Frequently Asked Questions
A joint is formed by two or more bones coming together,
as in the knee, hip and shoulder joints. The knee
joint is formed by the lower leg bones (tibia
and fibula)
connecting with the thighbone (femur). Joint replacement
surgery involves removing the damaged portion of
a joint, replacing it with new metal and plastic
components.
Sometimes, the surgeon will not remove the whole
joint, but will replace or fix only the damaged
parts, leaving
the healthy bone intact and in place. Joint replacement
surgery will help relieve pain and restore function
to the affected joint. The surgery is usually done
by a doctor called an orthopedic surgeon.
Total joint replacement surgery is considered if
other treatment options are unsuccessful in relieving
pain and increasing joint function.
Treatments that may be tried prior to deciding
to have a joint replaced include:
- physical therapy
- using a brace on the affected joint
- joint injections, such as cortisone or a visco
supplement.
Usually a combination of non-operative techniques
is tried prior to surgery.
Before your orthopedic doctor can determine
whether joint replacement surgery is appropriate
for
you, he will complete a thorough history
and physical
exam. The doctor will also review x-rays
and possibly other laboratory studies. If other
non-operative treatments have been unsuccessful,
the doctor
may
suggest that joint replacement surgery is
the best way to improve your quality of life.
Joints can be damaged by arthritis, other diseases,
or injuries. Most commonly, arthritis, or years
of use, may cause the protective cartilage on
the surface of the joint to wear away. This can cause
pain, stiffness, and swelling. Bones need blood
flow in order to be healthy, grow, and repair
themselves.
Diseases and damage inside a joint can limit
blood flow, causing problems.
The new joint, called a prosthesis, can be made
of plastic, metal, or both. Bone cement may be used
to anchor the prosthesis into place.
Joint replacements can also
be implanted without cement. When cement is not used,
the prosthesis
is fitted and locked directly to the bone.
The two methods are sometimes combined to keep
the new joint in place.
For most people a joint replacement will last ten
years or longer. This means that young patients
may need a second total joint replacement for
the same joint later in life.
Total joint replacements help to provide years
of pain-free living that would not be possible
without
the surgery.
As the American population continues to age, joint
replacement surgery is becoming more common.
About 435,000 Americans have a hip or knee replaced
each
year. Research has shown that even if you are
older, joint replacement surgery can relieve joint
pain
and help you move around more easily.
As with any surgery, there are risks to having
a joint replaced.
Joint replacement surgery is
successful in the vast majority of patients,
and, when complications do occur,
they are usually treatable. Our Quality
and Safety measures help assure that complications are kept
to a minimum.
Risks of joint replacement depend on:
- your health before surgery
- how severe the damage to the joint is
- the type of surgery being done.
Complications that
can occur with total joint replacement surgery include,
but are not
limited to the following
possibilities:
- Infection may occur around the incision
or deep around the prosthesis. Infection
may happen
while
you are in the hospital or after you
go home. It may even occur years later. Minor
infections
in
the wound are generally treated with
antibiotics. Major
or deep infections may require more surgery.
- Blood clots result from several factors,
including your decreased mobility
after surgery, causing
sluggish movement of the blood through
your leg veins. Blood
clots may be suspected, if pain and
swelling develop in your calf or thigh. If
this
occurs, your orthopedic
surgeon may consider tests to evaluate
the veins of your leg. It is important
to let
your surgeon
know if you develop swelling, redness or
pain in your leg following discharge
from
the hospital.
- Loosening of the prosthesis within
the bone can occur over time. This
can cause
pain and
may require
surgical revision of the joint
replacement. New methods of attaching the prosthesis
to the bone,
however,
help to reduce the possibility
of
this occurring.
- Dislocation occasionally occurs
after total hip replacement,
when the ball
becomes dislodged
from
the socket. In most cases, the
hip can be relocated without
surgery. A brace
may be
worn for a
period of time if a dislocation
occurs.
Dislocations are more frequent
after complex revision
surgery.
- Nerve injury can occur when
the nerves in the vicinity
of the total
joint replacement
are damaged
during
the surgery. However, this
type of injury is
infrequent. Over time, these
nerve injuries often improve
and
may completely resolve themselves without
intervention.
Strong commitment to the rehabilitation process
ensures that the vast majority of our patients are
extremely
happy with their decision to have joint replacement
surgery.
Patients have a variety of reasons for deciding
to get a joint replaced. Often the decision
is driven
by a desire to make activities of daily living
easier, and to decrease joint pain. During
the pre and postoperative
periods, you must work closely with your surgeon,
and your physical and occupational therapy team
to assure that your goals are met.
- Referral: If you are experiencing hip, knee or
shoulder pain, you should first consult your primary
care provider. If your primary care provider determines
that your joint condition requires orthopedic intervention,
he/she will refer you to an orthopedic doctor.
The orthopedic surgeons at Coastal Orthopedics will
be
happy to meet with you.
- Meet the surgeon: When you come to Coastal
Orthopedics and Sports Medicine, one of our
orthopedic surgeons
will do a thorough history and physical examination
of your joint. X-rays can be taken right
at our facility on Bath Road, and reviewed
by your doctor
during
your initial visit.
- Scheduling surgery: If, after a thorough
review of your history, the affected joint,
and your x-rays,
you and your surgeon decide that a joint
replacement is an appropriate treatment
option for you, the
Coastal Orthopedic office staff will assist
you in arranging
dates for your surgery and for the necessary
pre operative testing at Mid Coast Hospital.
