Setting Realistic Expectations Prior to Joint Replacement Surgery

The prospect of undergoing major surgery can be daunting. Some patients have gone through this process before, while others are experiencing it for the first time. Your surgeon and his or her team are your advocates. Believe it or not, your success is what makes most surgeons tick. There’s no greater pleasure for a surgeon than to see patients return to the office satisfied with their surgery, relieved of what previously was debilitating pain.  

There are preparatory steps that you can take to make the overall experience smoother. If you think about it, the hour or so it will take to replace your joint in the operating room is brief compared to the amount of time you’ve spent thinking about having surgery and the actual amount of time it will take you to recover.

Here are a few thoughts as you begin to plan your recovery…

Pain. Pain is a valid fear and unfortunately is an unavoidable part of surgery. Despite outstanding advances in medical care and surgical treatments, the act of creating an incision, removing damaged parts, and implanting the component will cause pain. It’s always helpful to come to grips with the fact that this will not be a pain-free process. The goal of your surgical team is to lessen the amount of pain in a safe manner.

In an effort to avoid over-prescription of opioid pain medications, many physicians are transitioning to other means of pain management. This often includes different prescriptions such as non-steroidal anti-inflammatory drugs (NSAIDs) and medications that help with nerve pain. Some surgeons will inject solutions of numbing medication in the tissues around your joint replacement during the surgery, which can help with initial pain. Other pain-relief methods such as ice and gentle muscle massage can be helpful as well. Starting physical therapy early on to get your joint moving can help too, because we often find that a stiff joint is a painful joint. Talk to your surgeon about how they plan to manage your pain, because being ready for what’s coming is helpful.

The buddy system. It’s hard for many people to imagine having difficulty getting up to go to the bathroom or get a drink of water. For patients undergoing surgery to the lower limb (such as the hip or knee) having someone to count on during the initial days after surgery is important. At the very least, you’ll need help with meals, going places, and perhaps even with tasks like grooming and dressing. This is highly variable; some patients breeze through the first few days, while others experience a fairly big shock. It’s a good idea to be prepared for the challenges that might lie ahead. Think of someone you trust who’d be willing to help you. That family member or good friend can also help keep you motivated and keep your spirits up during the recovery process. If you know someone who’s had a hip or knee replacement before, consider asking them about their experience. They’ll understand what you’re about to go through and might be able to provide unique insight.

Staying in the hospital. The duration of your hospital stay can vary. Most patients having hip or knee replacement don’t need to stay in the hospital very long. Traditionally, patients stay in the hospital for one or two nights. During that time, they work with physical therapists and occupational therapists to ensure they can move around and perform basic day-to-day functions.  When certain goals are met, patients go home to continue recovery. 

Many centers now offer outpatient joint replacement. This means you could go home on the same day that you have surgery. There are advantages to doing this, like the possibility of reducing a large hospital bill and getting you back to your home base as soon as possible. The reality is, if you’re a reasonably healthy patient, staying in the hospital often doesn’t add much value to your surgical experience. This decision should be made with your surgeon; it’s often dependent on your medical history and overall health, whether or not your insurance allows outpatient joint replacement procedures, and your ability to cope with the idea of going home so soon after surgery. Healthcare costs continue to rise, and it’s important to manage costs wisely. But ultimately, your safety comes first. If you need to stay overnight, your doctor will keep you in the hospital.

Returning to life. The million dollar question, when will I be active again? Returning to your normal routine depends on what that routine includes. Many patients begin putting their full weight on the hip or knee the day of surgery. It will be uncomfortable at first, and gradually improve as the muscles and tissues around the joint heal and get stronger. You can usually walk right away. In fact, it’s believed that early mobility may help reduce the risk of blood clots in your legs, which can be a dangerous complication. Depending on the way your surgery is performed, there may be some positions or motions your surgeon will want you to avoid for a period of time during the healing process. There also may be some permanent high-impact activity restrictions. Patients with sedentary or office jobs may be able to go back to work fairly quickly, sometimes the week after surgery. Others who perform manual labor or have physically-demanding jobs will take longer. Before attempting more challenging activities such as low-impact exercise or sports, you should speak to your surgeon to see if you are ready. You’ll likely continue to make improvements for at least six months, so be a patient patient!

Ultimate outcome. “When will I be normal?” The definition of ‘normal’ is tough. Joint replacement surgery can do a great job alleviating pain and restoring function, barring surgical or post-surgical complications. But, the reality is, no operation can turn back the clock to a time long before your joint was not injured or arthritic. You and your joint have been through a lot, and a joint replacement’s role is to make you better - not necessarily ‘perfect’ or ‘normal’ as you may remember it. Joint replacement can drastically alter your quality of life. Arthritis is a debilitating condition and joint replacement is a great solution for many people who haven’t improved with less invasive measures. 

That said, nobody can take away the fact that you and your joints have lived a lifetime together, and that you’re about to undergo a major operation. If you expect a perfect outcome, you will have a high chance of being disappointed. Perfection is hard to define and can be ever changing. It’s important for both patients and surgeons to be upfront about their expectations and the risks of joint replacement surgery in order to avoid surprises. The overwhelming majority of patients who have joint replacements do very well and consider it a worthwhile experience. It takes time to get better. Stay focused on the end goal.