Perception vs Reality of Knee and Hip Replacement surgery

My approach to knee and hip replacement helps patients avoid misconceptions.

My team and I care for people from all walks of life. Most patients express similar concerns and anxieties.  Some of their concerns are well founded and need to be addressed specifically.

The most common fear of all is that the surgery will be terribly painful.  The reality is that patients are recovering much faster and going home sooner than ever before.  In part, because we are more effectively regulating pain, in additional to advances in surgery such as minimally invasive approaches which cause less damage to muscles and robotic assisted technology which leads to more accuracy of implant positioning and less soft tissue damage. The combination of these lead to an enhanced recovery.

Routinely patients walk just hours after a hip or knee replacements and some go home the next day or normally within 2/3 days.  Knee replacements are more painful than hip replacements and often the first few weeks will be painful on the road to recovery. Hip replacements often report an improvement of pain straight away.

The second most frequent concern is about “going under”.  Some people, particularly older adults are terrified of general anaesthesia. Most of my patients have a spinal anaesthesia combined with IV propofol and a local anaesthetic.  The propofol assures they are completely asleep and comfortable with no need to place a tube down their throat or control their breathing. The spinal anaesthesia wears off more slowly than general anaesthesia and helps control post-operative pain.

I also routinely inject the tissues around the total hip or knee with a “cocktail” of medications which include a local anaesthetic that further decreases pain.  My knee patients also receive an adductor nerve block.  This modern approach to pain management contributes to why my patients feel comfortable and walk so quickly.

Once the surgery is over, rehab is a source of anxiety for many patients.  While many feel empowered and encouraged by the prospect of exercising and rebuilding their strength, others fear that physical therapy will last weeks or months and be awful.  The fact is that physical therapy is an essential part of the recovery process and needs to be customised for each patient, in large part based on how physically fit they were before surgery.

The next most common fear is about being housebound and immobile for months. Patients simply are not housebound or immobile for months. I encourage patients who had a hip or knee replacement to get off their frames or walking sticks as soon as they feel confident and go out. I think getting out of the house, going back to work, going shopping or to dinner is therapeutic. By being active and tending to their usual responsibilities, they stop focusing on their surgery and get busy. This is wonderfully therapeutic.

Many patients wrestle with the concern that pain and discomfort after surgery will deprive them of a good night’s sleep. Some fear that changing positions while they are asleep can cause a complication. This concern is unfounded. Patients who had their hip replaced are encouraged to sleep in whatever position they are comfortable. Some find it more comfortable to place a pillow between their legs, but it is not a requirement and there’s no harm if the pillow falls out. Sleeping on the operative side is also fine. There are no restrictions in most cases.

What is likely to keep people awake at night prior to surgery is everything they’re worrying about, including that they will get depressed because of pain and anxiety. While their concerns are mostly unfounded, they are scary enough to discourage some people from proceeding with surgery. Fortunately, the reality is very different. When these patients return for their final post-op visit, rather than hearing complaints about pain, I hear pride and enthusiasm about feeling so much better than they felt before surgery. They don’t express anxiety; they express gratitude.

Many people get depressed before their surgery because their arthritic knee or hip is limiting their ability to be active. Many become depressed because they’ve withdrawn from activities that require walking and are feeling isolated. Often this is one of the main motivators to proceed with surgery.

After surgery, I typically see patients looking more vibrant and smiling because they are out of pain and again more fully engaging with life. This is one of the greatest joys for me.