What Is A Total Joint Replacement?

Total Knee Replacement

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. Afterwards, 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 bone 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 Hip Replacement

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.

Where will I have surgery?

Total joint replacement surgery in most cases is now a same-day procedure whether performed in a surgery center or a hospital:

Surgery Center Setting

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.

Hospital Setting

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.

Surgical locations

Dr. Scott Goldsmith posing in front of the robot used to assist in joint replacement procedures

What is robotic assisted total knee replacement?

Robotic assisted surgery is specific to knee replacement only at this time and is now offered in our state-of-the-art OMG 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 are the risks of surgery?

Infection Infection is rare in joint replacement surgery, however smokers & patients with uncontrolled diabetes have an increased risk of infection. Symptoms of infection include persistent fever (over 101°F), chills, wound drainage, increasing pain, redness, tenderness, or swelling. If you are concerned about an infection, please contact our office immediately. Do not go to the ER.
Blood Clots Blood clots can form after surgery, however preventative measures are taken to help you avoid this risk. We recommend you continue to wear the white calf high TED hose stockings during the day for 2 weeks. If the stockings become too tight, you may fold them for comfort. You should also take an over-the-counter Aspirin (81mg) twice daily for 6 weeks total (please consult your medical doctor before taking this medication). Symptoms of a blood clot include calf pain or redness, as well as increasing swelling to the thigh, calf, ankle, or foot.
Nerve or Blood Vessel Damage During surgery damage to the surrounding structures is possible, but rare. It is common to have numbness surrounding your incision, which may be permanent.
Wound Healing and Scarring Chronic diseases such as diabetes as well as nicotine use may increase your risk of wound complications. We will discuss these risks with you prior to surgery to help minimize wound complications. There are also risks of permanent scarring.
Limited Range of Motion Your motion prior to surgery is correlated to your motion following surgery +/- 10 degrees. The day of surgery you will begin exercises to work on range of motion.
Leg Length Discrepancy/
Specific to total hip replacements, there is a risk of leg length difference, or dislocation of the joint, although these are rare.

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.

What are my options for anesthesia?

The type of anesthesia used for your surgery is based off your medical history, as well as the physician and anesthesiologist preference. Total joint replacement surgery is safely performed under general anesthesia as well as spinal anesthesia. In both cases you will be completely asleep in the operating room.

Helpful Links

Total Knee Replacement – OrthoInfo – AAOS

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Total Hip Replacement – OrthoInfo – AAOS

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Anesthesia for Hip and Knee Surgery

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