Recovery for joint replacement

Joint replacement procedures are one of the main methods to addressing prolonged joint pain and immobility, often stemming from arthritis or traumatic injury. In this article, a consultant orthopaedic surgeon explains what patients can expect during the recovery process after undergoing joint replacement surgery.

The most common joint replacement procedures are on the knees and hips, but many joints in the body can be replaced or reshaped with surgery, such as the shoulder, elbow, thumbs, and ankles. Joint replacement is best suggested to patients who are struggling with extreme pain from a dysfunctional joint, with a notable negative impact on their quality of life and ability to move, and have exhausted other, more conservative options of treatment like slings, physical therapy, and NSAIDs. Ideally, they are also more advanced in age, around 50-60, as the replacement prosthesis will not last a whole lifetime, and surgeons aim to minimise the need for revision; there are exceptions for younger patients if they, too, are experiencing severe debilitation due to their joint.

Immediately after the procedure

Joint replacement surgery may be a major procedure, but it can also be conducted rather quickly thanks to innovations in surgical techniques like arthroscopy and robotic assistance – most patients may only stay one night in hospital, and some clinics even offer day-case procedures.

Patients are typically encouraged to mobilise the operated joint as soon as possible (with assistance from hospital staff and loved ones, should the need be); prolonged bed rest can be counterintuitive. This helps to test if the prosthetic has been correctly aligned, and prevents corporal stiffness, as well as reducing the risk of blood clots forming in the leg (deep vein thrombosis). To further mitigate the risk of DVT, patients may be provided with surgical stockings to wear for a month post-procedure, a regimen of leg exercises (taking into consideration the type of joint surgery they underwent), or blood thinners to keep the blood flowing without obstruction.

Walking and mobility aids like frames and crutches can promote physical independence and allow the patient to go to the toilet or get dressed on their own. Once permitted to leave the hospital, it is not recommended they drive or try to leave alone, just in case an unforeseen complication arises.

First few weeks

Contrary to the encouragement to use the joint right after surgery, once at home, the patient should rest the joint and avoid strenuous activities so that their incision wounds can heal – though they should still avoid being sedentary in bed for long periods of time. During this period, the patient will be experiencing pain in the joint area as they heal, as well as some swelling and possible bruising, but this will be a different pain from their joint pain before and will subside over the following couple of weeks. Painkillers may be purchased or prescribed in order to manage the pain. Patients should expect scarring, which will vary in visibility depending on the size of the incision(s), location of the incisional site, and how well they maintain their post-procedure wound care.

After around two weeks to a month, the sutures (if any – some incisions are sealed with medical glue or dissolvable stitches) are removed, though the patient may be advised to keep using any splints, boots, slings, or crutches still. Patients must keep the wound clean and dry, and they will be given instructions on how to best care for their dressings at home.

A healthy diet is important to give the body the nutrition and minerals it needs to rebuild tissue and adjust to the prosthetics.

Returning to routine

When patients are able to return to daily tasks, work, or school is up to their personal judgement. A patient with a thumb joint replacement may feel more comfortable returning to their workplace sooner than someone who underwent a knee replacement. Factors to consider are how the patient commutes to work or school – driving is recommended only after six weeks, depending on the joint replacement, due to impaired reflexes and the effects of painkillers – and what is required of them to perform; patients with very physically taxing activities like carpentry or heavy lifting should err on the side of caution and let themselves heal for a little longer before returning. Similarly, engaging in sexual activity should also be abstained from for several weeks so as not to put the healing tissues at risk of injury or strain.

The maximum timeline for functional recovery is around four months, during which the patient should be partaking in stretches and exercises that comprise their physical rehabilitation. Low-impact exercises, like swimming and cycling, are suitable.

Estimating the ‘when’ of full recovery is not an exact science, but once the patient can move the joint without noticing or remembering that it was even replaced in the first place is a good benchmark.