If my hip or knee hurts, does that mean I have arthritis?
Not necessarily. This can be determined by your orthopaedic surgeon with x-rays and clinical examination. Arthritis is a wearing away of the cartilage at the ends of the bones (the joints) to expose the bone in the joint and results in pain, stiffness, and sometimes deformity.
If it has been determined that I have arthritis, when should I have surgery?
This is a mutual decision between you and your orthopaedic surgeon, although you alone always have the final say. It used to be that when you could not stand the pain any longer it was time for surgery. Today, that does not make sense! If you have had to give up certain aspects of your routine activities because of arthritis of your hip or knee, it is time for surgery.
What is hip replacement surgery?
Hip replacement surgery involves removing the arthritic ball of the femur bone as well as removing the damaged cartilage from the hip socket. The hip socket is replaced with a metal shell with a high-density plastic, ceramic, or metal liner. The ball of the femur is replaced with a ceramic or metal ball that is placed on the metal stem that is solidly fixed inside the femur bone. This creates a smooth new joint with minimal friction that will function to eliminate discomfort.
Why should Dr. White perform my hip or knee replacement?
Dr. White has performed over 6000 knee replacements and over 3500 hip replacements. EXPERIENCE COUNTS! Dr. White was a distinguished Aufranc Fellow in hip and knee reconstruction while in Boston and a former clinical instructor in orthopaedic surgery at Tufts University Medical School. With select other surgeons, he has developed hip and knee replacements which are used both nationally and internationally today.
What is the anterior hip replacement?
The anterior supine intramuscular hip replacement is placing the prosthesis in the correct position from the front of the hip through an incision length of usually 3˝ to 4˝ inches, truly minimally invasive surgery.
What are the advantages of the anterior approach?
It reduces the chance of dislocation
It usually provides for a quicker recovery
No muscles or tendons are cut
Minimal-to-no hip precautions
Clearly minimally invasive
Much more accurate in adjusting leg length to equal the other leg
Sleep in any position
Implant position and sizing are verified during surgery with fluoroscopy
Does Dr. White perform the anterior hip replacement?
Yes! Dr. White has experience with the posterior approach, posterolateral approach, anterolateral approach, and the anterior approach. 80% of his hip replacements are now done through the anterior approach, his preferred method.
With the anterior approach, do any muscles or tendons need to be cut to replace the hip?
NO! Muscles or tendons are cut at all.
What rehabilitation (therapy) is involved after an anterior hip replacement?
Normally the patient begins to walk on the day of surgery with crutches or a walker. Walking is the principal mode of therapy. The patient progresses from an assistive device to independent walking at his/her own pace. The patient will need instructional assistance in getting in and out of bed properly.
Will I need a blood transfusion and should I donate some of my own blood before surgery?
As of today, auto-donation is now discouraged. Only a few people require a blood transfusion after the operation. Blood bank pathologists tell us that now less than one pint of blood out of 5 million pints carry the hepatitis virus and less than one pint in 8 million pints carries the HIV virus. So, blood transfusion is now quite safe if needed. Donating your own blood is costly. It triggers your need for transfusion sooner by lowering your blood count before surgery and any unused blood cannot be given to another patient or go into the general blood bank population.
What risks should I be concerned about with the surgery?
Most of these surgeries go very well without complications. Blood clots in the first six weeks after surgery and infection (usually much later but rarely initially) are our greatest concerns. Precautions are taken at the time of operation with antibiotics and after surgery with blood thinners to reduce the risk of complications.
Is exercise before surgery important?
YES. Quadriceps strengthening exercises are most important before surgery to assist in expediting a speedy recovery post surgery.
How long is the recovery time for a hip replacement?
Most people go home from the hospital after two to three days. They then have therapy in their home for a couple of weeks and then participate in outpatient therapy if needed. For those individuals who require additional care or live alone, an extended care facility with special rehabilitation for the hip replacement is available. Most people do not need to use an external aid, such as a cane, after 2-4 weeks. Normal activity is resumed after four to six weeks.
Is it better to go to a rehabilitation facility or home at discharge from the hospital?
What if I live alone?
