FAQ's & Resources

How long will my new joint last and can a second replacement be done?

All implants have a limited life expectancy depending on an individual’s age, weight, activity level, and medical condition(s). A total joint implant’s longevity will vary in every patient. It is important to remember that an implant is a medical device subject to wear that may lead to mechanical failure. While it is important to follow all of your surgeon’s recommendations after surgery, there is no guarantee that your particular implant will last for any specified length of time.

What are the major risks?

Most surgeries go well, without any complications. Infection and blood clots are two serious complications. To avoid these complications, your surgeon may use antibiotics and blood thinners. Surgeons also take special precautions in the operating room to reduce the risk of infection.

How long will I be in the hospital?

You will probably stay in bed the day of surgery. However, the next morning most patients will get up, sit in a chair or recliner, and should be walking with a walker or crutches the following day. Most hip patients will be hospitalized for three days after surgery. There are several goals that must be achieved before discharge.

What if I live alone?

Three options are available to you. You may return home and receive help from a relative or friend. You can have a home health nurse and physical therapist visit you at home for two or three weeks. You may also stay in a skilled nursing facility following your hospital stay, depending on your insurance.

How do I make arrangements for surgery?

After your surgeon has scheduled surgery, the joint care coordinator will contact you. He will guide you through the program and make arrangements for both pre-op and post-op care. The coordinator’s role is described in the handbook on page 3 of the“General Information” section along with a telephone number.

What happens during the surgery?

RMH reserves approximately one to two hours for surgery. Some of this time will be taken by the operating room staff to prepare for surgery. You may have a general anesthetic. Some patients prefer to have a spinal or epidural anesthetic, which numbs the legs and does not require you to be asleep. The choice is between you, your surgeon, and the anesthesiologists. For more information, read “Understanding Anesthesia” on page 2 of the “Getting Ready” section.

Will the surgery be painful?

You will have discomfort following the surgery, but we will try to keep you as comfortable as possible with the appropriate medication. After surgery, most patients control their own medication with a special pump that delivers the drug directly into their IV. For more information, read “Understanding Anesthesia” at the start of this section on page page 1 of the “Getting Ready” section.

Will I need a walker, crutches or a cane?

Patients progress at their own rate. Normally we recommend that you use walker, crutches, or a cane from four to six weeks. The joint care coordinator can arrange for them if necessary.

Where will I go after discharge from the hospital?

Most patients are able to go home directly after discharge. Some patients may transfer to a skilled nursing facility, where they will stay from three to ten days. The joint care coordinator will help you with this decision and make the necessary arrangements. You should check with your insurance company to see if you have rehab benefits.

Will I need help at home?

Yes, for the first few days or weeks, depending on your progress, you will need someone to assist you with meal preparation, housework, etc. If you go directly home from the hospital, the joint care coordinator will arrange for a home health nurse to come to your house as needed. Family or friend need to be available to help if possible. Preparing ahead of time, before your surgery, can minimize the amount of help needed. Having the laundry done, house cleaned, yard work completed, clean linens put on the
bed, and single portion frozen meals will help reduce the need for extra help.

Will I need physical therapy when I go home?

Yes, you will have either outpatient or in-home physical therapy. Patients are encouraged to utilize outpatient physical therapy. The joint care coordinator will help you arrange for an outpatient physical therapy appointment. If you need home physical therapy, we will arrange for a physical therapist to provide therapy in your home. Following this, you may go to an outpatient facility two to three times a week to
assist in your rehabilitation. The length of time for this type of therapy varies with each patient.

Will my new joint set off security sensors when traveling?

Your joint replacement is made of a metal alloy and may or may not be detected when going through some security devices. Inform the security agent you have a metal implant. The agent will direct you on the security screening procedure. You should carry a medic alert card indicating that you have an artificial joint. Check with your surgeon on how to obtain one

What is osteoarthritis and why does my hip hurt?

