Adult Reconstruction FAQs

Arthritis is one of the most common causes of joint pain. There are many types of arthritis, including:

• Osteoarthritis (OA). This is sometimes called degenerative joint disease (DJD). The cartilage in the joints wears away, leaving the bones to rub against each other. This causes pain and stiffness. It tends to be more severe as one ages, although, it rarely is severe enough to warrant joint replacement until after age 55-65 years.

• Rheumatoid arthritis (RA). This is a disease that causes the lining of the joints to become thickened and inflamed. The end result is loss of cartilage, pain and stiffness. RA affects women about three times more often than men. It may also affect other parts of the body besides the hip.

• Post-traumatic arthritis. This may develop after an injury to the joint that does not heal properly, such as a broken bone or torn ligament. The joint is no longer smooth, which leads to more wear on the irregular joint surfaces.

• Osteonecrosis, or avascular necrosis (death of bone tissue): This is not a type of arthritis, but it may lead to arthritis. The bone cells beneath the cartilage die and in most cases the bone eventually breaks down and collapses. This results in a flattened joint surface, causing further pain, stiffness and loss of the remaining cartilage (arthritis). In the hip joint, the bone cells in the "ball" (femoral head) die, and the bone often eventually collapses. The process can be painful. When the ball loses its shape, it no longer fits well in the hip socket. In the knee joint, the end of the femur (femoral condyle) is most often affected and sometimes the disease in this site is called osteochondritis dissecans. The exact cause is unknown, but the problem often relates to steroids, such as prednisone, given systemically through pills or an intravenous route (doesn't include local injections). Additional causes include alcohol, bone marrow disease (such as sickle cell disease), blood clotting disorders or abnormal blood flow within the bone due to an injury.

• Septic arthritis: This occurs when an infection develops within the joint. The infectious process results in destruction of the cartilage and subsequent arthritis.

See this PDF for answers.

The hip is a ball and socket joint. The ball is the large, round upper end of the thighbone (femur). This fits into a cuplike socket (acetabulum) on the outer side of your pelvis, or hipbone.

The bones of the hip joint are covered with a layer of cartilage, a smooth, tough tissue that keeps the bones from rubbing together. (You've probably seen cartilage on the end of a chicken drumstick.) Muscles and ligaments (tough bands of tissue) surround the joint and hold the ball in place inside the socket.

Symptoms tend to get worse over time. However, you may have good months and bad months, and your symptom may change with the weather.

The most common symptoms of hip arthritis are:

• Pain with activities (the pain is usually in the groin area and can spread to the knee)

• Limited range of motion

• Stiffness of the hip

• Walking with a limp

Total hip replacement (or arthroplasty) is surgery to replace the ball and socket of the hip joint. First the surgeon removes the top part of the thighbone (femur). He or she replaces this with an artificial ball, usually made of metal. This attaches to the top of a metal stem, which fits inside the thighbone.

Next, the surgeon removes some bone from the hip socket, along with any cartilage that remains. A new socket is put in its place. The new ball fits into the new socket, so that the joint can move smoothly, without causing pain.

The decision to have this surgery is a "quality of life" choice. Many people have it when they find they can no longer do the things they used to enjoy. When hip pain keeps you from basic activities—like walking, shopping or recreational activities such as bike riding —you may want to consider surgery.

You and your surgeon will make this decision together after considering:

• How bad your symptoms are

• How much cartilage has been lost

• Your age

• Your overall health

• Your risk in having anesthesia and surgery

If you will have a hip replacement, your new joint will be chosen to meet your particular needs. Though it will be made of the ­most durable materials available, it will eventually wear out if you live long enough.

Studies show that, in people over 65, the first hip replacement will last at least 10 years in 90 to 95 percent of patients. It will last at least 20 years in 80 to 85 percent of patients.

Some factors may shorten the lifespan of an artificial hip joint. For example, the new hip may not last as long in someone who:

• Is overweight

• Is very active

• Is younger (for example, under age 65)

• Has poor bone quality

• Has had the same hip replaced before

• Has had a prior infection in the hip

As with any surgery, hip replacement carries some risk. Problems can happen either early or late after surgery. Serious problems are uncommon, but they do occur.

Early complications include:

• Infection

• Dislocation (when the ball pops out of the socket)

• Hemorrhage (severe bleeding)

• Nerve or blood vessel damage

• Blood clot

• Anesthetic complications, which can happen with any type of surgery

Late complications include:

• Infection

• Dislocation

• Loosening of the joint

See this PDF for answers.

