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Knee joint
While we may jokingly groan about the hitch in our hip or that nagging knee, gravity and everyday wear-and-tear take a physical toll on our joints—to such an extent, the number of hip and knee replacements is expected to double by 2030, when all baby boomers have reached the age of 65. But that doesn’t mean we’re resigned to a La-Z-Boy and orthopedic shoes for the rest of our days.
“The boomer population does not want to be limited by hip pain; they will get it replaced instead of just accepting it as a part of aging like their parents did,” says Gavin Pittman, MD, of TRIA Orthopedic Center in Woodbury. “They want to maintain an active lifestyle as they get older.”
While the success rates look impressive on paper, it’s what you do—or, rather, don’t do—that can set you up for the long run well after the operating room.
“Plan and Ice”
As they say, failing to plan is planning to fail. Your future self will thank you if your recovery plan is queued up with an accident-proof home, a supportive network of family and friends at the ready, and lingering projects checked off your list.
“Plan on getting your life as simplified as possible,” says Aaron J. Krych, MD, of Mayo Clinic. “Organize your home and surroundings, and get as many tasks done as you can before surgery to help minimize stress.” And don’t forget to make room for plenty of physical therapy and ice, he adds. The former is a given, but the power of icing cannot be understated: It’ll get you back to daily functional activities even sooner.
Pain Points
It’s one of the most commonly asked questions the ortho docs get: Is the post-op pain really as bad as they say?
“It depends on the surgery and the severity of your condition, so we set expectations for patients individually,” says Krych. No two knees—or hips!—are ever the same.
“There have been vast improvements in post-op pain management recently with a multipronged approach,” he continues. “We treat all patients with acetaminophen, NSAIDs, and control swelling using ice, compression, and elevation.”
Think of it this way: Pre-surgery, you probably experienced some pretty intense pain or discomfort for a long period of time. It can only go up from here.
“Plan on getting your life as simplified as possible. Organize your home and surroundings, and get as many tasks done as you can before surgery to help minimize your stress.”
Dr. Aaron J. Krych / Mayo Clinic
The Role of Rehab in COVID
The pandemic essentially halted in-person physical therapy appointments at TRIA, but therapists quickly pivoted to video to continue monitoring post-op progress—and to great success.
“We learned that physical therapy could successfully be completed in the patient’s home with adequate instruction,” says Pittman.
Combining your prescribed exercises and stretches with (light!) everyday activities will put you on the fast track, adds Corey A. Wulf, MD, of Twin Cities Orthopedics. “Range of motion of the joint is critical and can be accomplished by just simply moving the joint,” he says. “Whether you’re sitting or lying down, the joint can be moved, and the amount that it is moved is gradually increased in small increments.”
There’s a difference between post-workout muscle soreness, and inflammation associated with the overuse of soft tissue. In this instance, it’s less pain, more gain.
The Scarring Side Effect
It’s inevitable that you’ll come away from surgery with a distinctive line or some sort of bumpy marking. While the appearance of it depends largely on the doctor’s technique used for closure of the wound, how you respond to it in the aftermath also plays a part in the healing process.
“Some patients form very robust scars and produce excessive scar tissue or keloid,” says Wulf. “This is unavoidable for those patients, but there are products that can help decrease the formation and color, like vitamin E oil.” Pro Tip: Keep the incision out of the sun for the first year. (AKA, load up on the sun protection.)
Lifetime Guarantee?
Physical health, activity level, and weight all factor into the artificial joint’s lifetime. According to the American Academy of Orthopaedic Surgeons, more than 90 percent of total knee replacements are still functioning well 15 years after the surgery.
“As orthopedic implants and technologies have improved throughout the years, we tend to see this lifespan getting longer,” says Brent Warner, MD, of Summit Orthopedics. “As a shoulder replacement surgeon, I do counsel my patients that their implant is not designed for the rigors of sports that require repetitive, forceful overhead use of their shoulder.” He maintains, however, that most of his patients are able to golf, jog, bicycle, and perform various duties problem-free.
If you’re a runner or power lifter, injections, bracing, or regenerative medicine should be explored.
Travel Agency
Extended periods of immobility and/or pressure changes may cause some swelling and tightness, especially if the joint is still in the healing stages. For the majority of orthopedic procedures, most doctors advise against air or car travel for at least six weeks post-surgery. By that time, Warner says, the risk for early post-surgical complications has significantly tapered off. “Probably the most common risk at that point is feeling sore or stiff after sitting still for too long,” he says.
