Thinking About Joint Replacement? Are You A Candidate For Surgery?
What is Arthritis?
- Arthritis is the wear, tear, or breakdown of cartilage that surrounds your joints. This can occur as a result of age, genetics, or significant injury. As the cartilage wears away the spacing between the bones will decrease until bone-on-bone rubbing occurs. This rubbing can cause significant swelling or pain.
- Arthritis of the Knee – OrthoInfo – AAOS
- Hip Osteoarthritis – OrthoInfo – AAOS
What are my treatment options?
- At Orthopaedic Medical Group we offer several non-operative and operative treatment options. For arthritis of the knee or hip we begin treatments more conservatively with treatments such as anti-inflammatory medications, ice/heat, physical therapy or home exercise programs, bracing, or injections of cortisone or stem cell. These options may help at improving your pain but will not reverse the effects of arthritis. If our non-operative treatment options are no longer working, you may be considered a candidate for total joint replacement surgery.
When am I a candidate for Joint Replacement Surgery?
- If you have failed all available non-operative treatments and continue to have pain that affects your ability to exercise or perform activities of daily living, you may be a candidate for total joint replacement surgery. At Orthopaedic Medical Group we take your medical history seriously as certain health conditions can lead to a poor outcome from surgery. Patients who are smokers or use significant narcotic pain medications may not be an immediate candidate for surgery. Additionally, patients suffering from obesity with a BMI greater than 40, or patients with uncontrolled diabetes may not be an immediate candidate for surgery. Having one or more of these conditions can increase your surgical risk of infections, wound complications, or chronic pain after surgery. If you are suffering from one of these conditions, we will provide you with resources to help you become a better surgical candidate.
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 determining your individualized costs for the procedure and can offer different payment options for you.
What Is A Total Joint Replacement?
How is Total Knee Replacement Surgery performed?
- Knee replacement surgery is performed by making an incision along the front edge of your knee and inverting your kneecap to allow access to your knee joint. Afterward, specialized cuts are made along the ends of your thigh bone, shin bone, and the undersurface of your kneecap. Once the bones have been prepared metal implants will be placed on the thigh and shin bones specific to your anatomy. A plastic liner will be placed between the two implants and in most cases, your kneecap will be replaced. Once the implants are placed your skin will be closed with dissolvable sutures and surgical mesh tape.
- Total Knee Replacement – OrthoInfo – AAOS
- Total Knee Animation Nucleus – YouTube
How is Total Hip Replacement Surgery performed?
- Hip replacement surgery is performed by making an incision along the front or back edge of the hip. Muscles surrounding the hip joint are separated to allow access to your hip joint. Your hip is then dislocated to allow better access to the “cup” or acetabulum. Bony spurs and remaining cartilage are removed from this area and a metal cup and plastic liner is placed in the acetabulum. The head of the femur is then removed, and a metal stem and a plastic head are placed on the femur. The hip is relocated and you are taken through some range of motion exercises to ensure that it is a stable joint. Once the implants are placed your skin will be closed with dissolvable sutures and surgical mesh tape.
- Total Hip Replacement – OrthoInfo – AAOS
- Total Hip Replacement – YouTube
What is the difference between surgery performed in the hospital vs the surgical center?
- Total joint replacement surgery in most cases is now a same-day procedure whether performed in a surgery center or a hospital.
- Most total joint replacement surgery is now being performed in an outpatient surgical center where you arrive early in the morning for surgery and are discharged back home to your family within 3-4 hours of surgery. We prefer using the outpatient centers as we can control more aspects of your care to ensure you have the best result possible.
- Joint replacement in the hospital setting is reserved for patients with complex medical conditions or patients whose insurance is not contracted with the surgical center. Patients with complex medical conditions may benefit from having surgery in the hospital setting to better manage these other medical conditions.
- Winter Haven Hospital– 200 Avenue F NE Winter Haven, FL 33881
- South Florida Baptist Hospital– 301 N Alexander St. Plant City, FL 33563
- HCA South Tampa Hospital– 2901 W Swann Ave Tampa, FL 33609
- St. Joseph’s Hospital South– 6901 Simmons Loop Riverview, FL 33578
- Advanced Surgery Center– 1881 W Kennedy Blvd Tampa, FL 33606
- Fishhawk Surgery Center– 13837 Circa Crossing Dr Lithia, FL 33547
What is Robotic-Assisted Total Knee Replacement Surgery?