We find that patients going home with therapy from a Home Health agency two to three times a week do just as well if not better than those going to a subacute facility with a special rehabilitation area for total hip and total knee patients. About 25% of those patients undergoing operation for a total hip or total knee replacement live alone and often times do prefer the subacute facility with rehabilitation capabilities.
Will a nurse and physical therapist come to my home?
YES. Typically a Home Health nurse will come to your home to change the incision dressing, etc., for the first five days after surgery and as necessary after that. A physical therapist will generally come to your home two to three times per week for the first couple of weeks upon your return home from the hospital. Usually outpatient physical therapy will start after the second postoperative week. You are encouraged to use outpatient physical therapy as soon as possible.
Will I need any other equipment?
After hip replacement surgery you will need a high toilet seat for about three weeks. We can arrange to have one delivered to you. You will also be taught to use assistive devices to help you with lower body dressing and bathing. You may also want to buy a bath seat or put grab bars in your bathroom; this can be discussed with your physical therapist.
When can I take a shower?
Usually a shower is permitted on the 11th postoperative day, assuming there is no drainage from the incision line. This may be before the staples or sutures are actually removed. Nonetheless, we have found it safe for postoperative patients to shower without covering of the incision line at this time.
When can I drive and get back to work after hip replacement?
If you want to drive, you need to not be taking any narcotic pain medication and no longer in need of a walker. All of this depends on what your surgeon tells you. If you work, most people can return in about four weeks. If your job is sedentary, sometimes you can return earlier.
What activities may I participate in or what restrictions apply following surgery?
High-impact activities such as running, basketball, volleyball, singles tennis, racquetball, squash, and downhill skiing put you at risk. Common sense applies. One can usually start playing golf at four weeks with a partial knee resurfacing, six weeks for an anterior hip replacement, and eight weeks for a total knee replacement. Add 4-6 weeks to each of those for doubles tennis.
How often do I need to see my orthopaedic surgeon following surgery?
We will make an appointment for you to be seen in the doctor’s office for a two-week followup after your discharge from the hospital. Additional visits will be at six weeks from the time of surgery and then one or two years as directed by your surgeon.
If I have an arthritic knee, am I a candidate for a partial knee resurfacing?
This can be determined only by x-ray and clinical examination by your orthopaedic surgeon. Several criteria must be met to be a candidate. Dr. White finds in his practice that partial knee resurfacing represents about 30% of his knee surgeries.
How long is the recovery time for a knee replacement?
A partial knee replacement is very short. The patient usually goes home the day after surgery with a cane. Therapy is usually limited to the first two weeks at home and thereafter therapy is rarely indicated. Total knee replacement recovery usually is longer because of the need to regain motion and quadriceps strength. Therapy is oftentimes necessary for 4-6 weeks.
When can I drive and get back to work after knee replacement?
Returning to driving is dependent on you no longer needing narcotic pain medication as well as the development of quadriceps strength in your right leg. If surgery was on your right knee then your driving could be restricted for three weeks or more. If the surgery was on your left knee, you could be driving as early as two weeks. This will depend on the evaluation by your surgeon. If you work, you can usually return to work in two to three weeks with a partial knee and in about six weeks with a total knee. If your job is sedentary, sometimes that return can occur earlier.
How long do hip and knee replacements last?
At twenty years, 9 out of 10 hip and knee replacements are still doing well. That is about one-half of 1% failure rate per year.
When does one become too old for this type of surgery?
It is not so much dependent on age but on your general medical health. Dr. White has operated on several patients in their nineties who were in
good general health and they have done very well.
These frequently asked questions
are simply guidelines that apply to most patients.
Keep in mind, however, that each patient and surgery is unique and answers
to these questions for you particularly should be discussed with the doctor.
- Anterior Supine Intermuscular (ASI) Hip Replacement
- Smaller Incision Hip Surgery
- Conservative Hip Replacement
- Newer Trabecular Metal Cup Backing
- Metal, Ceramic, or Cross-Linked Polyethylene Articulating Surfaces
- Smaller Incision Knee Surgery
- Gender-Specific Knee Replacement
- Partial Knee Replacement (Patellofemoral)
- Partial Knee Resurfacing (Single Compartment)
- Advanced Total Knee Replacement
- Patient Specific Instrumentation Through MRI Navigation