What to Know About Joint Replacement

Hip and knee joints are crucial for our overall mobility — nearly every aspect of our day-to-day life depends on these joints, whether it’s walking, running, bending over to pick something up, or balancing. These joints are also susceptible to various injuries and wear and tear. As people get older, they may also be at risk for arthritis, a painful condition where the cartilage protecting the joint wears out and limits a person’s ability to move, be active, and at times even disrupts their sleep.

“In general, maintaining a healthy diet, healthy body weight, and getting regular exercise are all good to protect the health of your joints. In many cases, embracing the things that help your joints will help them function without replacement for as long as they can,” says Dr. Jeffrey Geller, chief of the division of Hip & Knee Reconstruction at NewYork-Presbyterian/Columbia University Irving Medical Center and chief of orthopedic surgery at NewYork-Presbyterian Westchester. “If your pain and mobility are getting worse, though, and non-operative treatment doesn’t help, total joint replacement surgery is one of the best tools we have to reduce pain and restore function in someone who needs a new hip or knee.”

In the United States, there are over a million combined hip and knee replacement surgeries a year. While joint replacement may sound intimidating, advancements in imaging, minimally invasive surgery, and robotics have allowed for quicker recovery times and positive long-term outcomes, says Dr. Geller. If you are a candidate for hip or knee replacement, Dr. Geller, who will also see patients at a new, state-of-the-art outpatient facility in Westchester called NewYork-Presbyterian The One, talked to Health Matters about how to know surgery might be a good option, and what you can expect before, during, and after joint replacement surgery.

How do I know I need joint replacement surgery?

When someone has exhausted non-operative methods of treatment — like physical therapy or taking anti-inflammatory medications — or if their arthritis symptoms have progressed to such a degree that their quality of life is so severely affected by their hip or knee pain, then it might be time for joint replacement. Typically, this is someone between the ages of 50 to 85 who has had progressive deterioration of the cartilage in the hip or knee.

People with conditions such as diabetes, obesity, kidney disease, and liver failure have increased rates of complications after surgery, so they should discuss with their doctors and see if they can modify some of their risk factors. Patients with autoimmune diseases should also discuss treatment options. We will not do a joint replacement for someone who’s a smoker because they may have impaired blood flow, which can slow down healing, and a weakened immune system, raising the risk of a severe infection.

What should I expect during the surgery?

In knee replacement surgery, the damaged surface of the joint is cleaned out, and metallic implants are securely fixed to the ends of the thigh bone and shin bone to form a new joint that is held in place by surrounding muscles and soft tissue ligaments. The smooth gliding motion is made possible by inserting a special polyethylene (plastic) liner between the two metal implants, which enables you to bend your knee without friction, similar to your original knee. These implants are usually secured to your bone using bone cement or with newer technology where your bone grows into the new implant for a more biologic fixation method. 

For hip replacements, metallic implants are fixed securely inside the thigh bone and the socket in the hip bone to form a new ball-and-socket joint that is held in place by muscles and soft tissue. Implants may be secured to your bone by cement, or they may have textured surfaces that promote bone growth into new parts as well.

In both cases, your surgeon will choose the method that best suits your individual condition, and the goal is to restore your joints to a condition that resembles its health status before surgery, and to correct any issues that may have existed.

What can I expect during my hospital stay?

While in the hospital, your care team – made up of doctors, nurses, physical therapists, physician assistants, and case managers – will monitor your progress to ensure your safe and efficient recovery. Following your surgery, the care team will assist you in getting out of bed to perform an assessment of your mobility, of your activities of daily living, and need for assistive devices. You will begin to walk on your new knee or hip using a walker, putting full or partial weight on the new joint.

Before you leave, you have to be safely up and walking, climbing and descending stairs, getting on and off a toilet, and getting in and out of a chair or bed. These are all things a person needs to be able to do safely at home, and it shows the implant is strong and stable enough to hold their body weight. If needed, this team can also help you manage medications or arrange for a home nurse, a home therapist or, in some cases, a home health aide during the first few weeks after your surgery to help you with your recovery process.

These days, joint replacement surgery may be done as an ambulatory procedure. If a patient has a support network at home and their overall health status going into surgery is good, they may be a suitable candidate for going home the same day. With robotics and anterior based hip surgery, we are now able to send many patients home and avoid a hospital stay. Our new ambulatory center NewYork-Presbyterian The One will have the most state-of-the-art facilities and technology so patient’s will have even more access to advanced joint replacement surgery.

What is a typical timeline for recovery?

There is commonly pain, bruising, and swelling for the first couple of weeks after joint replacement surgery. At two weeks, patients will come back to the office to be reevaluated. If there are no problems, they’ll start more aggressive physical therapy and rehab programs, working on more range of motion and adding strength to the muscles around the knee or hip. It’s important to keep up with physical therapy or the person can risk getting a stiff knee or hip, where it doesn’t bend as much as they want it to.

At three months the average patient should be about 90 percent recovered. The swelling, bruising, and pain from surgery should be mostly gone, motion should be back to normal and the patient shouldn’t need assistive devices, like canes or crutches. The strength component can take a little more time, just because muscles take time to add strength. That can continue all the way out to a year after surgery.

How long does a joint replacement last?

Barring some catastrophic issue like an infection, a knee or hip replacement on someone between the ages of 50 to 80 should last them the rest of their lives.