- Robotic-assisted surgery is specific to knee replacement only at this time and is now offered in our state-of-the-art Fishhawk surgery center. In some cases when there is severe arthritis or deformity, your surgeon may choose to perform your knee replacement with assistance from a surgical robot. This will involve you obtaining a preoperative CT scan in order to gain a 3D view of your knee. This CT scan will allow the robot to assist your surgeon in making very specific cuts on the bone, to ensure an appropriate implant is used. Your surgeon will speak with you during your office visit if you are a candidate for robotic-assisted surgery.
What is the recovery time for total joint replacement surgery?
- You will be up, walking, performing specific exercises, and climbing stairs on the same day of your procedure, however, it can take roughly 6-12 months for your strength, and range of motion to return. Additionally, it can be normal to have pain, stiffness, or soreness for the first year after surgery. These symptoms will improve over time throughout your recovery.
What are the risks of surgery?
- While surgical complications are rare after joint replacement surgery, risks include fracture, dislocations, infection, permanent numbness, stiffness, persistent swelling and tenderness, prominence of surgical scars, pain, weakness, nerve damage, vascular damage, blood clots, recurrence of symptoms, implant failure and need for future surgeries.
What type of approach is used for the Total Hip Replacement?
- Total hip replacement surgery can be performed via an anterior approach or a posterior approach. Our total joint replacement team largely uses a posterior approach.
How long does surgery take?
Total knee replacement surgery can take roughly 45-90 minutes while total hip replacement surgery typically takes 30-60 minutes.
Scheduling My Surgery And The Total Joint Replacement Class
What does the surgical scheduling process look like?
- Once indicated for surgery by our team you will receive a blue packet that contains all preoperative testing orders and preoperative educational materials.
- Within 24-48 hours of receiving the blue packet, you will receive a call from one of our surgical coordinators. The surgical coordinator will help you plan your date of surgery and facility, and help you navigate the preoperative testing needed. Surgery will usually be scheduled within 4-6 weeks of your first appointment.
- You will attend a total joint replacement class within 2-4 weeks of your surgical date to assist with preoperative questions/concerns and ensure you understand the postoperative protocol.
- You will attend a pre-operative appointment to review the results of all testing with your doctor roughly 2 weeks prior to your surgical date.
- After surgery, you will return to the office within 2-4 weeks for postoperative evaluation and X-rays.
Why do I have to come to a total joint replacement class?
- Class attendance is mandatory to ensure you understand the surgical booking process, understand postoperative expectations, recovery time, and pain management protocols. This information takes roughly 30-45 minutes to review and cannot be accomplished during the office visit. While we understand that attending the joint class is a separate event in which you will have to come into the office, this course significantly helps to decrease complication rates and ensures you are prepared for the major procedure you will be undergoing. Roughly 8-10 classes are offered each month in 7 locations. Your surgical coordinator will schedule you for a course date at the time of surgical scheduling.
What pre-surgical testing is ordered?
- Most patients will need to undergo blood work, EKG, medical clearance, and MRSA testing. Orders will be provided the day you are indicated for surgery in the office, however, results are due back to our office by at least 2 weeks prior to surgery to avoid cancellation. If you suffer from heart, lung, vascular, or neurologic conditions we may also request special testing or clearances from a specialist such as a cardiologist to ensure you are safe to proceed with surgery.
- Meet with your primary care doctor 4-6 weeks before surgery to work on improving your health to decrease the risk of surgical complications (control diabetes, stop smoking, decrease chronic narcotic use, weight loss).
- Begin pre-surgical testing & make sure is received by our office 2 weeks before surgery
- Begin your home exercise program 2-3x per week
- STOP the following medications 2 weeks before surgery (NSAIDs, fish oil or turmeric supplements, blood thinners).
