Richard Seiden, J.D., is a member of the NPF board of directors. Seiden, who has psoriasis and psoriatic arthritis and has had hip, knee and shoulder replacements, wrote “A Patient Perspective on Joint Replacement Surgery” for the American Academy of Orthopaedic Surgeons blog in 2018. We are pleased to share excerpts from his article, with the permission of AAOS.
“I am not a medical professional,” Seiden notes. “This article summarizes my own experiences and personal perspectives, so before you apply any of my advice to your own situation, consult your physician. However, if you have joint issues and are considering surgery, the sooner you start doing your homework and preparing, physically and emotionally, the better.”
2 things you can control: weight and muscle tone
Do your best to lose weight prior to the surgery, or to maintain the lowest weight you can, so that you minimize stress on your joints, especially weight-bearing hips and knees.
- See your dentist well before your surgery. In general, you should have no dental procedures performed within six months of your surgery date.
- Schedule a physical exam with your primary care provider two weeks prior to surgery. This should include blood tests, urinalysis, a chest X-ray and an electrocardiogram. These are necessary to determine your fitness for surgery.
- Schedule an early time for the surgery, since you will be unable to eat anything after midnight the day before. This will help you minimize anxiety and avoid headaches from lack of food and water.
- Discuss assistive devices with your surgeon or an assistant, including devices for mobility (walker, crutches, cane, sling) and to ease recovery (shower seats, elevated toilet seats, reaching devices).
- Don’t forget home safety. If you can, add bathroom handrails or grab bars, modify or eliminate rugs, relocate wires, clear the floor between your bed and the nearest bathroom and add nightlights.
2 things that are easy to overlook: driving and flying
If your surgery involves the hips or knees, obtain a handicap parking permit. You can park closer to your destination, and the wider parking space makes it easier to use a walker or cane.
Since the implanted device is most likely made of stainless steel, in most cases it will trigger an alarm when you pass through an airport screening device. Enroll in the TSA PreCheck program, if possible. TSA screening devices allow greater leeway in identifying locations of an implanted device, enabling the TSA agent to do a limited, rather than a full-body, pat down. Occasionally, I have been asked to show my surgical scar to a TSA agent.
Day of surgery: meet your anesthesiologist
Make sure your anesthesiologist has reviewed your primary medical history, particularly any prior difficulties you may have had with anesthesia. For example, if you have had problems with intubation through the mouth, request intubation through the nose instead. If your surgery involves your lower extremities (hips or knees), discuss with your surgeon and the anesthesiologist the possibility of using a spinal block rather than intubation. Your normal cognitive function can quickly be restored, often as early as when the surgery is completed. A similar type of block, called an interscalene block, may be used with upper extremity surgery.
2 visitors to expect after your surgery
The surgeon will visit you either later on the day of surgery or early the next morning to check the incision, the mobility of your toes and possibly the range of motion of the replaced joint.
After a hip or knee replacement, a PT will visit you either the day of surgery or the next day. Typically, the first step will be to sit up with assistance. Assuming you aren’t lightheaded, the PT will run a belt around your waist, position a walker next to the bed and assist you in getting up.
Once you’re comfortable standing, the PT will ask you to march in place, then take a few steps in the room while at your side holding your belt. If all goes well, the PT will accompany you on a walk down the hallway and back. Later in the day, the PT will return and ask you to stand, walk down the hallway, and climb up and down at least four steps to confirm that you can safely raise your repaired leg.
Your surgeon will prescribe pain medications for after surgery, most likely opioids of varying strength. When the pain is less severe, you can return to your pre-surgery pain medications, such as over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs). Consult with your surgeon as to when it is appropriate to switch back to any other medications you were taking prior to surgery. Always ask about side effects.
A TENS (transcutaneous electrical nerve stimulation) unit offers another method of pain management. Available at medical device stores or online, the battery-operated TENS unit applies electric stimulation to the muscles surrounding the joint through four wired sticky pads. Your PT can show you where to place the sticky pads.
Your temporary nighttime routine
For the first few days after surgery, you may need the assistance of another person to lift your legs onto the bed. Try to sleep at least 6 inches from the edge of the bed. For the first week or two after surgery, sleep on your back and not on the side that was repaired.
When getting into bed, use the non-repaired leg to lift the repaired leg, or pull up on the repaired leg gently to swing the leg into the bed. Use the non-repaired leg to slide the repaired leg farther into the bed. Sleeping with a pillow between your legs (for knee and hip surgery) and a pillow under your arm (for shoulder surgery) helps minimize some of the movements that occur during sleep and may allow for a better night’s sleep.
Place a pillow under your legs (for knee replacement) only if recommended by the surgeon.
Before getting out of bed, sit on the side of your bed to check for dizziness. When you first stand up, you can stand or march in place for a few seconds to ensure you have your balance before starting to walk. You may need a walker or cane at first.
Top 5 lessons learned
- Prepare in advance for the surgery and the recovery.
- Knowledge is power. Be informed about your condition.
- Be your own advocate. Ask questions and express your preferences. I had a written list for doctor visits. You’re likely to be nervous, flustered and hurried at the office and may forget important questions.
- Have someone accompany you to your pre-operative appointments and to the hospital for the surgery. This person can help ensure you get all the necessary information, serve as your advocate and stand ready to make things go smoothly.
- Complete your surgeon’s patient survey. This is part of your treatment plan. The information also goes into a clinical database such as the American Joint Replacement Registry, which uses patients’ results (without identifying the patients) to help improve procedures in the future.
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