Joint cartilage is a tough, smooth tissue that covers the ends of bones where joints are located. It helps cushion the bones during movement, and because it is smooth and slippery, it allows for motion with minimal friction. Osteoarthritis, the most common form of arthritis, is a wear and tear condition that destroys joint cartilage. Sometimes, as the result of trauma, repetitive movement, or for no apparent reason, the cartilage wears down, exposing the bone ends. Over time, cartilage destruction can result in painful bone-on-bone contact, along with swelling and loss of motion. Osteoarthritis usually occurs later in life and may affect only one joint and many joints.

What is total hip replacement?

The term total hip replacement is somewhat misleading. The hip itself is not replaced, as is commonly thought, but rather an implant is used to re-cap the worn bone ends. The head of the femur is removed. A metal stem is then inserted into the femur shaft and topped with a metal or ceramic ball. The worn socket
(acetabulum) is smoothed and lined with a metal cup and either a plastic, metal, or ceramic liner. No longer does bone rub on bone, causing pain and stiffness.

How long and where will my scar be?

There are a number of different techniques used for hip replacement surgery. The type of technique will determine the exact location and length of the scar. The traditional approach is to make an incision lengthwise over the side of the hip. Your surgeon will discuss which type of approach is best for you. Please note that there may be some numbness around the scar after it is healed. This is perfectly normal and should not cause any concern. The numbness usually disappears with time.

What is osteoarthritis and why does my knee hurt?

Joint cartilage is a tough, smooth tissue that covers the ends of bones where joints are located. It helps cushion the bones during movement, and because it is smooth and slippery, it allows for motion with minimal friction. Osteoarthritis, the most common form of arthritis, is a wear and tear condition that destroys joint cartilage. Sometimes, as the result of trauma, repetitive movement, or for no apparent reason, the cartilage wears down, exposing the bone ends. Over time, cartilage destruction can result in painful bone-on-bone contact, along with swelling and loss of motion. Osteoarthritis usually occurs later in life and may affect only one joint or many joints.

What is total knee replacement?

The term total knee replacement is misleading. The knee itself is not replaced, as is commonly thought, but rather an implant is used to re-cap the worn bone ends. This is done with a metal alloy on the femur and a plastic spacer on the tibia and patella (kneecap). This creates a new, smooth cushion and a function joint that can reduce or eliminate pain.

How long and where will my scar be?

Surgical scars will vary in length, but most surgeons will make it as short as possible. It will be straight down the center of your knee, unless you have previous scars, in which case your surgeon may use an existing scar. There may be lasting numbness around the scar.

What is wrong with my back?
You have what’s commonly known as a pinched nerve. This can be produced by one or more herniated discs and/or areas of arthritis in your back. The discs are rubbery shock absorbers between the vertebrae, and are close to nerves that originate in the spine and then travel down to the legs. If the disc is damaged, part of it may bulge (herniate) or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness. Bone spurs associated with arthritis may do the same thing.

What is required to fix the problem?

The discs or bone spurs pressing on your nerve must be removed. This is done by making an incision (usually two or three inches long) in the middle of your lower back, moving the muscles covering your spine to the side, and making a small window into your spinal canal. The nerve is exposed, moved aside and protected; and the protruding disc or bone spur is then removed. This decompresses the nerve and, in most cases, leads to rapid improvement in nerve pain, numbness and/or weakness. Sometimes the abnormality may be more extensive, extending over several disc segments, requiring a longer incision for decompression.

Who is a candidate for lumbar laminectomy and when is it necessary?

The primary reason for this operation is pain that is intolerable to the patient. Sometimes increasing nerve dysfunction (particularly weakness) or loss of bowel or bladder control may make the surgery necessary even if pain is not severe. In most cases, nerve dysfunction is not severe and pain can be controlled by nonsurgical means. However, if the pain becomes intolerable, surgery is a reliable way to solve the problem. Since the patient is the one feeling the pain, the patient is usually the one who decides when he or she is ready for surgery.

Who performs this surgery?

An orthopedic surgeon who specializes in spinal surgery will perform this surgery.

Is my entire disc removed?