- Remove any fall hazards in the home
- Make sure you have access to a two-wheeled walker
- Schedule your first visit with PT
The Importance Of Physical Therapy
Why Physical Therapy will make or break your surgical success
- Once the surgery is completed, it is your responsibility to ensure that you regain strength, and range of motion, especially in the case of total knee replacement surgery. Physical therapy is very important in helping you reach your goals early on after surgery. Lack of physical therapy can lead to deficits in strength, and range of motion, which then leads to chronic pain. It is important that you begin physical therapy immediately after surgery.
What is the difference between Home Physical Therapy and Outpatient Physical Therapy?
- Home physical therapy is used for the first two weeks after surgery while it may still be difficult to drive yourself to a facility. A physical therapist will come to the house 2-3 days per week for the first two weeks to help you navigate your home and perform exercises. Home therapy is not covered by every insurance plan. If your insurance does not cover this service, it will not impact your recovery if you commit to continue to perform the exercises provided every day. Outpatient physical therapy is a physical location you will need to go to. This begins no later than 2 weeks after surgery. In cases where your insurance does not cover home therapy services, you will need to be in outpatient physical therapy within the first week of surgery. Outpatient physical therapy has access to more space, equipment, and modalities to get you back to all your normal activities.
The importance of attending OMGPT
- Orthopaedic Medical Group offers physical therapy services in three locations. The teamwise approach we use in the office extends to our physical therapists. This means your surgeon can easily keep up with your progress after surgery and individualize your treatment plan to ensure the fastest recovery.
Pain, Recovery Time, & Post-Surgical Concerns
Post-surgical wound care
- The preferred wound closure system is the Dermabond Prineo skin closure tape. With this system, you will have sutures underneath the skin which will absorb with time. On top of these sutures, a clear piece of tape is placed. This tape creates a barrier between the incision and outside bacteria. The use of this tape allows you to begin showering normally within 24 hours of your procedure. You are not able to soak the area in a body of water. Additionally, you have no wound care with this system. You may remove the outer dressings 24 hours after surgery but should not have to perform dressing changes or clean the incision with special solutions. The tape will stay in place for about 14 days.
Goals and phases of recovery
Phase I: 0-2 weeks after surgery
- Remove outer dressings 24 hours after your procedure
- Begin home exercises 2-3 times daily for the first two weeks
- Transition to outpatient physical therapy as soon as possible
- Continue to ice/elevate the leg for swelling control
- Decrease narcotic pain medication use
Phase II: 2-6 weeks after surgery
- Continue outpatient physical therapy and exercises at home (knee replacement patients should focus heavily on range of motion at this time)
- Stop all narcotic pain medication use
- Continue to ice/elevate the leg for swelling control
Phase III: 6 weeks to 3 months after surgery
- Continue outpatient physical therapy as needed and graduate to performing exercises at home or in the gym to improve your strength
- Begin returning to exercises such as golf, swimming, and biking as tolerated
- Continue ice/elevate the leg for swelling control after significant activities
Phase IV: 3-12 months after surgery
- Continue exercises at home or in the gym to improve strength
- Gradually return to all activities as tolerated by 12 months after surgery
What are normal signs & symptoms after surgery? What to look for that indicates advanced medical care is needed?
- Difficulties walking/sleeping
- Pain with motion
- Fevers over 102
- Drainage from the incision site
- Calf pain
- Inability to bear any weight on the leg
How to contact us for help
- If you are having a medical emergency such as chest pain or shortness of breath, call 911. Contact our office immediately if you are having any abnormal signs or symptoms listed above. Many abnormal symptoms can be managed in the office so that you do not have to go to an ER or urgent care following surgery. Returning to our office ensures that you are receiving appropriate care for any of the abnormal symptoms listed above.
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 will hip or knee replacement 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, and active, consume 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.
Do I need to go to a rehabilitation center after surgery?
- Our preference is always to send our patients to the safest place for recovery. In many cases, you are safe to recover in the comfort of your own home. Rehabilitation facilities are reserved for patients who have severe chronic medical conditions and require 24/7 skilled care following surgery. While your insurance plan may state that they cover rehabilitation services, you must first medically qualify for this care. We cannot guarantee that you qualify to attend a rehabilitation center prior to surgery as this decision is made based on your medical status, and progress after surgery. You will speak with a case manager in the hospital regarding this decision.
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.
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.