner with either a metal or ceramic head, with other combinations used with lesser frequency. You can discuss these differences with your surgeon to determine which implant is best for you.

My surgeon talks about “approach.” What is this?

The way a surgeon gains access to the hip during hip replacement surgery is referred to as an “approach.” There are various types of approaches named according to the direction that the surgery is performed. The most common approach today is referred to as the “posterior approach,” which is done from the back of the hip. Some more recent improvements to this approach (small incision and less tissue trauma) have been called “mini posterior approach.” Another currently popular approach is known as the “anterior approach,” which is preformed from the front of the hip. 

There are pros and cons of each approach and little science to endorse one over the other. A conversation with your surgeon should help decide which approach is best for you.

Will my surgeon use a computer, robot, or custom cutting guide in my surgery?

There are many studies attempting to evaluate these emerging technologies and their influence of the success of surgeries. Each of these technologies has a specific goal that has fueled its development (i.e. more accuracy in implant placement, more efficient or faster surgery, etc.). To date, there appears to be both pros and cons to each of these technologies, but more research is required to determine what advantage, if any, these may offer. The best approach is to discuss this topic with your surgeon. You may want to know if they use one of these technologies, why they have chosen to do so, and what their experience has been in using it.

Will I need general anesthesia?

While general anesthesia is a safe option, both hip and knee replacements can be performed under regional anesthesia. Choices for regional anesthesia include spinal anesthesia, epidural anesthesia, or one of a variety of peripheral nerve blocks. Many surgeons and anesthesiologists prefer regional anesthesia because data shows it can reduce complications and improve your recovery experience with less pain, less nausea, less narcotic medicine required, etc.

What is minimally invasive surgery?

Minimally invasive surgery is a term that describes a combination of reducing the incision length and lessening tissue disruption beneath the incision. This includes cutting less muscle and detaching less tendon from bone. There have also been advancements in anesthesia and pain management during and after THA. All of these practices allow you to feel better, have less pain, and regain function faster than in the recent past.

How big will my scar be, and when will it disappear?

The size of the incision can vary and depends on several factors that include the size of the patient, the complexity of the surgery, and surgeon preference. Most studies have shown that smaller incisions offer no improvement in pain or recovery and may actually worsen the surgeon’s ability to adequately perform the procedure.

The scar will heal within a few weeks, but then will remodel and change appearance over the course of 1-2 years. The color often fades and gets smoother over time, blending into surrounding skin, but will likely never fully disappear. Everyone is different, and everyone will have different scars.

How long will I stay in the hospital?

You will likely stay in the hospital for 1-3 days depending on your rehabilitation protocol and how fast you progress with physical therapy. This is highly dependent upon your condition before surgery, your age, and medical problems which can hinder your rehabilitation.

When can I walk after surgery?

Most surgeons and hospitals today emphasize getting you out of bed quickly. Most people are walking with the assistance of a walker on the day after surgery, and using a cane or nothing at all by 2-3 weeks.

When can I shower?

Most surgeons do not like the wound to be exposed to water for 5-7 days; however, more surgeons are using waterproof dressings that allow patients to shower the day after surgery. You can remove the dressing at 7-10 days after surgery. Once you remove the dressings, you still shouldn’t soak the wound until the incision is completely healed 3-4 weeks later.

Is THR very painful?

Pain following total hip replacement has come a long way over the last 10-15 years with increased use of regional nerve blocks, spinal blocks, and various other modalities used for pain control. Total hip replacement is generally considered to be less painful than total knee replacement. Early range of motion and rapid rehabilitation protocols are also designed to reduce early stiffness and pain, making the procedure in general much less painful than in years past. You may have relatively mild pain following the procedure, or you may have a more difficult time than others. Everyone is unique and handles and perceives pain differently.

How long does it take to recover?

The majority of people who undergo THA are able to participate in a majority of their daily activities by 6 weeks. By 3 months, most people have regained much the endurance and strength lost around the time of surgery, and can participate in daily activities without restriction.

Will I need physical therapy, and if so, for how long?

Initially, you will receive some physical therapy while in the hospital. Depending on your preoperative conditioning and support, you may or may not need additional therapy as an outpatient. Much of the therapy after hip replacement is walking with general stretching and thigh muscle strengthening, which you can do on your own without the assistance of a physical therapist.

When can I drive?

Most surgeons allow patients to drive at 4 to 6 weeks after surgery, and sometimes sooner if the operative leg is the left leg. There is some literature that states that your reaction time will not be back to normal prior to 6 weeks. You should not drive while on narcotics.

When can I return to work?

Returning to work is highly dependent on your general health, activity level and demands of your job. If you have a sedentary job, such as computer work, you can expect to return to work by 4-6 weeks. If you have a more demanding job that requires lifting, walking, or travel, you may need up to 3 months for full recovery.

What restrictions will I have after surgery?

Depending on how your surgeon performs your surgery, you may have slight differences in your rehabilitation instructions including restrictions. In general most surgeons prefer that you avoid certain positions of the hip that can increase your risk of dislocation of the hip for about 6 weeks following surgery. After 6 weeks, the soft tissues involved in the surgery have healed, and restrictions are often lifted – allowing more vigorous activity. Many surgeons suggest that you avoid any repetitive impact activities that can increase the wear on the implant such as long distance running, basketball, or mogul skiing. Otherwise limitations following hip replacement surgery are few.

Are there complications to THR?

