Frequently Asked Questions

Anesthesia & Pain Management Questions

Hip Surgery Questions

Knee Replacement Questions

ANESTHESIA & PAIN MANAGEMENT

1. QUESTION:  What kind of anesthesia and pain relief is available if I opt for surgery?

ANSWER:  The surgeon and anesthesiologist will determine what’s best for you, taking into account any allergies you may have. There are two types of anesthesia used in total joint surgery:

  • General anesthesia: You totally lose consciousness, pain sensation and protective airway responses
  • Regional anesthesia includes spinal blocks, epidural
    blocks or peripheral nerve blocks, and only the area that requires surgery is anesthetized.

2.  QUESTION:  WITH REGIONAL ANESTHESIA, AM I AWAKE DURING SURGERY?

ANSWER:  You may stay awake, or the physician may give you a sedative, but you won’t see or feel the actual surgery.

“Conscious sedation” describes a semi-conscious state that allows you to be comfortable and pain-free, yet aware of what’s happening, compared with deep sedation where you sleep throughout the procedure and have little or no memory of what happened to you.

3. QUESTION:  HOW IS AN EPIDURAL OR SPINAL BLOCK PERFORMED?

ANSWER:  During a spinal or epidural block, you’re either sitting up or lying down on your side. 

  • Before the block is performed, your skin is cleansed with bacterial-killing solution  
  • The anesthesiologist uses local anesthesia to numb the target area of your spine  
  • A second needle is used to inject an anesthetic in case of a spinal, or a small plastic tube in case of an epidural
  • The needle is removed once the anesthetic or catheter is in place
  • The medication cleanses the nerves and blocks out any pain

After the anesthesiologist has performed the spinal or epidural block, you’ll generally feel numb and your legs may feel weak so you can’t move them, but this is normal.

4.  QUESTION: WHAT ARE THE CHOICES FOR PAIN RELIEF AFTER SURGERY? 

ANSWER:  All pain medications are prescribed by your surgeon. 

  • An epidural catheter is used in most knee patients for the first 24 hours after surgery for pain control. The medication used in the epidural will decrease the pain sensation. In most hip patients, patient controlled analgesia (PCA) is used. Patients can control their own pain by pressing a button. The pain medication will then be safely delivered through an IV when the patient feels like they are having pain.
  • IV or oral pain-relieving medications are injected into a vein or taken by mouth to help dull pain, but you may still experience some discomfort.
  • A pain ball may be used after surgery.  This is a device that delivers a numbing medication directly into the incision are helping to reduce the pain. The pain ball delivery system can stay in for up to 4 days after surgery, without impacting your rehabilitation.
  • A peripheral nerve block is a single injection into a catheter placed by the nerve used to help reduce your pain after surgery. Local anesthetics and other drugs are used to reduce or block pain and other sensation over a wider part of your body

HIP SURGERY

1.  QUESTION:  WHAT IS ARTHRITIS AND WHY DOES MY HIP HURT SO BADLY I CAN HARDLY WALK?

ANSWER:  Your hip joint contains a layer of smooth cartilage on the ball of the upper thigh bone (femur) and another layer of cartilage in the hip socket.  The cartilage acts as a cushion and allows smooth hip motion. 

Arthritis causes a gradual wearing down of this cartilage until there’s none left.  Every time you move, it’s bone rubbing against bone without the pillow of cartilage to ease your movement.

2. QUESTION: WHAT IS A TOTAL HIP REPLACEMENT AND WHY WOULD I NEED ONE?

ANSWER:  The arthritic ball of your upper thigh bone, as well as the damaged cartilage from your hip socket, are removed.

  • The ball is replaced with a metal ball solidly inserted inside your femur 
  • The socket is replaced with a plastic or metal liner that’s usually fixed inside a metal shell
  • Result: you have a smoothly functioning joint that leaves you pain-free

3. QUESTION:  WHAT RESULTS CAN I EXPECT FROM A TOTAL HIP REPLACEMENT?

ANSWER:  Results usually vary depending on:

  • The quality of the surrounding tissue
  • The severity of your arthritis at the time of surgery
  • How well you obey the physician’s orders

4. QUESTION:  WHEN SHOULD I HAVE HIP SURGERY?

ANSWER:  That’s between you and your orthopedic surgeon.  He can tell whether you’re a good candidate.  Age is not an issue if you’re in reasonably good health and wish to continue living an active life.

5. QUESTION: WHAT ARE THE MAJOR RISKS?

ANSWER: Complications are infrequent, but a couple can occur occasionally:

  • Infection
  • Blood clots

To avoid infection, use the antiseptic wash that is given to you prior to surgery. Also proper hand washing is essential. Antibiotics are given before and after surgery to reduce the risk of infection. 