Total hip replacement (or arthroplasty) is surgery to replace the ball and socket of the hip joint. First the surgeon removes the top part of the thighbone (femur). He or she replaces this with an artificial ball, usually made of metal. This attaches to the top of a metal stem, which fits inside the thighbone.

Next, the surgeon removes some bone from the hip socket, along with any cartilage that remains. A new socket is put in its place. The new ball fits into the new socket, so that the joint can move smoothly, without causing pain.

The decision to have this surgery is a "quality of life" choice. Many people have it when they find they can no longer do the things they used to enjoy. When hip pain keeps you from basic activities—like walking, shopping or recreational activities such as bike riding —you may want to consider surgery.

You and your surgeon will make this decision together after considering:

• How bad your symptoms are

• How much cartilage has been lost

• Your age

• Your overall health

• Your risk in having anesthesia and surgery

If you will have a hip replacement, your new joint will be chosen to meet your particular needs. Though it will be made of the ­most durable materials available, it will eventually wear out if you live long enough.

Studies show that, in people over 65, the first hip replacement will last at least 10 years in 90 to 95 percent of patients. It will last at least 20 years in 80 to 85 percent of patients.

Some factors may shorten the lifespan of an artificial hip joint. For example, the new hip may not last as long in someone who:

• Is overweight

• Is very active

• Is younger (for example, under age 65)

• Has poor bone quality

• Has had the same hip replaced before

• Has had a prior infection in the hip

As with any surgery, hip replacement carries some risk. Problems can happen either early or late after surgery. Serious problems are uncommon, but they do occur.

Early complications include:

• Infection

• Dislocation (when the ball pops out of the socket)

• Hemorrhage (severe bleeding)

• Nerve or blood vessel damage

• Blood clot

• Anesthetic complications, which can happen with any type of surgery

Late complications include:

• Infection

• Dislocation

• Loosening of the joint

After you schedule the surgery, you will need to see your family doctor for a physical exam. We urge you to also attend a free joint replacement class at the hospital. The class will explain how to prepare for surgery and what to expect before and after.

Besides the medicines you were taking before the surgery, you will take:

• Blood-thinning medicine, such as Coumadin, for one month after surgery

• Pain medicine, such as Percocet or Vicodin, for several days or weeks after surgery

This varies with each person. You will use a walker for about four weeks after surgery. You can drive a car in four to eight weeks.

Most people increase their activities slowly. They can often play golf, doubles tennis or go bowling in twelve weeks. More active sports, such as singles tennis and jogging, are not recommended.

It depends on the type of work you do. If you work at a desk, you may be able to return to work in three to six weeks after surgery. If your work is physically demanding, it may be as long as three months.

Right after surgery, getting out of bed and taking your first few steps will be a challenge, but after that it gets easier. Patients who have hip replacements often need much less physical therapy than those who have knee replacements.

You will work with a physical therapist while you are in the hospital. Few patients need physical therapy after they leave.

Walking will be the most important activity for your recovery. In the hospital you will learn how to use a walker. We will tell you whether to put full or partial weight on the hip. When you feel stronger, you can advance to walking with a cane. You should use either crutches or a cane for the next six weeks.

It is possible to replace both hips at the same time. But doing both hips together may increase the risk of surgery and put slightly more stress on your heart and lungs. Surgeons differ in their opinions on this issue.

We recommend doing the second hip one week after the first. Between surgeries, most patients stay in the hospital or spend a few days in a rehabilitation unit.

Most new joints are made of metal (such as cobalt chrome or a titanium alloy) and plastic (ultra-high molecular-weight polyethylene, highly crosslinked).

Surfaces where the ball and socket rub together are usually made of special plastic, ceramic material or cobalt chrome metal. Most people have a metal surface on the socket and a plastic surface on the ball. This combination has a proven track record of lasting many years in a majority of patients.

Many material surfaces have been tried in the 40 or so years that hip replacements have been done. The most common today include:

• Polyethylene (plastic). This is a durable, high-performance plastic resin. It is slippery, which is why it works well in a mobile joint like the hip. But it is known to wear out. When this happens, it sometimes causes bone loss around the joint. This can make repeat hip replacements (called revision surgeries) more difficult. A new type of polyethylene, called highly crosslinked polyethylene, may not wear out as quickly.

• Ceramic. This has been more popular in Europe than in the United States. Ceramic surfaces may last longer than plastic. But we do not know if they cause more or less bone loss when they do wear out. Also, the ceramic has been known to break and chip occasionally (similar to glass breaking). When this occurs, the small ceramic pieces may be difficult to remove from the joint. Usually, a repeat operation needs to be done without delay.