No, only the ruptured part and any other obviously abnormal disc material are removed. This generally amounts to no more than 10-15 percent of the entire disc.

How long will I be in the hospital?

Laminectomy patients are usually out of bed within an hour or two after their operation, and some can go home on the day of surgery. The remainder almost always go home the next morning.

Will I need a blood transfusion?

Transfusions are rarely needed after this kind of surgery.

What can I do after surgery?

You may get up and move around as soon as you feel like it, and may drive short distances when you feel able. You should avoid bending, lifting and twisting for 6 weeks to allow for healing of the surgical area.

When can I go back to work?

That depends on the kind of work you do, and how long you have to drive to get there. If your job is a desk job and within a 15 minutes drive from your home, you may return when you feel comfortable (usually 2-3 weeks). You should not drive long distances (30 minutes or more) for about one month after surgery. If your job requires physical labor, you should consult your surgeon.

What is the likelihood that I will be relieved of my pain?

90-95 percent of patients get relief of their leg pain. Some patients (about 15 percent) will continue to have noticeable back pain in some situations, and may require additional treatment.

Could I be paralyzed from surgery?

The chances of neurologic injury with spine surgery are very low; and the possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Rarely, injury to a nerve root with isolated numbness and/or weakness in the leg is possible.

What other risks are there?

There are general risks with any type of surgery. These include, but are not limited to, the possibility of a wound infection, uncontrollable bleeding, leakage of spinal fluid, collection of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs), and heart attack. The chances of any
of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure.

Will my back be normal after surgery?

Though you may have excellent relief of pain, a disc is never completely normal after it has herniated, and if your problem has been caused by arthritis, the arthritis cannot be cured even if the bone spurs have been removed and the nerves decompressed. Scar tissue may form around the surgically decompressed nerves and may cause residual pain. You may have more back pain than a normal person would have, and there is an increased risk of re-herniation of the damaged disc. However, most people can resume almost all of their normal activities after recovering from surgery.

What should I do after surgery?

You should resume low-impact activities as soon as possible, starting with walking. Try to walk a little farther each day, building up to a brisk three-mile walk each day by six weeks after surgery. Once your sutures are removed you may swim, which is very back-friendly. By two or three weeks after surgery you may try more vigorous activities such as an exercise bike or NordicTrack. Talk to your surgeon about aerobics and jogging. Physical activity is good for you, if done properly.

What shouldn’t I do after surgery?

In general, you should limit heavy lifting, bending, twisting and high impact physical activities, including contact sports. Consult your surgeon for details.

Could this ever happen to me again?

Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no way to return the disc to normal again, which means recurrent herniations do occasionally occur. Also, adjacent discs may be abnormal, too, and could rupture in the future.

Should I avoid vigorous physical activity?

No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking outside or on a treadmill and using an exercise bike are all examples of exercise that is appropriate for spine patients, but only when directed by your surgeon.

What is wrong with my back?

You have one or more damaged discs and/or areas of arthritis in your back. This produces pain, and may produce abnormal motion, or misalignment of your spine. Discs are rubbery shock absorbers between the vertebrae, and are close to nerves that travel down to the legs. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing leg pain, numbness or weakness.

What is required to fix the problem?

Your condition requires both a nerve decompression (freeing the nerves from pressure) and a spinal fusion. In this case, both nerve decompression and spinal fusion would be done.

What is spinal fusion?

A fusion is a bony bridge between at least two other bones; in this case, two vertebrae in your spine. The vertebrae are the blocks of bone that make up the bony part of the spine, like a child’s building blocks stacked on top of each other to make a tower. Normally each vertebra moves within certain limits in relationship to its neighbors. In spinal disease, the movement may become excessive and painful, or the vertebrae may become unstable and move out of alignment, putting pressure on the spinal nerves. In cases like this, surgeons try to build bony bridges between the vertebrae using pieces of bone called bone graft. The bone graft may be obtained from the patient, (usually from the pelvis), or from a bone bank. There are advantages and disadvantages to either source. The bone graft is either laid next to the vertebrae or actually placed between the vertebral bodies (the rubbery disc that normally lies between the vertebrae must be removed). In either case, the bone graft has to heal and fuse to the adjacent bones before the fusion becomes solid. Spine surgeons often use screws and rods to protect the bone graft and stabilize the spine while the fusion heals.

