Joint cartilage is a tough, smooth tissue that covers the ends of bones where joints are located. It helps cushion the bones during movement, and because it is smooth and slippery, it allows for motion with minimal friction. Osteoarthritis, the most common form of arthritis, is a wear and tear condition that destroys joint cartilage. Sometimes, as the result of trauma, repetitive movement, or for no apparent reason, the cartilage wears down, exposing the bone ends. Over time, cartilage destruction can result in painful bone-on-bone contact, along with swelling and loss of motion. Osteoarthritis usually occurs later in life and may affect only one joint and many joints.

The term total hip replacement is somewhat misleading. The hip itself is not replaced, as is commonly thought, but rather an implant is used to recap the worn bone ends. The head of the femur is removed. A metal stem is then inserted into the femur shaft and topped with a metal or ceramic ball. The worn socket (acetabulum) is smoothed and lined with a metal cup and either a plastic, metal, or ceramic liner. No longer does bone rub on bone, causing pain and stiffness.

The term total knee replacement is misleading. The knee itself is not replaced, as is commonly thought, but rather an implant is used to recap the worn bone ends. This is done with a metal alloy on the femur and a plastic spacer on the tibia and patella (knee cap). This creates a new,
smooth cushion and a functional joint that can reduce or eliminate pain.

Partial knee replacement is a minimally invasive surgical procedure that resurfaces the worn, arthritic surfaces of the knee joint with metal and plastic components.  If the arthritic surfaces are confined to one area of the knee, partial knee replacement may be an option.

The knee joint is made up of three bones—the femur (thighbone), the tibia (shinbone) and the patella (knee cap).  The femur contacts the tibia with two areas, called condyles—the medial condyle and the lateral condyle.  The underside of the kneecap also contacts the femur and tibia as it glides along the groove in the femur.  Any of these three areas of contact can fall victim to the wear and tear effects of arthritis—causing pain, heat, stiffness and swelling. Total knee replacement involves the replacement of all three surfaces with metal and plastic components. If arthritis is limited to either the lateral or medial compartment of the knee, partial knee replacement may be considered.

Knee or hip replacement surgery may be considered for those suffering from arthritic pain that severely limits the activities of daily living.  It is only recommended after careful examination and diagnosis of your particular joint problem, and only after more conservative measures such as exercise, physical therapy and medications have proven ineffective.

All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition(s). A total joint implant’s longevity ,will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specified length of time.

Most surgeries go well, without any complications. Infection and blood clots are two serious complications. To avoid these complications, your surgeon may use antibiotics, blood thinners or compression devices. Surgeons also take special precautions in the operating room to reduce the risk of infection.

You will get out of bed as soon as it is safe to do so, possibly the same day as surgery. The next morning all patients will get up, sit in a chair or recliner, and should begin walking with a walker or crutches. Most patients will be hospitalized for two to three days after surgery. There are several goals that must be achieved before discharge.

You can still return directly home from the hospital if you have someone to help you at home.  Talk to your coach, relatives or friends and determine if someone or different people can stay with you after your surgery to help out until you become more independent.  If you do not think you will be able to go directly home from the hospital, visit local skilled nursing facilities to determine where you want to go for rehabilitation until you become independent enough to return home alone.  For specific questions or concerns, contact the Joint Care Coordinator at 503-435-6571 to discuss your options.

After your surgeon has scheduled surgery, you will receive a letter in the mail outlining your pre-operative appointments and surgery date and time.  The Joint Care Coordinator (JCC) will also contact you to schedule your pre-operative class and Hospitalist consultation.  The JCC will guide you through the program, answer your questions and help determine any equipment or discharge planning needs you may have.

The hospital reserves approximately 2 hours for surgery.  Some of this time will be taken by the operating room staff to prepare for surgery.  Some patients may have a general anesthetic, which most people call “being put to sleep”.  However, most patients prefer to have a spinal anesthetic, which numbs the leg and does not require you to be fully asleep.  You can discuss this further during the pre-operative process when you meet with an anesthesia provider prior to surgery.

You will have some discomfort following the surgery, but we will try to keep you as comfortable as possible at all times.  Proper pain management is one of our primary goals after surgery because with good pain control, patients can get up and moving more easily.  Pain after surgery is quite variable from person to person, and not entirely predictable, but modern medications and improved anesthetic techniques greatly enhance our ability to control pain and discomfort after surgery.

If you have a knee replacement, surgical scars will vary in length, but most surgeons will make it as short as possible. It will be straight down the center of your knee, unless you have previous scars, in which case your surgeon may use an existing scar. There may be lasting numbness around the scar.

If you have a hip replacement, There are a number of different techniques used for hip replacement surgery. The type of technique will determine the exact location and length of the scar. The traditional approach is to make an incision lengthwise over the side of the hip. Your surgeon will discuss which type of approach is best for you. Please note that there may be some numbness around the scar after it is healed. This is perfectly normal and should not cause any concern. The numbness usually disappears with time.

We recommend all patients begin by using a front wheeled walker immediately following surgery.  If you are comfortable on crutches and have used them in the past, we will try to progress you to crutches prior to leaving the hospital. Patients progress at their own rate and wide variability exists for how long a patient will use an assistive device.  This determination will be made on an individual basis based on each patient’s progress.  You may ask your surgeon or joint care coordinator about this for more specifics. The Joint Care Coordinator can help you obtain these assistive devices if necessary.

Most patients are able to go home directly after discharge. Some patients may transfer to a sub-acute rehab facility, where they will stay until they are safe to discharge home. The Joint Care Coordinator will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have sub-acute rehab benefits. 

Yes.  For the first few days or weeks, depending on your progress, you will need someone to assist you with meal preparation, household chores and possibly daily activities.  Preparing ahead of time, before your surgery, can minimize the amount of help needed.  Having the laundry done, house cleaned, yard work completed, clean linens put on the bed, and frozen meals prepared will help reduce the need for extra help.  Talk to your coach, relatives, friends and even neighbors, to determine who can help you and in what capacity when you return home.  If it is determined that you will need home healthcare services at home, the hospital will arrange this for you during your hospital stay. 

For patients with a total knee replacement:  Yes, you will have either outpatient or in-home physical therapy.  Patients are encouraged to utilize outpatient physical therapy whenever possible.  The Joint Care Coordinator will help you arrange for an outpatient physical therapy evaluation the week after your surgery.  If you need home health physical therapy, we will arrange this during your hospital stay.  Following this, you may go to an outpatient facility two-three times a week to assist in your rehabilitation.  The length of time for this type of therapy varies with each patient, depending on progress and the patient’s long-term goals.

For patients with a total hip replacement:  You will need to discuss this with your surgeon.  If you do not have formalized outpatient therapy, you will still be expected to complete your daily home exercise program two times/day.

Your joint replacement is made of a metal alloy and may or may not be detected when going through some security devices. Inform the security agent you have a metal implant. The agent will direct you on the security screening procedure. You may carry a medic alert card indicating that you have an artificial joint. Check with your surgeon on how to obtain one.