KNEE
Myth 1: “Recovery is soooo long”
According to the Journal of Arthroplasty, the greatest improvement in patient reported outcomes occurs within the first month after total hip arthroplasty, and with patients reporting improved functional outcomes compared to their baseline by 3 months post-op. Most patients return to work by 12 weeks (often sooner) and return to low impact sports by 4-6 months after hip and knee replacement. Walking and weight bearing begins the day of surgery, as well as discharge to home typically within 24 hours.
Myth 2: “I’m too old for joint replacement”
Advanced age alone is not a contraindication for joint replacement. Comorbidities are a stronger predictor of intra-op and post-op complications than simply age. Many studies show that patients over 80 (and even 90) years old experience significant pain relief and functional improvement comparable to younger patients.
Myth 3: “I’m too young for joint replacement”
Modern implants have excellent longevity. With improved materials and technology used for joint arthroplasties in recent years, studies show that revision rates have declined significantly, with 92% implant survivorship predicted at 25-30 years. This is particularly important for younger patients who weigh having years of improved function to the longevity of the implant. Many surgeons have extended indications for surgery to include younger patients.
Myth 4: “I’ll have activity restrictions/precautions forever”
While specific post-op restrictions/precautions are recommended by some surgeons, overall, many traditional post op restrictions lack evidence. According to a review article by the JBJS in 2021, continuous passive motion, compression stockings, range of motion restrictions, and hip precautions may not be needed routinely following joint replacement. Always consult with your surgeon for any specific restrictions after surgery.
Returning to activities after joint replacement is typically much sooner than you’d think. Approximately 82-85% of patients return to sports after a joint replacement. Low and moderate impact activities such as cycling, swimming, walking, golf, downhill skiing and hiking, are widely supported. The average return to sports after total hip replacement is 4-7 months post op according to the American Journal of Sports Medicine. Higher impact activities and sports (such as singles tennis) are possible, especially if the patient has prior experience in that activity but could come with an increased risk of implant loosening. These risks should be discussed with your specific surgeon.
Myth 5: “Being overweight means I can’t have surgery”
While morbid obesity can increase perioperative risks, such as infection, patients with Body Mass Index (BMI) greater than 35, and even greater than 40, experience similar pain relief as non-obese patients.
Myth 6: “Most people are unhappy after surgery”
Historically about 80% of total knee recipients and 90% of total hip recipients report little to no lasting pain. This concluded that perhaps up to 20% of patients having had a total knee replacement were dissatisfied for a multitude of reasons such as post op pain, limp, standing and kneeling ability and return to work. However, a 2023 review in the Journal of Arthroplasty reveals that the average rate of dissatisfaction for patients having had a total knee replacement is more likely around 10%. Some factors that affect this are due to improved risk assessment and identifying comorbidities as well as setting expectations for the recovery process.
References:
Sato EH, Stevenson KL, Blackburn BE, Peters CL, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty. J Arthroplasty. 2023 Jul;38(7S):S65-S71. doi: 10.1016/j.arth.2023.04.012. Epub 2023 Apr 15. PMID: 37068568.
Rubin LE, Blood TD, Defillo-Draiby JC. Total Hip and Knee Arthroplasty in Patients Older Than Age 80 Years. J Am Acad Orthop Surg. 2016 Oct;24(10):683-90. doi: 10.5435/JAAOS-D-15-00278. PMID: 27579814.
Lee GC, Illescas A, Fowler M, Poeran J, Memtsoudis S, Liu J. Should Chronological Age be a Consideration in Patients Undergoing Elective Primary Total Knee Arthroplasty? J Arthroplasty. 2024 Sep;39(9 Suppl 2):S179-S184. doi: 10.1016/j.arth.2024.04.036. Epub 2024 Apr 17. PMID: 38640964.
Sowers CB, Carrero AC, Cyrus JW, Ross JA, Golladay GJ, Patel NK. Return to Sports After Total Hip Arthroplasty: An Umbrella Review for Consensus Guidelines. Am J Sports Med. 2023 Jan;51(1):271-278. doi: 10.1177/03635465211045698. Epub 2021 Oct 20. PMID: 34668788.
DeFrance MJ, Scuderi GR. Are 20% of Patients Actually Dissatisfied Following Total Knee Arthroplasty? A Systematic Review of the Literature. J Arthroplasty. 2023 Mar;38(3):594-599. doi: 10.1016/j.arth.2022.10.011. Epub 2022 Oct 14. PMID: 36252743.
