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Quality & Safety

Frequently Asked Questions

What is joint replacement surgery?

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.

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
  • 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.

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?

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.

How long will my new joint last?

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.

Is joint replacement surgery common?

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.

What are the risks with joint replacement surgery?

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.

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.

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. 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.

What will happen on the day of my 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.

How long will the surgery take?

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.

What can I expect while I am in the hospital?

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.

Will I need a blood transfusion after my joint replacement surgery?

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.

What happens when I am discharged from the hospital?

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.

The Mid Coast Center for Joint Replacement
123 Medical Center Drive, Brunswick, Maine 04011
Phone: (207) 386-0418
Mid Coast Medical Group-Orthopedics
430 Bath Road, Brunswick, Maine 04011
Phone: (207) 442-0350