Q: Joint Replacements: What Are the Basics?
A: If you've decided to have a joint replacement, you
probably have many questions. But you need answers, so you can get back to your
activities and life! First, the basics: in joint replacement surgery part of your
arthritic or damaged joint is removed and replaced with a metal, plastic or
ceramic device called prosthesis. The prosthesis is designed to replicate the
glide of a healthy joint. Joint replacement surgeries are common and occurring
in younger patients; in 2011, almost 1 million total joint replacements were
performed; most commonly the hip and knee. Other joints, such as the ankle,
wrist, shoulder and elbow can be replaced too.
Q: Why Do I Need A Joint Replacement?
A: Dealing with the pain of a worn down or injured hip or
knee joint can take its toll. It's physically and mentally draining to deal
with the constant ache and avoid daily activities. Joint replacement surgery
involves removing the damaged joint and replacing it with new, shiny parts. It's
a fairly common surgery, so you may know others who have had these operations.
Reasons for joint replacement include:
- · Joint pain, stiffness due to arthritis
- · Negative affect on quality of life
- · Bone damage from accident or injury
- · Medical treatment failure
- · Joint deformity
Q: What's Involved In Hip Replacement Surgery?
A: You'll arrive at the surgery center, most likely early in
the morning for a hip replacement. You are usually given a general anesthetic
and spinal or local pain medication to keep you asleep and control pain. An
incision is made into the skin and through the muscles to reach the hip joint.
The diseased bone and cartilage are removed, but the healthy parts of the joint
are left intact. The surgeon replaces the head of the femur (thigh bone) and
hip socket (acetabulum) with new, artificial parts. These new parts allow a
more natural gliding motion of the joint. The surgery usually lasts 2 to 3
hours, but varies. You'll stay in the hospital for a few days, most likely.
Q: What's Involved With a Knee Replacement?
A: With a knee replacement, the surgeon will remove the
damaged knee joint and resurface the knee joint with a piece made of metal and
plastic. The new joint is attached to the intact bone with surgical cement, or
it may also contain uncemented pieces, which grows to a porous surface on the
bone. The replacement joint is usually made of 3 components: 1. tibial (shin
bone) component; 2. femoral (thigh bone) component; 3. a patellar (kneecap)
component which prevents the kneecap from rubbing against the thighbone.
Surgery can last 1-3 hours; you'll be in the hospital for 1-3 days but may be a
candidate for outpatient surgery, too.
Q: How Will A New Joint Affect Me?
A: Each person has an individual response to surgery. Most
have a successful procedure and their quality of life will be greatly enhanced.
Follow all your doctor's directions; including physical therapy, medicines,
diet, and at-home exercise programs. Possible complications of a new joint may
include infection, blood clots, dislocation, wear and tear, joint loosening,
and infrequently, nerve damage. Medicines like antibiotics can be used for
infections, and blood thinners are given for blood clots. Most new joints
typically last 10 to 15 years, so if you are younger when you have your surgery
you may need more than one replacement.
Q: What Happens After Surgery?
A: Your care team at the hospital will have you up and
moving your new joint the next day after surgery. Physical therapy will focus
on range of motion and strengthening exercises. You will need support at first,
like a parallel bar, walker, cane, or crutches to help support your full
weight. You are given pain control medications to help with physical therapy,
so don't be too worried about that. After surgery it's often easier to prevent
pain than treat it after its set in, so request analgesia at the first sign of
pain. In 2 to 5 days, you may go home if you have help, or to an extended care
facility to re-learn your daily activities like bathing and dressing. You may
also have several months of outpatient physical therapy to strengthen your
surrounding muscles.
Q: What Other Options Do I Have?
A: If you have an upcoming hip or knee joint replacement,
you've probably tried other options first. Over-the-counter (OTC)
anti-inflammatory medicines like NSAIDs are usually initial therapy, and local
corticosteroid or lubricating shots may provide relief. Physical therapy,
walking aids such as braces or canes, and periods of rest may be tried.
However, you may get to the point that you can't do regular activities, like
bathing, walking upstairs, or even walking down the block. It's at this point
that your doctor may recommend consultation with an orthopedic surgeon for
evaluation, if you also agree to surgery as a possible solution.
Q: What about A Minimally Invasive Procedure?
A: Minimally invasive surgery uses a smaller incision and
can result in less post-operative pain, a shorter recovery time, and a smaller
scar. This kind of surgery often requires special equipment not available in
all hospitals. Unfortunately not everyone is a candidate for minimally invasive
joint replacements. In general, candidates for minimal incision procedures are
younger, healthier, not overweight, and more motivated to participate in the
rehabilitation process. Ask your surgeon if you are a candidate, if minimally
invasive procedures are available in your area, and if there are doctors that
are trained in this special procedure.
Q: How Is Pain Managed After Joint Replacement Surgery?
A: Rest assured that every effort will be made to control
your post-operative pain. Treating your pain will allow you to more easily
start your rehabilitation program, too, which will speed you to your full
recovery. Pain management may include:
- · IV or oral opioids (like morphine, meperidine), also used in patient-controlled analgesia
- · Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen and diclofenac
- · Acetaminophen (Tylenol)
- · Local anesthetics like lidocaine, bupivacaine, and ropivacaine; may be used in epidural anesthesia.
Q: Should I Be Concerned About Possible Blood Clots?
A: One of the major risks with any surgery, but especially
joint replacement, is a clot formation, either a deep vein thrombosis (DVT) or
a pulmonary embolism (PE). A DVT is the formation of a clot in a deep vein,
often in the leg. A PE is a clot that travels to the lungs and blocks the flow
of blood to the lungs and heart. To help prevent a clot, your doctor will
prescribe ways to lower your risk:
- · Exercises to improve circulation
- · Elevation of limbs
- · Pneumatic compression and compression stockings
- · Medications known as anticoagulants (blood thinners)
Q: What Are Anticoagulants?
A: Your doctor will decide which blood thinner will best
protect you from a clot, but how do these drugs work? Anticoagulants don't
actually "thin your blood" but block certain coagulating factors that
promote blood clotting. Be sure you understand the safe use of your blood
thinner by discussing with your doctor and pharmacist, as your risk of bleeding
in general will be increased while taking these medications. Depending upon the
drug, they can be given either by injection or in an oral pill.
- · Coumarins like warfarin
- · Low molecular weight heparins like enoxaparin
- · Factor Xa inhibitors like Arixtra, Eliquis, or Xarelto
Q: I Wonder What Others Have Experienced.
A: Group support is a great way to gain confidence prior to
surgery. Joining the Drugs.com Hip Replacement Support Group or the Knee
Replacement Support Group is a great way to discover others with related
questions and similar concerns, to read news, and share your own experience.
Maybe you have questions about how the stairs or bathing are handled. What are
some useful ways to spend your recovery time at home? Do you have questions
about medication costs or insurance coverage? Any of these topics can be fair
game. But remember, your healthcare provider is always the best source for
individual medical and drug information.
Q: Your Job? Ask Even More Questions.
A: Having joint replacement surgery requires preparation.
Open communication with your doctor is very important to ensure success.
Consider taking a family member or friend to your appointments to lend a hand,
provide morale support, and help record answers to questions such as:
·
How do I prevent the most common complications?
·
If I don't have surgery, what is the risk?
·
What will be my restrictions, if any, after I
recover?
·
How will my pain be managed?
·
How can I contact you after surgery for an
emergency?
No comments:
Post a Comment