FAQs About Hip and Knee Replacement

Hip pain and knee pain may come from an injury that happened a long time ago or from a recent trauma, such as a car accident or a fall. You may also experience pain simply as a result of the natural aging process. As we age, the cartilage that cushions our joints wears thin and the bones may begin to rub together or press on surrounding nerves. Oftentimes the hip causes knee pain and vice versa. You may be experiencing pain in your knee but upon examination it's discovered that the source of the problem is actually in your hip.

It might be time for hip or knee replacement when severe pain from arthritis limits your everyday activities such as walking, taking stairs, or getting in and out of chairs. Other reasons to consider knee joint replacement surgery or hip joint replacement surgery include:

• Experiencing moderate to severe hip or knee pain while resting day or night
• Having swelling or stiffness of the hip joint or knee joint that does not improve with rest or medication
• Being unable to move at the hip or having difficulty bending or straightening the knee

Only a doctor can accurately diagnose your condition by performing a physical exam, reviewing your health history, and looking at results from tests, such as an X-ray or MRI. Together, you and your orthopedic specialist will determine if these limiting symptoms justify undergoing surgery.

If surgery is a recommended option, the hip replacement specialists and knee replacement surgeons at Main Line Health, including a medical staff of employed and independent providers. They'll be able to answer all of your questions and help you know what to expect before, during and after surgery.

There are conservative, nonoperative methods of controlling your discomfort. In some cases, physical therapy can help alleviate your pain. You may also benefit from taking medication that blocks the sensation of pain or helps relax your muscles. Oftentimes patients benefit from a combination of physical therapy and medication. Certain patients may need to avoid physical therapy, however, as it may aggravate pain and inflammation. If or when conservative hip and knee treatments fail, and after careful diagnosis and assessment of severity of symptoms, hip or knee replacement may be recommended. One of the hip and knee surgeons at Main Line Health, including medical staff of employed and independent providers, can review your medical history and condition, and help determine a treatment path that's best for you.

Hip replacement and/or knee replacement, often referred to as total joint replacement, is an operation that involves replacing the worn or missing cartilage of the joint. The hip or knee itself is not replaced, but rather a cartilage substitute is placed on the ends of and inside the bones. The prosthetic substitute is a combination of metal alloy and plastic that recreates a healthy space between the joints, allowing for a smooth functioning joint and relief from discomfort, and allowing you to perform normal daily activities.

The hip and knee replacement surgery success rate is greater than 95 percent—meaning, of those who do get surgery, more than 95 percent achieve good to excellent results with relief of discomfort while significantly increasing activity levels and improving mobility.

As with any surgery, there are risks. The most common hip and knee replacement risks are blood clots and infection. After joint replacement surgery, however, complications are rare.

A general rule of thumb is, your stay in the hospital may be considered an outpatient stay if you stay only one overnight. If you stay more than one overnight, you may be considered an inpatient. Depending on your status as an inpatient or outpatient, your surgeon's office may need to contact your insurance company for approval for the surgery. This is called a prior authorization. With certain insurances, you cannot proceed with surgery unless you have this. Be sure your surgeon's office has contacted your insurance company for a prior-authorization.

Inpatient vs. outpatient status for your planned knee replacement surgery or hip replacement can mean that your responsibility/copay is different. Find out which option your surgeon is recommending for you and what your insurance plan covers for inpatient vs. outpatient.

Patients typically go home after one to two nights in the hospital. You will begin physical therapy while still in the hospital, often on the same day as surgery. Your recovery as well as your therapy routine will continue at home.

Your plan for postoperative care should be discussed with your surgeon before surgery. Most people go home to recover following knee replacement after an overnight in the hospital—you will be evaluated both medically and for function by the multidisciplinary care team at Main Line Health, including a medical staff of employed and independent providers. Your discharge plan will adjust to surgeon and therapy recommendations in the hospital.

While most patients go home from the hospital after hip or knee replacement surgery, where you go depends on your progress in the hospital as well as your medical condition and health insurance. A case manager will coordinate your needs, including medical equipment, home services if indicated, or arrangements at a rehab facility, if you are eligible.

Recovery varies from person to person. Generally speaking, however, the better your current health and activity level, the more quickly you'll be back on your feet enjoying the things you like to do in life. It's also essential to follow your surgeon's instructions and exercise program for best results. You should be able to resume most daily activities in the weeks after surgery. Most people gradually increase their activity level at the surgeon's discretion.

Common activities include:

• Recreational walking
• Biking
• Swimming
• Golf
• Doubles tennis
• Bowling
• Dancing

You'll need to avoid high-impact sports, such as jogging, downhill skiing and singles tennis.

It also helps to take a positive and very patient attitude towards recovery. Being patient yet persevering can make a tremendous difference in your first weeks and months of recovery. We work with patients to begin rehabilitation therapy on the same day as surgery. The sooner you start moving, the sooner your recovery begins!

Thanks to cutting-edge protocols and advances in pain control medication, we are able to keep you relatively comfortable after surgery. Your orthopedic surgery team will discuss various pain management strategies with you with the goal of helping you achieve freedom from pain without relying on medication.

This also depends on your current health condition and activity level, but it may also depend on how your individual surgery went. Before your surgery, it helps to have a reliable friend or family member in mind who can help you when you return home if you need extra assistance. In some cases, we may recommend someone be with you for the first few days following your discharge from the hospital. In general, patients can typically care for themselves when they go home but may need extra assistance with household and driving duties. It can be quite helpful to have someone managing your household tasks during the first few days and weeks at home—so you can simply focus on healing and recovery.

It will be the patient's responsibility to make any follow-up appointments with the surgeon and any appointments for outpatient therapy needed. Outpatient therapy prescriptions are given in the hospital if they are part of the postoperative plan. Your surgeon is the one who will direct the type of therapy required. While you're in the hospital, the care coordination staff will meet with you to determine any other support resources available to you upon discharge. They can contact your insurance company on your behalf to see what services you might qualify for.