If you’re on the road, a way to ease the “creaky bones” feeling is by breaking up a long drive into manageable chunks of time. Stop and get out of the car every few hours to stand, walk around, and shake it off for five to ten minutes. Pro Tip: If you’re a knee replacement patient, consider sitting in the back seat to keep your leg elevated across the seat.
O.R. P(R)ep Talk
Joint replacement surgery used to mean spending the better part of the week lying in a hospital bed (followed up with a week-long rehab stay), but times have changed. Thanks to modern tech and multimodal pain management protocols, the majority of today’s options include outpatient surgery—meaning, resting in the comforts of your own bed later that same day.
“In most cases, the entire process takes a half-day commitment,” says Krych. “For the actual surgery, most knee surgeries range from 30 minutes to two hours. A typical hip arthroscopy ranges from 60 to 90 minutes.”
It’s been widely reported that outpatient joint replacement recipients have an accelerated recovery protocol and tend to be more satisfied with the care they’ve received.
“Over the past several years, there’s been an increasing number of patients who elect to have their surgery at an outpatient surgery center,” says Pittman. “Studies show that healthy patients can have a safe and pleasant experience without ever entering the hospital. Currently, half of my patients opt for outpatient surgery at TRIA Woodbury, where we’ve seen very good results.”
A Healing Outlook
According to Krych, the biggest improvement Mayo Clinic has made in the joint replacement space is the controlling of pain after surgery. “We are increasing the use of local injections at the time of surgery to help with pain control,” he says. “Pain medications can have unwanted side effects, and our protocol has minimized the amount that patients need after surgery.”
While post-surgery dislocations remain rare and few (they occur in just 2 to 3 percent of patients following hip replacement), dislocation is still considered the most common complication. Mayo Clinic has been using dual-mobility constructs, a special design that allows for more mobility within the socket liner to prevent dislocation, Krych adds.
Wulf says one of the more exciting innovations in the recovery space is the blood flow restriction for extremity rehab. “The concept allows for a quicker or more efficient fatigue of muscle groups, with the added benefit of growth factor induction that also regenerates muscle strength and recovery,” he says.
Pro Tips:
Fast-Tracking Recovery
“Follow your restrictions. I promise that there are good reasons for them and you will benefit by doing it. And ask questions! We try to answer common questions, but that doesn’t mean that I’ve answered the one that might be the most important to you and your individual needs.” Dr. Corey A.Wulf, Twin Cities Orthopedics
“We used to introduce new patients to other patients [in clinic or physical therapy] six weeks out from the procedure so they could see how they’re moving around—it’s a real-life testimonial. Currently, we try to limit extended close contact between patients for safety but are considering other ways of introducing patients in the future.” Dr. Gavin Pittman, TRIA Orthopedic Center
“Even small amounts of movement and exercise after surgery can be beneficial. Start small, like walking in your own home or around your yard. As things get easier, going for short walks in your neighborhood or a local park can benefit both your body and mind. For shoulder surgery rehab, we will often instruct patients on home-based exercises that use common household items, like soup cans and broomsticks.” Dr. Brent Warner, Summit Orthopedics
The Before + After: Answers to Your Top Questions
Is it OK to get my incision wet? “The dressing we use after surgery allows patients to shower as soon as the patient wishes. However, the incision is not ready to be submerged in water until it’s fully healed, which usually takes about four to six weeks. Always check with your surgeon before submerging the incision post-surgery.” Dr. Gavin Pittman, TRIA Orthopedics
When will I be able to drive my car again? “We recommend patients not drive a motorized vehicle until they are finished with their pain medications, braces, and/or crutches. This can be anywhere from one to six weeks after surgery. Patients should plan for alternative arrangements during this time.” Dr. Aaron J. Krych, Mayo Clinic
When can I go back to work? “I try to encourage all of my patients to return to work as soon as possible while simultaneously making allowances to keep them safe and appropriately focused on their recovery. Even if a patient isn’t able to perform the physical portions of their job right away, they can often return to work on ‘light duty’ or with other specific restrictions in place.” Dr. Brent Warner, Summit Orthopedics
How can I prevent a blood clot? “The risks of clotting vary. Being mobile after minor procedures may be all that patients need to do to avoid blood clots. Medications may be prescribed for higher-risk surgeries or those patients who are genetically predisposed to developing clots.” Dr. Corey A. Wulf, Twin Cities Orthopedics