  • Total hip replacement is an excellent pain relieving procedure, and most patients receive approximately 95% pain relief.
  • Although complications are relatively rare (1-5% of patients), patients may experience a complication in the postoperative period. These include very serious and possibly life threatening complications such as heart attack, stroke, pulmonary embolism and kidney failure.
  • Infection (1%) is one of the most debilitating complications and often requires prolonged antibiotics with several additional surgeries to rid the infection.
  • A blood clot in the leg is also a relatively common complication requiring some type of blood thinner following surgery to reduce the incidence.
  • The implants used can also fail over time due to wear of the bearing components or loosening of the components from the bone, both of which usually occur over many years.
  • Another complication specific to hip replacement is dislocation of the joint (1%) that may require additional surgery if dislocation becomes recurring.
  • Leg length differences following surgery are also a possibility and may be difficult to avoid sometimes in order to insure a stable hip. Often this leg length discrepancy is mild are rarely needs treatment.

Should I continue to see my surgeon after I’ve healed?

It is important to follow up with your surgeon after your joint replacement. In most cases, joint replacements last for many years. You need to meet with your treating doctor after surgery to ensure that your replacement is continuing to function well. In some cases, the replaced parts can start to wear out or loosen. The frequency of required follow up visits is dependent on many factors including the age of the patient, the demand levels placed on the joint, and the type of replacement. Your physician will consider all these factors and tailor a follow-up schedule to meet your needs. In general seeing your surgeon every 3-5 years is recommended.

Will I need to take antibiotics prior to seeing a dentist or having other invasive procedures?

The American Academy of Orthopedic Surgery (AAOS) and American Dental Association (ADA) have generally recommended short-term antibiotics prior to dental procedures (1 dose 1 hour prior to dental procedure) for patients who have had joint replacements. This recommendation continues for up to 2 years after your joint replacement.

Two or more years after the replacement, continued use of antibiotics prior to dental procedures is based on the discretion of the treating surgeon and the patient. Your surgeon will consider many factors including whether or not you are at increased risk of infection due to immune suppression (i.e. diabetic, transplant patients, and rheumatoid arthritis).

The use of prophylactic antibiotics prior to dental cleanings and other invasive procedures remains controversial. Most orthopaedic surgeons now recommend lifetime suppression. Patients should discuss whether or not they need antibiotics prior to dental or other invasive procedures with their treating orthopedic surgeon.

Will my implant set off metal detectors at airports and courthouses?

Usually patients with joint replacements will set off metal detectors. It is reasonable for you to inform the TSA screening agent at the airport that you have had a joint replacement; however, you will still require screening and will need to follow the directions of the screening agent.

There are millions of individuals with joint replacements, and screening protocols recognize that people who have had joint replacements may set off detectors. You do not need to carry specific documentation to prove that you have a joint replacement. Metal detector screenings follow universal protocols that allow for people with joint replacements to proceed after confirmation that no threat exists.

Total Knee Replacement

How long does a TKR last?

A common reply to this question is that total joint replacement lasts 15-20 years. A more accurate way to think about longevity is via the annual failure rates. Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years. With improvements in technology, these numbers may improve.

What types of implants are there?

The orthopaedic implant industry has developed a number of innovative technologies in an effort to improve the outcomes of TJA. In recent years, these technologies have been marketed directly to patients, which has increased the awareness as well as confusion on what these different designs mean. The most important message is that while a certain manufacturer may claim that their design is better, almost all of the available registry data (large collections of data from countries that track TJA) show that there is no clear advantage to any of these designs when it comes to improving outcomes. Here are specific implant design terms:

  • Gender specific: This refers to a modified implant design that accounts for average anatomic differences between men’s and women’s knees. Most manufacturers have incorporated similar modifications in their newer designs, which allow for more sizing options so that the prosthesis can be more accurately fit to the patient’s native anatomy and recreate the natural function of the knee.
     
  • Rotating platform: This refers to a plastic bearing that independently rotates on a metal tray on which it is seated. More often, the plastic bearing locks into the metal tray – referred to as a “fixed bearing.” Some theoretical advantages to the rotating platform concept when it was initially designed was that it could reduce the wear of the plastic bearing, reduce the rate of loosening of the metal parts, and better replicate how a patient’s knee works (kinematics). Most current data shows that after 5-10 years in use, there does not appear to be any difference between rotating platform and fixed bearing designs in any of these outcomes.

Will I need to stay in the hospital?

On average, patients spend one to two nights in the hospital following surgery. Some patients may spend as little as one night, others may stay as long as three nights.

Will I be able to walk after surgery?

Most patients use a walker or crutches after surgery but often will be able to progress rapidly to using a cane.

Can I go directly home from the hospital?

Many patients are able to leave the hospital and go directly home after surgery. It is important to identify a family member or friend who will be able to help with common household tasks such as preparing meals and doing dishes. Some patients will require a stay a specialized care facility such as a nursing home or rehab hospital.

Will I be able climb stairs when I leave the hospital?

In general, patients are able to climb stairs after leaving the hospital; however, it is often initially slow and tiring. This soon improves, but most patients are happiest if initially they are able to stay on one floor after returning home from surgery.

Will I be able to drive immediately after surgery?

Most patients are not safe to drive for the first three to six weeks after surgery. Your surgeon and their team will guide you as to when it is safe to drive.

How long will I be out of work after surgery?

Most patients are out of work for at least a few weeks following surgery. Patients with very physical jobs may take as long as three months to return to work.

Will I have to take pain medication after surgery?

Many efforts are ongoing to reduce the pain patients have after surgery; however, most patients still do require some pain medications for the first few weeks after surgery.

Will I need Physical Therapy after surgery?

All patients benefit from specific exercises after surgery. These will be directed by your surgeon and often will involve a physical therapist. Most patients need to do their exercises for a minimum of four to six weeks following surgery.

How much will my joint replacement weigh?

They weigh between one and two pounds.

Are there any activities I will not be able to participate in after I recover from my joint replacement?

In general, most patients are advised to avoid running, jumping, or impact sports after surgery. It is hoped that these recommendations will make your joint replacement last longer.