There is a layer of smooth cartilage on the lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the undersurface of the kneecap (patella). This forms the knee joint. This cartilage serves as a cushion and allows for smooth motion of the knee. Arthritis is a wearing away of this smooth cartilage down to bone. The process is similar in the hip.

WHY DOES MY KNEE OR HIP HURT?

As the layer of cartilage wears away it causes rubbing of bone against bone, which causes the discomfort and stiffness commonly associated with arthritis.

A total knee replacement is really a resurfacing of the knee. The knee itself is not replaced, but the cartilage is substituted for on the end of the bones. This is done with a metal alloy on the femur and plastic on the tibia and kneecap (patella). This creates a new smooth functioning joint that does not hurt.

A total hip replacement is an operation that removes the ball of the upper thighbone (femur) that is arthritic, as well as damaged cartilage from the hip socket. The ball is replaced with a metal ball that is fixed solidly inside the femur. The socket is replaced with a plastic liner that is usually fixed inside a metal shell. This creates a new smooth-functioning joint that does not hurt.

Not necessarily. The only absolute indication for total joint replacement surgery is pain. We perform the surgery to alleviate pain. Joint replacement has a 95% success rate with regards to relieving pain. Merely having arthritis is not an indication for replacement and may be treated by a variety of other methods including medications, injections, and exercise.

At present, long term studies are showing that hip replacements may last 20-25 years, and knee replacements may last 15 years. Further follow-up is needed to determine how much longer these replacements last, but a patient can reasonably expect at least 10-15 years from a well done, well designed, hip or knee replacement.

The most common reason for failure for knee and hip replacements at 10-15 years is loosening due to wearing of the plastic component.

Yes they can. Redoing of a hip or knee replacement, which is known as revision surgery, can be done and does require a surgeon with special training in this area. The Peninsula Joint Replacement Center offers revision replacement by highly trained revision specialists.

Most surgeries go well without any complications. Infection and blood clots are two of the complications which concern us the most. To avoid these complications we give antibiotics and blood thinners before and after surgery. We also wear special enclosed "space" suits in the operating room to reduce the risk of infection.

Recent studies have indicated that total joint replacements perform equally as well in the old, young, and overweight patient. These concerns should be discussed with your surgeon.

WHAT WILL BE MY LIMITATIONS ONCE I HAVE TOTAL HIP OR KNEE REPLACEMENT?

The only absolute restrictions are no running or jumping sports. Other activities to avoid are extreme heavy lifting.

Your replacement surgery will be performed from start to finish by one of our surgeons at Peninsula Joint Replacement Center. Your surgeon may have one of the other surgeons assist him or may use one of our experienced surgical Physician’s Assistants.

The surgeons at the Peninsula Joint Replacement Center do 5-10 joint replacements per week.

Most patients can begin walking 1-2 days after surgery, putting weight on the limb as tolerated. We encourage full weight bearing as soon as the patient is comfortable with a walker or crutches. The patient is then advanced to a cane and may remain with the cane for 6-12 weeks depending on muscle strength and their level of comfort.

Most patients stay in the hospital 3 days. After this, the patient can either go home or go to one of our specialized inpatient rehab facilities.

There will certainly be some discomfort after replacement surgery, but we make every effort to keep the patient as comfortable as possible. In the first 48 hours after surgery, you will be receiving intravenous, patient-controlled analgesics. This means that when you experience pain, you will push a button and receive either intravenous Morphine or Demerol for excellent pain relief. After 48 hours we change to some very strong oral narcotic pain pills and these are frequently necessary for between 2-6 weeks after the surgery.

There is no need to be "put to sleep" for joint replacement surgery. Hip and knee replacement surgery can be done under regional anesthesia where the patient will be "numb" from the waist down. Most of our surgeons prefer this type of anesthesia since it has been shown to decrease intraoperative bleeding and the postoperative risk of deep venous thrombosis (clots).

Certainly. Even though you are not "put to sleep" the anesthesiologist can give you medication through your intravenous so that you will have no recollection of what has gone on in the operating room, and actually you will be resting quite comfortably.

You may need blood after the surgery. You may donate your own blood or use the blood bank. Bank blood is considered safe, but we understand if you want to use your own.

The scar resulting from a total knee replacement will be approximately 6-8 inches long. It will be straight down the center of your knee, unless you have previous scars in which case we may use the prior scar. There may be some numbness about the scar. This will not cause any problems.

The scar resulting from a total hip replacement will be approximately 6-8 inches long. It will be straight down the side of your hip, unless you have previous scars in which case we may use the prior scar. There may be some numbness about the scar. This will not cause any problems.

No. You do not need a private nurse, although if you want to get one, we will give you information so you can make these arrangements.

Yes. For about 6 weeks we do recommend that you have a walker, cane, or crutches. We can arrange for these to be delivered to your home, or you can rent or borrow them.

At the time of discharge from the hospital, you will be walking comfortably with a walker and you will be able to go up and down stairs with some restrictions. You will be able to shower but not bathe or swim until your surgical staples are removed.

We recommend that this be accomplished 3-4 weeks after surgery when the patient is off any type of pain medication, but of course the final determination is left up to the patient.

Assuming no problems or complications in a first time replacement surgery, we have found that most patients are back to 90-95% of normal function at 3 months.

A follow-up office appointment will be scheduled 10-14 days after the surgery for staple removal and x-ray check.

Yes. You may have some numbness to the outside of the scar. The area around the scar may feel warm. This may last a year or more, and is not serious. In knee patients, kneeling will be uncomfortable for a year or more. You may also notice some clicking when you move your knee as a result of the artificial surfaces coming together. It is not serious.

Bilateral replacements are done at the Peninsula Joint Replacement Center and should be discussed with your surgeon.