Tired of the limited mobility and pain that have thwarted her love of foreign travel and fall hiking, Lynda S. Johnson, 72, scheduled a knee replacement surgery for later this month. She chose a doctor, found a pet sitter to watch her Cairn terrier, and enlisted her sister to live with her while she recovers.
“I had been debating for months about whether to have it,” she said. “I was in so much pain, though, that I don’t really think I have anything to lose.”
“The extent that patients can have control over their weight and their medical conditions, in particular things like diabetes, the better their chances for success.”
— C. Anderson “Andy” Engh, M.D. orthopedic surgeon, Anderson Orthopedic Clinic at Inova Mount Vernon
For Johnson and approximately 7 million other Americans living with a hip or knee replacement, the decision to undergo such a surgery is fueled by a quest for less pain, more mobility and an overall boost to their quality of life.
Nearly 90 percent of patients who have knee replacement surgery experience less pain and 85 percent of the replacement joints still work after 20 years, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The odds are that most patients will feel better, and feel better quickly. There are several ways patients and their doctors can improve their chances of success and speed their recovery time, however.
Addressing overall health issues like high blood pressure, diabetes and obesity can, for example, boost the chances that a joint replacement surgery will be successful, says Dr. C. Anderson “Andy” Engh orthopedic surgeon, Anderson Orthopedic Clinic at Inova Mount Vernon. “Work on both your overall health and conditioning,” he said. “The top things that lead to infection are obesity and uncontrolled diabetes. The extent that patients can have control over their weight and their medical conditions, in particular things like diabetes, the better their chances for success.”
In addition, while it may seem counterintuitive, patients should be up and out of their hospital beds as soon as possible. “Patients are walking with assistance hours after their surgery. The reason patients do better when they get up and move around is that they decrease the risk of pneumonia and blood clots,” said Dr. Mark P. Madden, an orthopedic surgeon with OrthoVirginia. “We start out with patients using a walker and having someone assist them in walking, and they generally progress to become fully weight bearing without any assistance at all.”
Also, have a support system in place prior to surgery, whether it’s a significant other, grown child or close friend. Often dubbed coach or advocate, that person might attend medical appoints with a patient prior to surgery, serve as their point of contact the day of surgery and provide morale support throughout the recovery process.
“The more eyes and ears in addition to the patient’s, the better,” said Engh, explaining why it’s so helpful to have someone with the patient at appointments and throughout the recovery. “We approach things that we have to do with set expectations, and sometimes those expectations can keep us from hearing other things. Having another person there is a good reality check and note taker.”
Like Johnson’s sister, the coach should be able to spend a significant amount of time with the patient during the early recovery period.
“That person can expect to be with you 16 hours a day for two to five days after surgery,” said Engh. “I don’t want someone alone by themselves all day during work hours. The coach or advocate is like a safety marshal who keeps the patient safe and reminds them to take their time during their recovery.”
That person might also stop injuries by encouraging the patient to avoid complications during recovery. Patients should avoid everyday tasks like lifting heavy bags of groceries, for example.
Dr. George Aguiar, an orthopedic surgeon at Reston Hospital Center, advises patients to address issues such as determining how they will get help with grocery shopping, transportation, pet care and house cleaning in advance. “Having these types of things handled before you go into surgery can only help the recovery process.”
Patients should also plan ahead and safety-proof their homes. “Do everything you can do to avoid a fall within the first two to three months after your surgery,” said Engh. “Do a good assessment of the home. Have clear pathways and be aware of rugs that can catch your feet. Have good, secure handrails on stairways to help prevent falls.”
Timing also plays a role in the success of joint replacement surgeries. “Some patients ask if they’re too old to have surgery,” said Engh. “The question is ‘How often do you get out of your house every week?’ I think that the person who gets out, walks around, goes up and down the stairs, and is using their muscles and reflexes on a regular basis, they’re in good condition no matter how old they are. Don’t wait until you’re home bound to have this surgery because they recovery will be quite long.”
To decide whether joint replacement surgery is the best option, says Madden, work with a physician and weigh the effect the pain is having on one’s quality of life.
“There’s no right answer for every patient,” said Madden. “The real answer is to work with your doctor to find the right treatment."