Common Questions Regarding Knee, Hip, or Shoulder Surgery

We know that you may have a lot of questions about your pending surgery. These questions and answers will help to understand what to expect before, during, and after surgery.

Q: What is arthritis?
A: The bones in your joints are covered by a layer of cartilage. Cartilage is a tough, lubricating tissue that provides smooth, pain-free motion to your joints. Arthritis causes the cartilage to wear away, eventually resulting in painful bone-on-bone contact.

Q: Why does my knee or hip hurt?
A: As the layer of cartilage wears away, bone begins to rub against bone, which causes the discomfort and stiffness commonly associated with arthritis.

Q: What is a total hip replacement?
A: A total hip replacement removes the arthritic ball of the upper thighbone as well as the damaged cartilage from the hip socket. The ball is replaced with a metal ball that is solidly fixed inside the femur. The socket is replaced with a plastic or metal liner that is usually fixed inside a metal shell. The implants create a new smoothly functioning joint that prevents painful bone-on-bone contact.

Q: What is a total knee replacement?
A: A total knee replacement is really a cartilage replacement with an artificial surface. The knee itself is not replaced, only the cartilage on the ends of the bones. The replacement implants include a metal alloy on the end of the thighbone and polyethylene (plastic) on the shinbone and kneecap. The implants create a new smoothly functioning joint that prevents painful bone-on-bone contact.

Q: What is a total shoulder replacement?
A: A total shoulder replacement replaces the arthritic humeral head (ball) with a metal ball and resurfaces the glenoid (socket) with polyethylene (plastic). The subscapularis muscle, one of the four rotator cuff muscles, must be cut to expose the joint. This muscle is repaired at the end of surgery but must be protected while it heals.

Q: What is minimally invasive knee surgery? Minimally invasive hip surgery?
A: The field of orthopedics is constantly researching new techniques to help make joint replacement surgery less painful and to help patients recover more quickly. One of the most talked about orthopedic advancements is the minimally invasive joint replacement, also called mini-incision joint replacement. Minimally invasive knee replacement is performed through an approximately four inch incision, half the length of a typical knee replacement incision. Minimally invasive hip replacement is performed through an approximately two to four inch incision, half to one-third the length of a typical hip replacement incision. Surgeons can perform surgery through such a short incision because they use instruments specifically designed for minimally invasive hip replacement.

Q: Do I need to bring anything with me to the hospital?
A: No. However, if you'd like to bring your own toiletries (toothbrush, toothpaste, comb, etc.) you may do so. You may also bring a robe and slippers. If so, ensure that the robe is a light one and that the slippers have rubber soles for traction. Jewelry should be left at home.

Q: When can I start walking again?
A: You may begin walking with support (cane, crutches, or walker) the day after surgery. Most patients can climb stairs after three days and are discharged to home at that time. You will continue to use support for 3-6 weeks. You may ride in a car but will typically not be able to drive for between 2-6 weeks. Dancing, golf and the ability to take trips usually occur between 6-12 weeks. Return to work depends on your type of work. Office workers may return in 2-3 weeks while others will require more time.

Q: How long does the typical knee or hip implant last?
A: All implants have a limited life expectancy depending on an individual's age, weight, activity level and medical condition(s). A total joint implant's longevity will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon's recommendations after surgery, there is no guarantee that your particular implant will last for any specific length of time.

Q: What are the results of total knee or hip replacements?
A: Results will vary depending on the quality of the surrounding tissue, the severity of the arthritis at the time of surgery, the patient's activity level and the patient's adherence to the doctor's orders.

Q: What are the possible complications or risks of joint replacement surgery?
A: While uncommon, complications can occur during and after surgery. Some complications include infection, blood clots, implant breakage, mal-alignment and premature wear. Infection and blood clots are two of the complications that concernt surgeons the most. To help avoid these complications, surgeons prescribe antibiotics and blood thinners before and after surgery. Most surgeons also wear special enclosed suits in the operating room to further reduce the risk of infection.

Q: When should I have this type of surgery?
A: Your doctors will decide if you are a candidate for surgery. Their decision will be based on your history, exam and X-rays. Your doctors will ask you to decide if your discomfort, stiffness and disability justify undergoing surgery. There is no harm in waiting to have surgery if conservative, non-operative methods can adequately control your discomfort.

Q: Am I too old for this surgery?
A: Age is not a problem if you are in reasonably good health and have the desire to continue living a productive, active life. You may ask to see your personal physician for an opinion about your general health and readiness for surgery.

Q: Where will I go after discharge from the hospital?
A: Most patients are able to go directly home after discharge. Some patients may transfer to a sub-acute facility and stay there between 3-7 days. The Nurse Case Manager will help you decide where to go after you are discharged from the hospital and can make the appropriate arrangements. Either way, you will continue to receive physical therapy.

Q: How often will I need to be seen by Dr. McPherson following this surgery?
A: Your first postoperative office visit will occur 6 weeks after discharge. You will then be seen for further follow-up as required by Dr. McPherson. Most patients need to see Dr. McPherson for a check-up at least once a year.

Q: How long until I can drive and get back to normal?
A: The ability to drive depends on whether the surgery was performed on your right or left leg and the type of car you have. If your left leg is your surgical leg and you have an automatic transmission, you could be driving as early as two weeks. If your right leg is the surgical leg, your driving may be restricted for as long as six weeks. Getting back to normal will depend somewhat on your commitment and individual circumstance.

Q: When will I be able to get back to work?
A: We recommend that most people take at least one month off from work. Patients with more sedentary jobs may be able to return to work sooner if they can go to work with crutches. The timing of your return to work depends considerably upon your commitment to recovery.

Q: Will I have any restrictions following this surgery?
A: For the first few months after surgery, you will be restricted from such activities as running, singles tennis and basketball. You will also be restricted from performing high-impact activities, contact sports and downhill skiing. Hip patients will additionally be restricted from crossing their legs or bending their hips more than 90° for three months after surgery. Once Dr. McPherson has cleared you for physical activity, you may resume your normal activities.

Q: Will I notice anything different about my knee or hip?
A: Yes, you may have some numbness to the outside of the scar. The area around the scar may feel warm. In knee patients, kneeling will be uncomfortable for a year or more. You may also notice some clicking when you move your hip or knee as a result of the artificial surfaces coming together.


L.A. Orthopedic Institute • 2200 W. Third St., Suite 400, Los Angeles, CA 90057 • Phone (213) 484-7600 • Fax (213) 484-7566