Cheryl Martin (Host): This podcast is for informational purposes only and is not intended to be used as personalized medical advice. What you need to know about total joint replacement surgery, how to prepare, and what to expect during recovery. Learn more about the entire process with Dr. Alexander Willis, an orthopedic surgeon at Skagit Regional Health. This is Be Well with Skagit Regional Health. I'm Cheryl Martin. Dr. Willis, how can patients best prepare for surgery?

Dr. Alexander Willis: Well, first of all, thanks for having me on the podcast. I kind of put that into a couple broad categories. There are ways to mentally prepare, physically prepare, medically prepare and socially prepare for a surgery, like a total joint replacement. The medical part certainly starts in the office. We want to make sure that patients are great candidates for total joint replacement. So that will mean things like smoking cessation and making sure diabetes is well managed. From a social standpoint, it's very important that patients have some social support at home to help them initially in the recovery process.

From a physical standpoint, it's important that patients are able to set up their home environments to make recovery much easier for themselves. And then from a mental standpoint, they need to get as educated as possible about the surgery and what's involved and what to expect afterward going into it.

Cheryl Martin (Host): So how long does it typically take for joint replacement patients to get back to work or normal activities?

Dr. Alexander Willis: Well, that will certainly depend on the type of work patients are doing. I usually say that for patients that have sedentary jobs, they're usually able to go back to those within four to six weeks after a hip or a knee replacement. For a patient that has a job that involves occasional walking, standing, things like that might be two, two and a half months. And then for a relatively physical job, it's going to be at least three months or so.

Cheryl Martin (Host): So, do patients typically experience pain during recovery, and if so, how is that pain controlled?

Dr. Alexander Willis: Yes. So total knee and total hip replacement procedures can be painful, and we use something called multimodal pain management to try to decrease that overall pain requirement. So, we'll use medications such as Tylenol, anti-inflammatories and your typical opioid medications like oxycodone and hydrocodone to get that pain under control, around the surgical period. We also use, something called regional blocks, which will temporarily numb some of the surgical field to allow for the first couple days to be relatively pain-free.

Cheryl Martin (Host): Now, what are some unanticipated challenges that a patient might experience during recovery?

Dr. Alexander Willis: Well, so one of the things I hear in my office when patients come back for their post-op visits is that they oftentimes have trouble sleeping and sometimes they have changes in their appetite. And those are both very normal things to experience after a major surgery like this.

Cheryl Martin (Host): When you say major surgery, let's go back a bit. Is this in an out surgery or a patient can expect to be in the hospital more than one day?

Dr. Alexander Willis: So it really depends on the patient, since Coronavirus started, we've been doing more of these surgeries outpatient, where the patient comes in the morning, has the surgery, does a little bit of physical therapy and then is actually able to go home in the afternoon. And I would say at this point, that's the majority of what we do. Occasionally patients have some other medical problems that require them to stay in the hospital a day or two.

Cheryl Martin (Host): So what are some red flags patients watch for or should watch for during the recovery process?

Dr. Alexander Willis: So with a total hip or a total knee procedure, the incisions are somewhere between six to eight inches typically, and we really want to make sure that those incisions close and heal and do well. And so something to look out for is drainage from the incision that lasts for more than a week or two, redness around the incision. And then of course if there's abnormal swelling in the leg, then that can be certainly concerning for something like a blood clot.

Cheryl Martin (Host): So then what should a patient do if he or she has any concerns while recovering, especially concerns what you just mentioned?

Dr. Alexander Willis: So I always emphasize to the patients that they should call our office. If we don't know about the problem, then we can't really help them with it. So they should call our office if they have any concerns at all. Oftentimes I'll have patients come in a little bit earlier than their scheduled post-op visit just to have something checked out and it's usually fine, but I always encourage them to just contact the office if there's ever any question about what's going on.

Cheryl Martin (Host): Now, do you recommend physical therapy or other services to support a healthy recovery?

Dr. Alexander Willis: Yeah. My personal belief is everyone should get physical therapy after a total knee or a total hip replacement. I think that having an expert guide you through which motions you can do after the surgery and checking in with them frequently is going to give you the best possible outcome.

Cheryl Martin (Host): So what can family and friends do to help someone recovering from joint replacement surgery?

