Frequently Asked Questions

This is a very common question for patients. It is also one that varies from patient to patient. This is a difficult question to answer because every patient is different, not only in how they tolerate pain, but how their brain and body respond to pain. That being said, each patient who has surgery at OJRCA will receive our “pain cockatil” to help decrease their pain in the post-operative period. We also will have you up and walking as soon as it is safe to do so, to get you up and moving! Moving quickly after surgery not only helps prevent blood clots but it also helps prevent you from feeling stiff. The vast majority of patients say their pain after surgery is minimal. They describe it as soreness around the incision and some swelling. It is most common described as “I feel like I’m sitting on a fat wallet”. 

Every patient and every case is different. Each person has a different experience and handles and tolerates pain differently. We typically say the recovery period for a total hip is 3-6 weeks and the recovery period for a knee is 6-10 weeks That being said, we have several patients back at work in as little as a few days or more typically within 2-3 weeks for hips and 3-4 weeks for knees. That being said, the “global period” for post-operative patients is 3 moths, and it can take even more time for your new joint to feel “normal”. Remember, this is not the joint you came into the world with. It will be warm, it can swell, and  it may ache. These are all normal sensations that can be expected.

At OJRCA, we are very selective on who should and should not receive a partial knee replacement. This is not because we do not want to do them but rather because if you are not the appropriate candidate for the surgery, you will not have a good outcome. If the whole knee is worn then a complete replacement is best. We screen our patients thoroughly so that they have the best outcome possible. There are multiple companies who have partial knee replacement implants. We choose to utilize the Makoplasty system due to its bone conservation, its computer guided system to allow for the best alignment and the ease it is to perform. The Mako uses a precisionbur to allow for bone conservation.

Walk as much as you can SAFELY tolerate! We fixed your joints so you can walk and live your life with minimal pain. You will not hurt your knee or hip implant by walking. This is one of the best exercises you can do for your rehab! Not only does it help with your motion but it also helps decrease your risk of blood clots. You will notice swelling after walking and doing exercises. It’s important that you take time to ice and ELEVATE your legs after doing exercises and walking. Elevate as high as you can tolerate, above your HEAD not just your heart. Recliners do not elevate adequately. Again, make sure you’re being safe when walking. For the first few days or weeks, patients use  appropriate assistive devices, such as a walker or cane as instructed by your therapist.

The majority of hospitals and ASC’s in the US have implemented a BMI limit for elective total joint replacement surgeries. Most commonly seen is a BMI restriction of 35-40. This is because the risk associated with a high BMI skyrockets after 40. This includes, but is not limited to, wound break down and delayed healing, fracture risk, infection, etc. Each hospital and surgeon is different with their BMI limit. At OJRCA our BMI limit is 40, but some hospitals we operate at do have a limit of 35. We work closely with bariatric surgeons and fitness coaches to help patients who need/want a joint replacement to lose weight, if that’s an option they are interested in.

There are different levels of osteoarthritis. Treatment options vary for each patient, at each grade and is based on their symptoms, limitations and medical problems. The majority of times patients should try ice, activity modifications, oral anti-inflammatory medications such as Tylenol, Advil, Aleve, etc, physical therapy and cortisone injections before proceeding with surgery. These options vary based on symptoms and other medical conditions. 

Grade one: There is slight damage to the cartilage and slight narrowing of the joint space.

Grade two: The space between the bones continues to narrow but to a greater extent

Grade three: The damage to the cartilage has progressed, the gap between the bones has narrowed significantly. As osteoarthritis progresses, the cartilage will continue to thin and break down. The bones will respond by thickening and growing outward to form lumps called osteophytes. The tissue that lines the joint will become inflamed, and it may produce extra synovial fluid, resulting in increased swelling. The lining swelling is called synovitis, and the free fluid is called an effusion, commonly known as “water on the knee”.

Grade four: This is the most advanced stage of OA, and the symptoms are very visible. The space between the bones in the joint is gone and we have “bone on bone”. X-rays will show bone on bone, meaning that either the cartilage has completely worn away or there is very little left. The individual will likely develop more bone lumps and experience pain that is often intense during simple activities, such as walking. In severe cases, the bones may become deformed and angulated because of asymmetric loss of cartilage.

Bilateral knee and hip replacements are NOT common any longer. Years ago bilateral knees were frequently performed. The risk of doing one knee at a time has fallen so much that bilateral surgery carries more risk than doing one at a time and assessing the total risk of the two procedures. When we do bilateral joint replacements we have to divide the medication we put into your joint, to help with pain immediately post operatively, in half. So instead of getting ALL of that medication in one joint, you get the same medication divided into two. We cannot give more because of toxicity levels. Also, therapy and relearning your gait is hard enough for one joint, it’s even harder with two. We need you to focus all energy on getting your one operative joint back to 100%.  Bilateral knee and hip replacements are done, but very rarely. It is usually done with the angle deformity of the joint is so bad that it will make ambulation difficult if the other joint IS NOT fixed as well. This is a case by case discussion and other medical problems play a factor as well.

Dr. Clifford has performed total hip replacements on younger patients. This is usually due to trauma, avascular necrosis from certain medications, or hip dysplasia. We are happy to see and evaluate any person, of any age. Obviously, we do not want to rush anyone into a total joint replacement, because there is nothing like the joint you were given when you were born. But sometimes, things happen, joints wear out and you might need a new one. We can evaluate you and see if you are an appropriate candidate for joint replacement surgery. The same thing goes with patients that have been told they’re “too old”. If you’re healthy, active and still busy living life, and the one thing holding you back is a bad joint, come in and we’ll talk to you about options. A bad knee or hip should not be holding you back!

Recovery after a total knee is hard work. Don’t let anyone tell you differently. You will be in physical therapy 3 times a week for at least 3-4 weeks, and then it decreases to 2 times a week for another 2-4 weeks. Ideally, patients will be bending their knee to 95-100 degrees by TWO WEEKS after their surgery, and will be getting their leg very close to full extension. By six weeks we love our patients to be fully straight in extension and bending to 120+ degrees. If patients have difficulty bending because they are not pushing hard enough in therapy and are not doing their home exercises appropriately they may need to be taken back to the operating room for what is called a manipulation under anesthesia. At that time, patients are sedated and their knee is pushed, so scar tissue is broken up and motion will hopefully get better. After MUA you will go back to aggressive PT. This isn’t a “do over” because the scar that has already formed can markedly effect the future of the knee. So it’s IMPORTANT to do your physical therapy as directed. Push as hard as you can from the start.

Only if you could tap dance before! 

The is one of our favorite questions. Yes, we want you to be able to dance as much as you’d like!