Interviewer:
Welcome back, Dr. Amanatullah! How are you?
Dr. Derek Amanatullah:
Great thank you.
Interviewer:
Okey Doke, so today we’re going to talk a little bit about the phases of recovery, starting from immediately after surgery up until about a year. So in the very first phase like right out of surgery up until I’m released to go home from the hospital, what can I expect fresh out of surgery?
Dr. Derek Amanatullah:
So I think what you can expect is that you will just have a surgery. The pain that you have been experiencing in the joint whether in your knee or your hip will be different.The pain in the groin or the pain in the knee should be gone and most of the pain will be incisional in nature, and your surgeon can do lots of things to help you with that initial pain. Meaning, there’s a multimodal pain control, Tylenol or maybe a medicine called Lyrica or other anti-inflammatory medicine on top of narcotics, if they’re even necessary. Those help control the pain. I can’t promise you, and no surgeon can promise you the pain will be gone, but the pain will definitely be manageable. You shouldn’t have unmanageable pain with medicine that I described.
That said, right after the surgery you should also be able to stand, walk, put your weight on your leg, move it, straighten it, bend it, flex it, and that should be relatively pain-free other than that incision. You should be able to sit and lay in bed relatively comfortably, and day by day for the first two weeks, that’s what we call the first phase of recovery, your hip or knee will improve. That doesn’t mean you won’t need medicine; it just means that each day will be better than the last. If you have a good day or a bad day inside of that, that’s normal, because if you push it, it can hurt more.
A couple things to pay attention to is that especially for knees you may notice over the first day or two that the knee gets stiffer, not less stiff, and that’s because after the surgery there’s some swelling. This is nothing to worry about about this. The surgeon will have seen how much motion your knee dot and if your knee swells a little bit here or there, overtime that swelling will abate and all motion come back.
Interviewer:
After that two weeks, what will it look like for about the first three months after that two week period you just described? Talk me through the next phase.
Dr. Derek Amanatullah:
The next phase it’s pretty variable. Every patient recovers differently because even though we call them all hip and knee placements everyone has their own subtleties how much exposure or what needs to be done to correct or replace their hip or knee. As a result of that exposure and however much trauma was needed to get things done, you should notice that the recovery changes after two weeks.
Now you should be recovering week by week, getting better and more endurance more range of motion. You again can have good days and bad days that might last two or three days because we are really good day and walk three blocks and then it’s a little harder the next day. You don’t really need any formal therapy. You should notice over this time interval that that narcotics if you’re using them requirement should be trending down, meaning you’re needing less and less to the point of needing almost none by around two months to three months. Patients will report feeling about eighty percent better by about two to three months, and that would be my expectation that most of the recovery is done. You may be having some fatigue with ambulation.
Maybe rarely there’s a bad day at the end of three months, but in general the joint should still relatively pain-free. It’s still really normal to experience some swelling at this point or even a touch of a limp if it was your hip and you were using a walker or a cane.
Interviewer:
Now at that three-month checkup what are some of the things that you as a doctor are going to test me for?
Dr. Derek Amanatullah:
Yes so, the first visit actually at two weeks is normally one just to check your wound. It’s very hard to assess much more than that. But for a knee at around six weeks we definitely want to see ninety degrees of motion in the knee.
And for a hip by around three months we want to see the patients completely off with their gait aides, able to return to their activities, even strenuous activities that they have a relatively high-stress job. For a knee, we would expect the same but there may be some swelling at the end of the day and some subtle changes that slowly will abate over the next year or so.
Interviewer:
Now talk to me about that year. I’ve heard from other people who have had joint replacement surgeries that recovery can take up to a full year. In your experience how true is that?
Dr. Derek Amanatullah:
I think that’s very true I think that most patients are about again 80 percent better around the three-month mark, but there’s plenty of improvement still to come. There’s the subtle increase in range of motion that can occur. Additionally, some of the swelling in the joints finally goes away.
And all the pain begins to abate. So around here some patients will come in and say, “I don’t even remember having a joint replacement at all” because they forgot. Their activities of daily living and their life have returned to what they want. That is rare to see a three months, you can see it, but it really takes about a year nine months, a year, maybe even a year and three months for patients to get full recovery to the point where they really feel like they got all the benefits that they wanted out of the knee replacement.
And I think that’s really independent of the surgery that you get. So the short-term gains can really be dependent on your surgeon or the approach or lots of different things. But regardless everyone kind of reaches the same plateau of improvement over the course of about one year once the joint replacement’s been done.
Interviewer:
Do I need to come back and see you as my doctor after that three month, or should I only come to you if there’s issues after that point?
Dr. Derek Amanatullah:
This is a controversial topic. Actually, some doctors have begun to go to no follow up because patients do so well.
What I would tell you is there are things that can happen to your joint replacement that you may not feel, meaning you can develop something called osteolysis where actually the bone begins to erode because of particles in the joint. You could have an infection, you can have a loosening of the implant over time. These are rare events, but I think if you’re having any pain you for sure want to see your doctor.
If you see someone like me who’s in an academic setting, we want to know you’re doing well so that we can document it for study because we need to know how well everything’s performing. So checking in with your doctor I would say every two years, and then checking in every five years or so after that would be beneficial but it’s not something you do every year after that first-year visit.
Interviewer:
Awesome! thank you so much for your time today I think that’s all the questions I have for you!
Dr. Derek Amanatullah:
Great, have a great day.
