Some of those fears may come from friends and family who’ve shared stories of their own surgeries that happened years ago. However, joint replacements have improved significantly in the last decade, says Kristopher Collins, MD, an orthopedic surgeon with OrthoVirginia in Lynchburg. Those improvements, like better surgical techniques, pain management and advancements in joint implants, allow patients to recover faster and get back quickly to their favorite activities.
“By the time patients get to me, 20 to 30 percent of them have joints in pretty bad shape,” says Dr. Collins. “These patients are already losing a lot of function and ability to do the things they want to do.” Wait too long to seek treatment, and you’ll extend your rehab time, because the more inactive you become, the more the muscles weaken. The weaker your muscles are, the more they’ll need to be built back up after surgery. “I try to caution patients against getting to the point where function and activity are decreasing significantly,” Dr. Collins says.
If you’ve been stalling on a possible joint replacement, read on for expert advice on navigating every stop to create your own roadmap to success, and get on the road to recovery from joint pain.
Stop I: The Consult
Yellow Light Thought: “I’ve overwhelmed by the whole process. I don’t know which surgeon to choose and how to get started.”
Green Means Go: Just take the first step!
Start with your primary care doctor, and find out if your insurance requires a referral to see an orthopedic surgeon—the type of specialist who does joint replacements. Your doctor may recommend a surgeon, and you can talk with friends, family and colleagues for their recommendations if they’ve had a joint replacement. Book an appointment for a consult with the recommended surgeon to discuss your options.
At the consult phase, your surgeon should take the time to discuss your fears and give you the real facts. Write down your questions and concerns on a piece of paper, and bring them with you to your appointment, along with any imaging studies (X-ray, etc.) of your joint. Ask about your doctor’s experience with joint replacement, and what he or she expects for your surgery day and recovery. If you aren’t comfortable with the first surgeon you see, make an appointment for additional consults until you find someone that you trust. Make sure you call your insurance company or speak with the surgeon’s business manager to understand what your financial responsibilities will be.
Stop 2: Surgical Joint Replacement
Yellow Light Thought: “I don’t want to be in hospital for days. And will my joint pain really go away?”
Green Means Go: Many patients can be discharged the day after surgery, and most wake up from surgery with an immediate feeling of pain relief.
A majority of joint replacements are due to arthritis—which can occur as early as the 20s or 30s. “The cartilage on the end of your bones wears away with age, and you have pain because your body perceives it as an injury,” explains Dr. Collins. “Your body is trying to heal it, but the problem is, it can’t be healed because the body can’t remake cartilage.”
In a joint replacement, the old cartilage is removed, and the joint is replaced with metal and plastic. The body no longer tries to respond, and the pain goes away, sometimes immediately. “Hip patients usually know as soon as they wake up [from surgery],” says Dr. Collins. “The deep aching pain is gone. There is temporary pain from the surgery, but that’s going to get better in a couple of weeks.”
Patients who have stable medical problems are able to have both knee and hip replacement in an outpatient setting. These patients go home the same day. All others can expect to be discharged within 24 hours from the hospital.
Stop 3: Recovery & Rehabilitation
Yellow Light Thought: “Will I be in a lot of pain from the surgery? Will I have to be transferred to a rehab facility? When will I be able to return to the activities I love?”
Green Means Go: Physical therapy is no longer a necessity for most people after joint replacement and many get back to regular activities quickly.
In the decades since joint replacement became a mainstream treatment option for joint deterioration and pain, doctors and researchers have learned a lot about what patient require to return them to the mobility they desire, says Dr. Collins. “Very few patients go to physical therapy and ten percent or less of our patients are going to a rehab facility or skilled nursing facility…the day after [surgery] for hips, most people are walking as well as the day before their surgery,” he says.
While knees can take a little longer to heal, as more nerves may be affected during knee surgery, Dr. Collins says patients still often experience an immediate relief of the pain that had been dogging them, sometimes for years. The surgical pain is temporary, but the deep ache is gone.
“I think a lot of patients worry about pain both during and after surgery, but we’ve come so far in the field or orthopedics on pain control around surgery,” Dr. Collins says. “Many patients are surprised by how well they’ve done—many don’t need narcotics.”
In Dr. Collins’ practice, the physician and the care team work closely with each patient to be sure that pain while in the hospital and during recovery is manageable and well-controlled with appropriate medications.
As for getting back to the golf game, or back to the walks with friends?
“I tell patients that I expect them to be able to return to all activities they want to do,” Dr. Collins says, “And that they should expect that, too.”