How is the operation performed?

A four to five inch incision is made in the middle of the lower back. Muscles supporting the spine are pushed aside temporarily. The spinal nerve is exposed, moved aside and protected, and the ruptured disc or bone spur is removed to loosen the nerve. The fusion is performed as described above. The wound is then closed and dressings are applied. The operation typically takes a minimum of three hours and may be longer, depending on the complexity of the problem. Sometimes the spinal fusion is performed with an anterior approach. In this case, the surgeon would make a four to five inch incision in the lower abdomen, gently move the internal organs aside, and proceed with the surgery as described above.

Who is a candidate for lumbar fusion, and when is it necessary?

When the back and nerve problems cannot be corrected in a more simple procedure and the pain persists at an unacceptable level, it is necessary to do a fusion. Instability of the spine may require a fusion and this may be necessary due to curvature of the spine or slippage of vertebrae. Some of the conditions which require spinal fusion are discussed in the answer to “What is Spinal Fusion?”

Who performs this surgery?

An orthopedist who specialize in spine surgery will perform this procedure.

Could I be paralyzed from surgery?

The chances of neurologic injury with spine surgery are very low; and the possibility of catastrophic injury, such as paralysis, impotence or loss of bowel or bladder control are highly unlikely. Injury to a nerve root with isolated numbness and/or weakness in the leg is possible.

Are there other risks involved?

There are general risks with any type of surgery. These include, but are not limited to, the possibility of a wound infection, uncontrollable bleeding, leakage of spinal fluid, collection of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs), and heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure.

What are my chances of being relieved of my pain?

More than 90 percent of patients get relief of their nerve symptoms or leg pain. Relief of back pain is less predictable, occurring about 75 percent of the time.

Will I need to wear a neck brace?

Most patients will wear some type of neck brace after this surgery. The type of brace and length of time you need to wear the brace will be determined by your surgeon.

Will my back be normal after surgery?

No. Even if you have excellent relief of pain, the spine is not completely normal after a fusion. Stiffening one segment of the spine with the fusion may put additional strain on other areas. Other discs may have started to wear out. Even if they aren’t causing you pain now, they may do so in the future. For these reasons, you may have more back pain than a normal person would have. However, most people can resume almost all of their normal activities after their fusion has healed.

How long will I be in the hospital?

The hospital stay is generally one to three days.

What shouldn’t I do after surgery?

Generally, you should avoid bending, lifting and twisting for six to nine months. Even if screws or rods are used, six to twelve months are required for the fusion to heal completely. You must protect your spine during this time. Your surgeon will usually prescribe a brace for you to wear for part of this time. If you are a smoker, you definitely should not smoke until your fusion is completely solid, since smoking interferes with bone healing.

What can I do after surgery?

You should get up and move around frequently as soon as you feel like it. If you are
feeling well enough, you may begin driving in two to three weeks with your back brace on.

When can I return to work?

This should be discussed individually with your surgeon. Generally, patients may return to sedentary jobs whenever they are comfortable, which is usually within three to six weeks. If you drive more than 30 minutes to get to work, your surgeon may want you to wait longer. It takes much longer to get back to work that requires strenuous physical activity due to the increased stress these activities play on the healing bone.

Could this happen to me again?

Unfortunately, yes. A fusion may add stress to the levels above and below the fusion. If the fusion doesn’t heal solidly, even with plates and screws, your symptoms may recur and additional surgery may be needed.

Should I avoid vigorous physical activity?

No. Exercise is good for you! You should get some sort of vigorous, low-impact aerobic exercise at least three times a week. Walking either outside or on a treadmill are all examples of exercise that are appropriate for spine patients, but only when directed by your surgeon.