• Metal. Metal surfaces are used regularly, but metal rubbing against metal is being used more and more often. Interestingly, this was tried early on in the history of hip replacement, but problems related to the manufacturing led surgeons to move on to other materials. Now those problems have been overcome. In fact, metal surfaces have the potential to last a very long time. Some scientists question whether they will lead to increased amounts of metal ions or corrosion being released in the body. These concerns are valid, but the risk is unknown. And because the renewed interest in these designs is fairly recent, we have little information about the lifespan of metal-on-metal surfaces.

The choice of surface is still somewhat controversial. Reasonable scientists, surgeons and patients will sometimes disagree. This is one of the most exciting areas of research in the field of hip replacement surgery. Surgeons consider many factors in selecting implants and understand that only metal-on-plastic surfaces have a widespread, long-term track record longer than 10 years.

The knee is a hinge joint that provides motion where the thigh meets the lower leg. The joint is made up of three bones held together by tough bands of tissue called ligaments. The thighbone (femur) makes up the top part of the joint. It meets the shinbone (tibia) at the lower part of the joint. In front of these bones is the kneecap (patella), a round shield that protects the joint. The kneecap glides in a groove on the end of the thighbone whenever you bend or straighten your leg.

The thighbone and shinbone are separated by cartilage, a smooth, tough tissue that keeps the bones from rubbing together. (You've probably seen cartilage on the end of a chicken drumstick.) The cartilage acts as a cushion. It allows the two bones to move together so you can bend your knee.

Total knee replacement, or arthroplasty, is surgery to replace the diseased knee joint. The surgeon removes the bottom of the thighbone (femur) and the top of the shinbone (tibia). He or she re-surfaces the bone ends with metal and plastic. The surgeon may also add a plastic "button" under the surface of the kneecap (patella), if needed.

As with any surgery, knee replacement carries some risk. Problems can happen either early or late after surgery. Serious problems are uncommon, but they do occur.

Early complications include:

• Infection

• Hemorrhage (severe bleeding)

• Nerve or blood vessel damage

• Blood clot

• Anesthetic complications, which can happen with any type of surgery

Late complications include infection and loosening or wearing out of the joint.

If you smoke, stop! Even quitting the week before surgery will help reduce your risk of lung problems and blood clots.

To further prevent blood clots, you will need to start moving your foot and ankle again right after surgery. We will also give you blood-thinning medicine to help keep blood clots from forming.

Infection is a lifelong risk after a knee replacement. An infection causing illness in one part of the body—such as the skin, teeth, respiratory tract or urinary tract—can cause an infection around the new knee joint. If you have any kind of infection, you need to tell your doctor right away.

You will also need to take antibiotics before having dental work or any surgical procedure that could allow germs to enter your bloodstream.

If you have a knee replacement, your new joint will be chosen to meet your particular needs. Though it will be made of the >­most durable materials available, it will eventually wear out if you live long enough.

Studies show that, in people over 65, the first knee replacement will last at least 10 years in 90 to 95 percent of patients. It will last at least 20 years in 80 to 85 percent of patients.

Some factors may shorten the lifespan of an artificial knee joint. For example, the new knee may not last as long in someone who:

• Is overweight

• Is very active

• Is younger (for example, under age 65)

• Has poor bone quality

• Has had the same knee replaced before

• Has had a prior infection in the knee

This varies with each person. Some pain with activity and at night is common for several weeks after surgery. You will be able to go back to most of your daily activities within several weeks. Most people can start driving again once they can bend the knee at least 90 degrees, usually in about four to six weeks.

Yes. Assistive devices will make life after surgery more comfortable. Your occupational therapist will help you get the equipment you need. This may include:

• Safety bars or a secure handrail for the shower or bathtub

• Secure handrails along stairways

• A raised toilet seat with arms

• A stable shower bench or chair for bathing

• A leg lifter to help you move your leg in bed

You will also need to set up a short-term living space with a bathroom on the same floor. It will be hard to walk up and down stairs early in recovery.

The surgeon may prescribe one or more measures to prevent blood clots and decrease leg swelling, such as special support hose, inflatable leg coverings (compression boots), and blood thinners.

To restore movement in the knee and leg, we use a knee support that slowly moves the knee while in bed starting on the day of surgery. The device, called a continuous passive motion (CPM) machine, decreases leg swelling by elevating the leg and improves the venous circulation by moving the muscles of the leg.

Foot and ankle movement is encouraged immediately following surgery to also increase blood flow in the leg muscles to help prevent leg swelling and blood clots.