Joint Replacement Portal

How long do I have to stay in the hospital?

Most patients return home from the hospital on the first or second day after surgery. For some patients, joint replacement can be performed as an outpatient procedure. Outpatient total joint replacement allows a patient to have their total knee, total hip or total shoulder performed at a surgery center (NOT in a hospital) where they DO NOT spend the night. Patients generally have their procedure completed in under an hour and then go to the recovery room. After their anesthesia has worn off (usually about 30-45 minutes), they are mobilized to a chair.

How long does the surgery take?

Dr. Goldsmith uses a team of anesthesiologists, surgical technicians, physician assistants
and nurses that allow the procedure to be done in a safe and efficient manner. In general, total knee replacements take about 45-60 minutes and total hip replacements take about 35-45 minutes.

How long will a hip or knee replacement it last?

This is best determined by 2 variables:

1) The person performing the surgery. You should select a surgeon who performs high volumes of total joint replacements. Currently, Dr. Scott Goldsmith performs around 350-400 total joints per year.

2) the patients themselves – the patient who remains thin, active, consumes a healthy diet and avoids high-impact activities (jumping, long distance running) has a better chance of extending the life of the implant. There are published studies showing both total hip and total knee replacements lasting greater than 20 years. As the average life expectancy of a male (~76yo) and a female (~81yo) here in the USA is about 79yo, most patients should expect their joint replacement to outlast them.

What hip approach does Dr. Goldsmith use?

Dr. Goldsmith prefers the posterior approach. This remains the GOLD STANDARD approach for hip replacement surgery. My patients get out of bed and walk about 45-60 minutes after the surgery and most return home the day after the surgery. Most patients DO NOT have a limp.

How long will I be down after surgery?

Patients are out of bed and walking as soon as 45 minutes after their surgery, once their anesthesia has worn off. Our therapists encourage patients to be up and out of bed as much as possible. You can expect to ambulate as much as you can tolerate.

Hip & Knee Replacement

Will my insurance cover the surgery?

Every insurance plan is unique and variable. You should check with your insurance company to best determine associated costs for your surgery, hospital stay, anesthesia care, home and out-patient physical therapy and medications. In general, most insurance companies will cover ~90% of the costs for a total joint replacement. Also, our office staff will assist you in determine your individualized costs for the procedure, and can offer different payment options for you.

What are the risks of surgery?

As with any major procedure, there are risks of bleeding, infection, injury to arteries or nerves, fracturing bones, blood clots and anesthesia complications. Specific to total hip replacement surgery, there is the risk of leg-length inequality (your legs might be slightly different lengths) and hip dislocation. All of these risks are uncommon, but can vary from patient to patient depending on their individual risk factors.

Will I buzz at the airport?

You will receive a card from our office that documents your joint replacement. Nonetheless, most airport scanners will NOT alarm due to your prosthesis.

Do I need to go to a rehabilitation center after surgery?

Patients are generally encouraged to go home after surgery rather than to a rehab facility.

What are my restrictions after surgery?

The total knee replacement patients have no specific restrictions. The total hip replacement patients will be instructed on universal posterior hip precautions so as to avoid hip dislocation. Although the therapists and nurses teach these precautions, I do not have my patients overly concerned or worried about hip dislocation. Dr. Goldsmith does not use large pillows between the legs. He allows his patients to sleep on either hip immediately after surgery. Caution with low seats in cars and toilets is warranted for about the first 6 weeks.

For the pre-op patient:

  1. Medical Clearance
    • ALL patients must receive medical approval for surgery
    • need for cardiac clearance determined by primary care physician
    • all pre-op labs must be done within 30 days of surgery date
  2. limiting all narcotic use
    • multiple studies demonstrate WORSE outcomes from those patients taking narcotics prior to their joint replacement
    • non-narcotic options include: Tramadol, Motrin 800mg, Flexeril, Gabapentin
  3. quit smoking and cessation of all nicotine products

For the post-op patient:

  1. wound care
    • dressing to be left alone; there is no reason to change it
    • do NOT get dressing wet until after 1st post-op visit
  2. DVT prophylaxis
    • ASA 325mg once daily
    • for patients with history of blood clot – Lovenox 40mg SQ daily x 14 days
    • for patients on Coumadin – may restart Coumadin on day of surgery, Lovenox 40mg SQ daily until INR therapeutic
  3. home PT
    • will be arranged by social workers on POD #0 and 1, pending insurance
  4. first office visit
    • will be scheduled pre-operatively, normally 10-14 days after surgery
    • first visit often supervised by a Physician Assistant