Dr. Alexander Willis: While the family and friends of the patient have a big role after the surgery. And we think that every patient should have what we call a coach after a total joint replacement. So that's somebody that's really involved in all of the care, presurgical, postsurgical and around the time of surgery. It's another person that can be really educated about what's going on and help the patient when they're confused about any of the instruction. So I think the family has a huge role to play in making sure that the patient does as well as they can.

Cheryl Martin (Host): And this is something that your team talks to the patient about, so family members or friends know before the surgery what's expected of them?

Dr. Alexander Willis: Absolutely. So before the surgery, I always make sure that patients have at least one person that can be there for the first four to five days after the surgery. Someone that comes with them to the appointments, to make sure that they understand all the instructions. And if they don't have anybody, then sometimes we actually don't feel comfortable doing the surgery. Like I said, it's a major surgery and having us also support is critical to the recovery.

Cheryl Martin (Host): So what recommendations can you offer to patients about how their home should be set up to support recovery following surgery?

Dr. Alexander Willis: One of the main things they're going to want to do is reduce clutter. We certainly don't want anyone to trip and fall on things that were left around. If patients don't have a recliner, then I think they should get one. They're usually very helpful after a hip replacement surgery in particular. And I oftentimes recommend that patients set up a small area of their home as an exercise space so they can do their exercises at home so they don't have to worry about sending that up later. Additionally, I think it's pretty helpful if patients think about how they're going to have access to food after the surgery. So oftentimes it's good to stock up on frozen meals or pre-prepared meals that make it easy for to eat.

Cheryl Martin (Host): A good friend of mine just had hip replacement surgery about six or seven weeks ago, and one of the things she said is, it really does take time to heal. And she's had the physical therapy, I think. Have you found that some patients have been unrealistic from the beginning thinking it's not going to take as long as it has taken?

Dr. Alexander Willis: Oh, absolutely. And after one of the covers slightly different speed. So I don't think people should compare themselves to others. Everyone heals differently, but I certainly have had patients that at six weeks thought that they would be out there running around the neighborhood, when they just need a little bit more time.

Cheryl Martin (Host): What benefits Dr. Willis do patients typically see after joint replacement surgery? I mean, what's considered a good outcome?

Dr. Alexander Willis: I think joint replacement surgery is one of the most amazing surgeries out there. I've had patients that have been able to walk after not having walked for two years. They've been wheelchair bound. I think that most patients can expect to walk without pain or with 95% of their pain relieved and to have greater range of motion of their joint than they did before. I would consider a good outcome someone that's satisfied with their progress and satisfied with their pain.

Cheryl Martin (Host): Once you've had a hip replacement, is it good for life?

Dr. Alexander Willis: So the technology has certainly improved over the last 10 to 15 years, and it depends at what age you have the joint replacement. Nowadays, we can expect joint replacements to last about 20 to 25 years and often times longer. So it, it certainly depends on when you have it done, but in stark comparison to how long joints used to last. So they're lasting much longer every year.

Cheryl Martin (Host): Anything else you'd like to add on the recovery, if you've had a total joint replacement?

Dr. Alexander Willis: Yeah. I think that the more educated you are going into it and the more realistic your expectations are about the perioperative period and the postoperative, the better you're going to understand the pain that you're experiencing, the better that you're going to understand the therapy that you have to do and I think you're going to be much more satisfied with your experience.

Cheryl Martin (Host): And when you say get educated, I'm sure your office provides information, but are you suggesting that they, for example, seek out other people who've had hip replacements do their own search on the internet?

Dr. Alexander Willis: Well, I think there is some valuable information on the internet, but in our office we certainly give patients books and we have a lot of information about the recovery process. Certainly encourage patients to talk to their friends that have had the surgery done to find out any tips and tricks. We have a preoperative education class that can help give patients more information about the surgery. I think some of the patients that do the best come to their office visits with a notebook of all the questions they've thought of since their most recent visit. And I think that is hugely helpful in the recovery process, just understanding as much as you can about what to expect.

Cheryl Martin (Host): Dr. Alexander Willis, thanks so much for walking us through the prep and recovery process for total joint replacement. Thank you.

Dr. Alexander Willis: Oh, absolutely. My pleasure. Thank you.

Cheryl Martin (Host): If you'd like to learn more, visit SkagitRegionalHealth.org, that’s SkagitRegionalHealth.org. If you found this podcast helpful, please share it on your social channels and thanks for listening to Be Well with Skagit Regional Health.