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The Mid Coast Center for Joint Replacement

Call us: (207) 442-0350

Joint Replacement
Joint Replacement FAQs

Joint Replacement
FAQs

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What is joint replacement surgery?

Joint replacement surgery involves removing the damaged portion of a joint, replacing it with new metal and plastic components. Joint replacement surgery will help relieve pain and restore function to the affected joint.

Who is a candidate for joint replacement surgery?

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, bracing, and/or joint injections. Usually a combination of non-operative techniques is tried prior to surgery.

Why is joint replacement sometimes necessary?

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.

What will my new joint be like?

How do I know it’s time to have a joint replacement?

The timing of your join replacement is up to you. If your pain is an occasional inconvenience, it may be best to wait. If it is bothering you and significantly impacting your life every day, or preventing you from sleeping, working, or doing the things you want to do, and non-operative treatments have failed, it may be time to consider a replacement.

Is joint replacement surgery common?

As the American population continues to age, joint replacement surgery is becoming more common. Research has shown that even if you are older, joint replacement surgery can relieve joint pain and help you move around more easily.

Do I need a medical evaluation before joint replacement surgery?

Yes. You should be evaluated by your primary care provider to ensure you are in optimal health to undergo the surgery. If you have a medical issue (heart, lung, kidney, etc.) that needs to be addressed, it should be taken care of prior to surgery. Chronic conditions, such as diabetes, should be controlled as well as possible to minimize surgical risks.

Do I need to have physical therapy before surgery?

No, you do not need physical therapy before surgery. However, it is important to remain generally active, strong, and flexible as this will make your recovery easier. Patients who are deconditioned prior to surgery may have more difficulty with their recovery.

What complications could occur and how do you prevent them?

What steps do I need to take to have joint replacement surgery?

In general, joint replacement is a very safe procedure and major complication rates are very low (in the 1-2% range). Certain medical conditions can increase your risk of complications, which is why it is important to optimize your health prior to surgery.

  • Infection is a very rare but potentially serious complication. Certain types of infections can be treated with antibiotics alone, others require repeat surgery, and severe or chronic infections may require removal of all of your implants and a delay prior to reimplantation of another replacement. Your procedure will be performed using sterile surgical techniques and you will receive intravenous antibiotics before, during, and after your operation.
  • Blood clots can form in your legs and can also travel to your lungs. Although rare, a blood clot in your lungs (pulmonary embolism) can be harmful and even fatal. You will have compression stockings, pneumatic boots, and a medication (usually aspirin) to prevent blood clots after your surgery.
  • Injury to nerves or blood vessels is rare but can occur. Surgical retractors are used to safely protect nerves and blood vessels in the surrounding area to avoid injury.
  • Stiffness can occur after joint replacement and can lead to discomfort. We test different sizes of implants during surgery to choose the ones that will give you the best motion and stability. Physical therapy after surgery is critically important to maximize your range of motion and this will begin immediately after your operation.
  • Bleeding occurs to a small degree during all joint replacements. If your blood count is low prior to surgery, you may require a blood transfusion after, although this is extremely rare after a joint replacement. A tourniquet and electrocautery are used to reduce bleeding, and also give an intravenous medication to reduce blood loss during and after the operation.
  • Medical complications including heart attack, stroke, and kidney failure are rare but can occur. This is another reason to optimize your health prior to surgery. Mid Coast Hospital has a dedicated team of physicians available to assist with medical complications that arise. Medications can also be given to prevent and treat minor issues such as nausea and constipation.
  • Loosening, breakage, or failure of the joint replacement can happen, but this is very uncommon and may happen years later. This may require more surgery to fix. While these complications may arise, the majority of joint replacements should last the rest of your life.

Will my surgery be successful?

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. A successful joint replacement should provide you with decades of pain-free activity.

What type of implants do you use?

There are a variety of implants available based on your individual anatomy. They come in different shapes, sizes, and types and your surgeon will discuss these with you.

What steps do I need to take to have joint replacement surgery?

