OSTEOARTHRITIS
Total joint replacement, including knee and hip replacement, is rapidly becoming one of the most commonly performed procedures in orthopedics. The most common indication for joint replacement is debilitating joint pain from underlying osteoarthritis. Osteoarthritis develops when cartilage (the “cushion” in the joint) wears away, which can eventually result in bones rubbing against one another. This can lead to joint pain and stiffness. If nonsurgical treatments, such as anti-inflammatory medications, physical therapy, and joint injections, do not provide adequate pain relief, joint replacement may be a viable option.
Total joint replacement has been traditionally considered an inpatient surgical procedure that requires a several day hospitalization. The reasons for this belief include concerns over postoperative pain control, limited mobility after surgery, and concerns about perioperative complications. Over the past decade, however, advances in perioperative pain control and less invasive surgical techniques have allowed earlier patient mobilization and more aggressive rehabilitation. The combination of regional anesthesia, including spinal and local nerve blocks, intraoperative peri-articular injections, and multimodal perioperative protocols have significantly improved postoperative pain control. This has resulted in more rapid recovery and shorter length of hospital stay after joint replacement. Furthermore, recent literature has illustrated that shorter hospitalization has not resulted in increased perioperative complications. Of note, a “short hospital stay” is defined as a 23-hour hospitalization for total joint replacement.
You may be asking yourself, “what can I expect after surgery if am a considering total joint replacement?” Individual encounters may vary, but the overall experience is consistent. In general, you will be allowed to place as much weight as you can tolerate on your leg immediately after surgery. Because of the recent surgery, another person should always assist you when you are out of bed to prevent falls. You can expect physical therapy twice per day while in the hospital. If your surgery is scheduled for later in the day, you may only have one session on the day of surgery. Physical therapy will focus on range of motion, strengthening, and gait training. You must demonstrate that you can walk with minimal assistance and navigate stairs in a safe manner before you are discharged. While you are in the hospital, a Case Manager will coordinate home physical therapy and visiting nursing so that your rehabilitation continues after you arrive home. Once you are medically stable and have reached the appropriate functional milestones with physical therapy, you will be discharged from the hospital.
It is important to recognize that not all patients are candidates for short hospital stays after total joint replacement. At the initial Pre-Admission Testing evaluation, every patient will be screened with the Risk Assessment and Prediction Tool (RAPT). The RAPT consists of a survey of six questions that assess age, gender, functional abilities, and social support. The tool is scored on a 12-point scale, and a score of 10 or more identifies patients that are candidates for a short hospital stay. Patients with scores of 9 or less generally benefit from a more traditional length hospital stay of greater than 24 hours. Of note, the RAPT has been consistently shown to predict discharge disposition accurately in recent orthopedic research.
Before considering joint replacement, I believe that it is important to understand what the procedure can and cannot do. Greater than 90% of people who have joint replacements report a dramatic reduction in joint pain and a significant improvement in the ability to perform common activities of daily living. Joint replacement, however, will not allow you to do more than you could before you developed arthritis. If you continue to experience debilitating pain despite nonsurgical treatment, I encourage you to ask your medical provider if joint replacement is a reasonable option.