Blood thinners will be given to you postoperatively to prevent blood clots. Special compression devices are used in the hospital to reduce the risk of blood clots as well.

6.  QUESTION: HOW LONG WILL I BE HOSPITALIZED?

ANSWER:  Normally you will be hospitalized for two to three days. After the hospital stay you will need therapy either at home or in an inpatient facility for an additional week or two. Our team will design a rehabilitation plan that is designed to fit your specific needs.

7. QUESTION: WILL I HAVE ANY RESTRICTIONS AFTER SURGERY?

ANSWER: You’re advised to avoid high-impact activities:

  • Running
  • Tennis
  • Basketball
  • Soccer
  • Down-hill skiing
  • Any injury-prone activities
     
    Other restrictions may include:
  • Crossing your legs
  • Twisting operated legs
  • Twisting side-to-side
  • Bending 90 degrees at the hip

8. QUESTION:  WILL I NEED PHYSICAL THERAPY OR AN EXERCISE PROGRAM?

ANSWER: The simple answer is “yes” to both.  The number of physical therapy sessions you’ll need varies for by individual, but exercise must be a lifetime commitment. Your surgeon and physical therapist will design a program to specifically meet your needs.

9.  QUESTION:  WILL I NEED MEDICAL OR ASSISTIVE EQUIPMENT AT HOME?

ANSWER:  A walker, cane or crutches may be used for about six weeks.  Our qualified staff will take care of any equipment needs you may have prior to discharge from the hospital.

Some other devices you may need:

  • Grab bars in the bathroom
  • An elevated toilet seat (for about three months)
  • A bath seat
  • Help with lower body dressing

KNEE REPLACEMENT

1. QUESTION:  WHAT IS ARTHRITIS AND WHY DOES MY KNEE HURT?

ANSWER:  Your knee joint contains a layer of smooth cartilage on the lower end of the thigh bone (femur) and the upper end of the shinbone (tibia) and the undersurface of the kneecap (patella).  Cartilage acts as a pillow that cushions your knee and allows for its smooth motion.

2. QUESTION:  WHAT IS A TOTAL KNEE REPLACEMENT AND WHY DO I NEED ONE?

ANSWER:  A total knee replacement replaces the worn cartilage with an artificial surface.  Arthritis wears away your natural cartilage and the pain comes from bone rubbing against bone with no cartilage to protect it. Result: pain, swelling and stiffness.

The knee isn’t really replaced.  The artificial cartilage now becomes the cushion that gives your knee smooth motion.

3. QUESTION: WHAT ARE THE RESULTS OF TOTAL KNEE REPLACEMENT?

ANSWER:  Knee replacement surgery enjoys a high rate of success in eliminating pain and restoring your range of motion. The operation has a high rate of success:  90% to 95%.

4. QUESTION:  WHEN SHOULD I HAVE KNEE REPLACEMENT SURGERY?

ANSWER:  Your orthopedic surgeon will decide if you’re a candidate for knee replacement surgery.  His decision will be based on your history, x-rays and response to conservative treatment.  You’re never too old for knee replacement if you’re an active person who wants to lead a productive life.  Active people in their 90s have enjoyed successful knee replacement.

5. QUESTION:  WHAT ARE THE MAJOR RISKS?

ANSWER: Most surgeries go smoothly – no complications.  But the two serious risks are:

  • Infection
  • Blood clots

To avoid infection, use the antiseptic wash that is given to you prior to surgery. Also proper hand washing is essential. Antibiotics are given before and after surgery to reduce the risk of infection. 

Blood thinners will be given to you postoperatively to prevent blood clots. Special compression devices are used in the hospital to reduce the risk of blood clots as well.

6. QUESTION: SHOULD I EXERCISE BEFORE SURGERY?

ANSWER:  Definitely.  Discuss pre- and post-operative physical therapy options with your surgeon, but exercises should begin as soon as possible.

7. QUESTION:  WILL I HAVE PAIN AFTER SURGERY?

ANSWER: Yes, but your pain will be managed with appropriate medications. Immediately following your surgery, you will have an epidural to reduce the pain in your leg. The day after surgery you will be switched to pain pills and the epidural will be discontinued. Our caring staff will continue to monitor your pain level and manage you pain with medications and other therapeutic measures to maintain your comfort throughout your hospital experience.

8. QUESTION:  HOW LONG WILL I BE IN THE HOSPITAL?

ANSWER:  Most knee replacement patients can count on two to three days in the hospital after surgery. Many patients go directly home after surgery. Our team will design a rehabilitation plan that is designed to fit your specific needs.

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