Features September 2013 Issue

Reality of New Knees and Hips

Joint replacement is no ticket to a pain-free life. Learn about your surgeon, your recovery and what you can expect after surgery.

Joint replacement surgery can ease pain and improve function if arthritis has severely eroded your knee or hip and damaged your quality of life.

Yet, although knee and hip replacements have transformed the lives of many patients, not everyone reaps the same level of benefit from them, suggests a study published in the May issue of Arthritis & Rheumatism (A&R). Researchers found that among 202 patients who had a total knee or hip replacement, only about half reported improved pain and disability in the next year or two. Patients who reported poor outcomes tended to have pain in multiple joints, other health problems, and less severe pain to begin with.

The findings reinforce the importance of educating yourself about joint replacement so that you have realistic expectations going in. And, a Cleveland Clinic expert emphasizes that finding a trusted surgeon and working with your healthcare team on your recovery can improve your odds of success. “Managing expectations is more than half the battle,” says Peter Brooks, MD, a Cleveland Clinic orthopaedic surgeon. “Artificial knees and hips do a great job but cannot be expected to be perfectly normal. …And it won’t matter how wonderful the device is if it’s not put in correctly. First and foremost, pick a surgeon you have confidence in.”

Factors that affect outcomes
As the A&R study suggests, many people undergoing a knee or hip replacement also have severe arthritis pain in their other knee or hip, and they may be less satisfied with their replacement joints until their other painful joint is replaced. Patients can have both knees or hips replaced during the same operation, or they can space out the surgeries over three to four months.

Reasonable expectations
The severity of your arthritis also may factor into your expectations of joint replacement. A patient with severe pain in multiple joints probably will have different expectations than someone who is healthier, more active, and has pain in only one joint and expects to return to a more normal functional level, says Dr. Brooks.

He says people who undergo total hip replacement tend to be more satisfied with their results compared to their knee replacement counterparts. Part of the reason is that knee joints are more complex, involving ligaments and other soft tissues that can be left too tight (producing stiffness) or too lax (causing instability).

“It’s the experienced surgeon who can balance the soft tissues, the ligaments all around the knee that may have to be collectively loosened or tightened. That becomes more of an art than a straightforward knee replacement,” he says. “That’s why you can have a perfectly good-looking X-ray and a knee that still hurts and won’t bend, and why patients often feel things that the doctor can’t see.”

After surgery, you’ll notice a “change in the character of your pain,” Dr. Brooks says. The deep groin or buttock pain from hip arthritis and the dull pain of bone-on-bone arthritis of the knee are replaced by pain from the surgical incision, which improves each day.

It’s normal for your new knee or hip to click or for you to feel numbness on the opposite side of your knee incision, Dr. Brooks says. You’ll experience swelling, you may develop a low-grade fever, and your knee or hip may be inflamed for up to a year or two after surgery, he adds. Unfortunately, these symptoms also are potential signs of infection, which tend to occur several days after surgery but may not manifest for months to years. If your pain does not diminish or worsens, tell your doctor.