  • 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.
  • Meet the surgeon: When you come to Mid Coast Medical Group–Orthopedics, one of our orthopedic surgeons will do a thorough history and physical examination of your joint. X-rays can be taken right at our office, and reviewed by your doctor during your 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 Mid Coast Medical Group–Orthopedics staff will assist you in arranging dates for your surgery and for the necessary preoperative testing at Mid Coast Hospital.
  • Preoperative education: The office staff at Mid Coast Medical Group–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. A physical therapist will also review what to expect after your surgery.
  • Preoperative testing: After your appointments, you will have the pre-surgery lab work and testing required. This may include a blood test, urine test, EKG, or a chest x-ray. Depending on your current health status and health history, you may need to see your primary care provider before your surgery.

What will happen on the day of my surgery?

How long will the surgery take?

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.

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 mark the surgical site.

You will also meet your anesthesiologist who will discuss the different anesthesia options with you. Your joint replacement can be done under general anesthesia (fully asleep with a breathing tube) or spinal anesthesia (an injection into your lower back that numbs you from the waist down). This will be up to you and your anesthesiologist.

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 and warm blankets will be provided 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.

How long will the surgery take?

The surgery itself usually takes between 1-2 hours. After the surgery is completed, your wound will be closed with an absorbable suture beneath the skin and skin glue on the surface, so there is nothing that needs to be removed.

When the team feels you are ready, you will be transferred to your room on our medical/surgical unit. Your surgeon, physical therapist, and orthopedic providers 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.

What will I have for pain medication after surgery?

Having a joint replaced is major surgery. You may or may not have pain after the procedure. In addition to the anesthesia (spinal or general) you received during the surgery, we inject local analgesic medication in and around the joint to lessen the pain. After surgery, you will be given Tylenol and a strong intravenous anti-inflammatory medication around the clock while you are in the hospital. Our nurses will help you to stay on top of your pain control. Additionally, we will discuss pain medications that you can take at home.

How long will I be in the hospital?

The majority of our patients undergoing joint replacement surgery will spend 1-2 nights in the hospital. Sometimes patients may be ready to return home sooner and some will stay longer than two days, but most will be discharged two days after surgery.

Will I go home or to a rehabilitation facility?

The majority of patients will go home. This will depend on your mobility after surgery and your living situation. Our dedicated team of physical therapists will assess you and help prepare you to take care of yourself after discharge. Sometimes patients may require extra support, and desire to go to a rehabilitation center such as Mid Coast Senior Health Center’s Bodwell Rehabilitation.

How long is the recovery?

Everyone is different, but generally it takes 6-8 weeks before returning to strenuous activity. You will be able to do simple things right away, such as getting around your house, and will even go up and down stairs before you leave the hospital, but it may take several weeks before you feel comfortable walking long distances. You will use an assistive device (walker, cane, or crutches) at first but should only need it for a few weeks.

Do I need to have physical therapy?

Absolutely. Physical therapy is very important after joint replacement because the joint tends to get stiff after surgery. You should work on your motion every day under the guidance of a physical therapist. Whatever motion you achieve in the first few months after surgery will be a good indication of the motion you will have forever, so work hard to regain as much motion as possible. You will probably require an assistive device (walker, cane, or crutches) for a few weeks.

When can I drive?

Everyone is different but, on average, you should be able to drive 2-4 weeks after a joint replacement. There may be additional limitations depending on medications. If you are unsure, please consult your doctor or pharmacist before driving.

When can I go back to work?

It depends on what you do. If you sit at a desk, you can go back as soon as you feel comfortable, are off narcotic medications, and can travel to work, even within a week or two. If your job is more physically demanding, it may take several weeks or even months. This will be discussed with you on an individual basis.

After my initial recovery, can I do anything I want?

Yes. You can do anything you want with your new joint including running and jumping, and other activities. With hip replacement, repeated high-impact activities should be limited as this may lead to the implant loosening, breaking, or wearing out.

Do I need to take antibiotics before dental procedures?

Yes. There is not overwhelming evidence that this is necessary, but any time bacteria enter your blood stream (such as from dental work), your artificial joint can become infected because it does not have an immune system to protect itself. An infected joint replacement can be a serious problem, so taking one dose of an antibiotic before dental work is worth it. Our surgeons can provide you with the antibiotic and discuss it with your dentist as well.

Will my joint replacement ever wear out or need to be redone?

The technology of joint implants has improved in recent years, so it very unlikely that your joint replacement will “wear out.” Other problems can occur including infection, loosening of the implant from the bone, or fracture of the bone around the implant, and any of these problems could require revision surgery. For the vast majority, however, this joint replacement will last the rest of your life.


 

 

 

 

 

 
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