- Preoperative
education: The
office staff at Coastal Orthopedics will arrange
an
appointment for you at
Mid Coast Hospital's Pre-Admission Department
before your surgery. During your
appointment, a nurse will review your
health history and
discuss your upcoming surgery and hospital
stay. At this
appointment, you will also meet one of
Mid Coast Hospital's inpatient
physical therapists. The
physical therapist will review what to
expect
after your surgery.
- Preoperative
testing: After your appointments,
you will have the pre-surgery lab work
and testing required.
Tests may include:
- blood test
- urine tests
- EKG
- chest x-ray
Depending on your current health status
and health history, you may
need to see your
primary care
provider before your surgery.
On the day of your surgery, you will go to the
Ambulatory Care Unit at Mid Coast Hospital at the
prearranged
time. The nurse assigned to your care in this
unit will prepare you for surgery. This will include
reviewing your medications and health history,
having you put on a surgical gown, shaving the
area that will be operated on, and starting an
IV.
Before you go to the operating room, your surgeon
will visit you to answer any last minute questions
that you and your family may have. At this time,
your surgeon will verify the location of the
surgery, and write his initials on the surgical site.
You will also meet your anesthesiologist
who will discuss the different anesthesia options
with you.
This includes regional anesthesia, which will
block sensations to part of your body, or general
anesthesia
in which your entire body will be relaxed,
and you will be put to sleep. You and your anesthesiologist
will work together to determine what anesthesia
option
is best for you.
After you have met with your surgeon and anesthesiologist,
you will be brought to the operating room
on a hospital bed by your operating room nurse.
When
you arrive
in the operating room, you will be moved
to a narrow bed for the surgery. People often
notice
that the
operating room temperature is cool. We will
give you warm blankets, as well as a special
blanket
that blows warm air on you during the surgery
to ensure
that you stay warm.
Once you have been positioned on the surgical
bed, the nurses will put a blood pressure
cuff on your
arm and a soft rubber probe on your finger
to measure the oxygen level in your blood.
You will
also be
hooked up to an EKG monitor. This allows
the anesthesiologist to monitor all your
vital
signs during your surgery.
The nurse may also put a catheter in your
bladder. This allows your healthcare
team to easily
monitor your intake and output of fluid,
and also helps
to make urinating easier after your surgery.
The catheter
is usually removed within 24 hours.
The surgery itself usually takes
between 1-2 hours. After the surgery is completed,
the wound will be closed with sutures and staples,
and a surgical dressing will be applied to the
area. You will then be taken to the Post Anesthesia
Care Unit (PACU). At this time, your surgeon
will
speak with your family, letting them know how
you are doing.
While you are in the PACU, our nurses will be
taking your vital signs and asking you questions
about your
pain, trying to help keep you as comfortable
as possible. When the team feels you are ready,
you will be transferred
to your room on our medical/surgical unit. You
will continue to receive care from our orthopedic
team
throughout your stay in the hospital. Your surgeon,
physical therapist, and nurse practitioner will
check on you after your surgery, and every
day that you
are in the hospital. They will work closely with
the nurses on the floor monitoring your labs,
vital signs, surgical pain and other relevant medical
parameters.
The majority of our patients
undergoing joint replacement surgery will spend 2-3
nights in the hospital. Sometimes patients may be
ready to return home sooner.
Sometimes
patients may require extra support, and desire
to go to a rehabilitation center such as Bodwell
Rehabilitation Center or Winship Green. This
is usually discussed prior to surgery, but the decision
is also dictated by the progress you make with
physical and occupational therapy while at Mid
Coast Hospital after surgery.
A physical therapist will begin
working with you the day of your surgery once you
have gotten
to your
room on the medical/surgical floor. People who
have hip or knee replacements will often stand
or begin
walking the day of the surgery. At first, a walker
or crutches will be used to help with stability
when moving around. Your physical therapist
will show
you how to use these walking devices properly
and work with you to strengthen the muscles around
the new joint. This will help you to regain
range
of
motion and increase your muscle control.
Having a joint replaced is major
surgery. You may or may not have pain after the procedure.
It is
very important not to wait until your pain
is out of control
to let your nurse know that you need pain medication.
Our nurses will help you to stay on top of
your pain control, rather than playing "catch up."
This will
make the
recovery process easier, allowing you to work
more effectively with your physical and occupational
therapists.
Blood transfusions are not always
necessary after joint replacement surgery. However,
sometimes a
blood transfusion is required. This will depend on
your
daily lab work as well as how you are feeling overall.
Please refer to Mid Coast Hospital's pamphlet
"Answers to your questions about blood transfusions"
for further
information. This pamphlet can be obtained through
the Mid Coast Hospital Pre-Admission Teaching
Unit.
Patients are typically discharged from the hospital
with one of two care plans:
- Discharged home with outpatient physical therapy
- Discharged
to a skilled rehabilitation facility for further
inpatient physical therapy
and care. Once a patient is discharged from
the rehabilitation
center, he/she will continue physical therapy
at the facility of his/her choice as an outpatient.
See Mid Coast Hospital's rehabilitation
services.
Your
discharge plan will be determined by you and your
orthopedic care team over the course
of your
stay in the hospital. It is important that
you understand
your discharge plan thoroughly. You should
discuss any questions or concerns you have about
your
discharge plan with your doctor, nurse practitioner,
nurse,
or physical therapist. |