What is wrong with my neck?

You have a pinched nerve. This can be produced by a ruptured disc or by bone spurs. Discs are rubbery shock absorbers between the vertebrae, and are close to the nerves which travel down to the arms. If the disc is damaged, part of it may bulge or even burst free into the spinal canal, putting pressure on the nerve and causing arm pain, numbness, or weakness. Bone spurs, usually the result of arthritis, can also put pressure on nerves. Occasionally, pressure from bone spurs or a ruptured disc may affect the spinal cord and cause abnormalities in the legs or lower parts of the body.

What is required to fix the problem?

In most cases, a small (2-4 inch) incision is made in the posterior part of the neck. Muscles supporting the spine are pushed aside temporarily, and a small “window” is made into the spinal canal. The spinal nerve is protected, and the ruptured part of the disc or the bone spur is removed. If bone spurs and arthritis are the cause of your problem, you may require a bigger incision and more bone may have to be removed.

When is this operation necessary?

In almost all cases, the major reason for spine surgery is pain. Often non-surgical measures can control the pain. However, if the pain persists or becomes worse, if you cannot function because of pain, or if weakness or other neurological problems develop, then surgery may be necessary to relieve the problem.

Who performs this surgery?

An orthopedic surgeon who specializes in spinal surgery will perform this surgery.

How long will I be in the hospital?

Most patients stay 24-48 hours. Complications may require longer stays.

Will I need a blood transfusion?

Transfusions are rarely needed after this kind of surgery.

What can I do after surgery?

You should try to get up and move around as much as your symptoms allow. You may walk as much as you like.

What shouldn’t I do after surgery?

For at least 6 weeks, you should avoid lifting (no more than 10 pounds), overhead lifting, frequent or repetitive neck movements and vigorous sports until instructed otherwise by your surgeon.

When can I go back to work?

That depends on what kind of work you do and how far you have to drive. It can be as little as two weeks, but may be longer if your job involves manual labor or if you have to drive more than 30 minutes to get there.

What are my chances of being relieved of my pain?

90-95% of patients get relief from their nerve symptoms or arm pain. Neck and shoulder pain are less predictably relieved by disc surgery. Up to 15% of patients may have some neck and shoulder aching after surgery; this percentage may be higher in patients who have a substantial amount of neck and shoulder pain before surgery. Other conditions such as fibromyalgia may also produce continued pain even after successful disc surgery.

Will my neck be normal after surgery?

No. Even if you have excellent relief of pain, the disc has still been damaged. However, most people can resume almost all of their normal activities after disc surgery. People who do heavy work generally take longer to recover and may not be able to do everything they could do before their injury.

The chances of neurological injury with disc surgery are very low, and the possibility of catastrophic injury such as paralysis, is highly unlikely, though not impossible. Injury to a nerve root with isolated numbness and/or weakness in the arm is possible.

What other risks are there?

There are general risks with any type of surgery. These include, but are not limited to, the possibility of wound infection, uncontrollable bleeding, collection of blood clots in the wound or in the veins of the leg, abdominal problems, pulmonary embolism (a blood clot to the lungs), and heart attack. The chances of any of these happening, particularly to a healthy patient, are low. Rarely, death may occur during or after any surgical procedure.

Is my entire disc removed?

No, only the ruptured part and any other obviously abnormal disc material is removed. This generally amounts to no more than 10-15 percent of the whole disc.

Could this ever happen to me again?

Unfortunately, yes. As mentioned above, only part of the disc is removed and there is no way of making the remaining disc normal again, which means recurrent herniations do occasionally occur. Also, adjacent discs may be or may become abnormal, too, and could rupture in the future.

Should I avoid vigorous physical activity?

No. Exercise is good for you. You should get some sort of vigorous, low-impact aerobic exercise at least 3 times a week once directed by your surgeon. Walking outside or on a treadmill and using an exercise bike are all examples of the type of exercise that is appropriate for spine patients, but only when directed by your surgeon.