Luna recently had the privilege and opportunity to sit down with Dr. Christopher Boone of Proliance Orthopaedics and Sports Medicine in Seattle to talk about what patients need to know when considering hip or knee replacement.

Here are Dr. Boone’s answers to commonly asked questions by patients considering surgery to manage their hip and knee pain:

Why do patients need hip or knee replacements?

Dr. Boone: “I get this one all the time: ‘Why do I need my hip/knee replaced?’ Very simply, because your [hip/knee] is worn out. People think of arthritis as something you ‘catch, ’ but you don’t ‘catch’ arthritis. Rather, arthritis represents the loss of the smooth gliding surface within a joint. Hips, knees, and other joints have a special surface that degenerates and wears out over time – that’s arthritis. With the loss of that surface, you end up rubbing two pieces of bone together, which feels very painful – a lot like rubbing two pieces of sandpaper together, that’s how I describe it. When that pain sets in, that’s when it is time to consider a hip/knee replacement.”

As a patient in pain, when should I consider having hip or knee replacement surgery?

Dr. Boone: “More bad days than good days? That’s a question I typically pose to my patients. More specifically, I ask them how joint pain affects their day-to-day activities – what we call ADLs (activities of daily living). For example, does it hurt to go to the store? Do you have pain at night? Does it hurt to come into my office? Do you have a limp? Are you grouchy? Pain puts people in a bad mood. It can causes depression, frustration, and anger. Oftentimes I will ask patients about their sleep hygiene. A lot of patients with arthritis have difficulty sleeping, which turns into a vicious cycle of not getting sleep and then not being able to function the next day, and it just kind of gets worse and worse from there.”

What should I expect after knee or hip replacement surgery? When can I get back to my normal life? Or to sports?

Dr. Boone:  “I tell patients to take people’s input with a grain of salt. Surgeons have different approaches, technology is constantly changing, etc. Patients will say ‘well my cousin had this done five years ago and they said they rode their bike home from the surgery and walked Mount Rainier two weeks later.’ It is important to keep in mind that the farther you get away from a traumatic event, the less traumatic it seems in retrospect. If someone tells you that they had their knee replaced ten years ago and it was a walk in the park, that’s not necessarily true.

That being said, there is nothing better than talking to someone who has had a joint replacement – it provides a good frame of reference. But just realize that everyone responds to things differently and everyone has a different experience than they remember. Talk to a caregiver who went through it with someone – they may have a totally different experience than what the patient recalls.

The goal is at one year, you forgot you had your joint replaced. That’s what we are looking for – you’re walking down the road and you forgot you had your joint replaced. What happens in-between is different from patient to patient. The goal is to be doing great at one year.”

What activities should I avoid in the first 6 weeks after knee replacement surgery?

Dr. Boone: “The first six weeks are the most critical. They run the highest risk of complications, blood-clots, infections, dislocations, fractures, etc. Anything bad that can happen typically happens in the first six weeks. Of course that is not a guarantee, but once you’ve hit the six week mark, you can take a deep breath. After six weeks, you can start to increase your outdoor walking. You will feel better because you are building your blood level back up. A lot of patients go back to work at six weeks. Some will go back earlier, but it depends on your job – if you do a lot of computer work, you can do that sooner, but if you work at Boeing, you’ll probably have to wait eight to ten weeks before returning to work. You can drive at six weeks – that’s another big one. A lot of people drive before six weeks, but you should be careful doing so because your reaction time takes about six weeks to return, especially if it is your right lower extremity.”

How do I find a great joint replacement surgeon? What is the main question a patient should ask?

Dr. Boone: “How do you find a surgeon? Look for someone who is fellowship-trained. We all do five years of residency and one-year specializing in our specific field...Especially in the Seattle area, we all specialize in specific fields, which is kind of the way medicine is going now. When I first started only 50% of surgeons did a fellowship; now that number is well over 90%. Look for someone who does over 50 surgeries a year. At 50 times a year the surgeon is doing the surgery often enough that things become routine and it is not a new procedure. The studies show that typically that’s when you see the complication numbers decrease. Personal recommendations are also good. Other professionals, especially some of the nursing staff, will provide good recommendations. Physical therapists too. Physical therapists spend hours with my patients, much more time than I do. For that reason, I think they offer good recommendations. In general, multiple opinions are always a good thing. If you see a doctor that tells you not to get a second opinion, see another doctor – we shouldn’t be offended by that. If someone is, that’s a red flag in my opinion.”

From the PT perspective, Palak Shah, PT and Chief Clinical Officer from Luna...

Should I have PT before my knee surgery? Or Joint replacement surgery?

Palak: "Physical therapists often get asked: is it better to do physical therapy before my joint replacement surgery or after? The evidence strongly suggests the benefits of doing 2-3 pre-operative physical therapy visits right before surgery. A licensed physical therapist can show you conditioning exercise, help you prepare your environment, and set expectations for after surgery. If a joint replacement surgery is on the horizon but you are dealing with pain and limitations today, you will benefit from 8-12 visits of physical therapy to manage the pain and improve your functional ability in day to day life."

What should I expect after knee or hip replacement surgery? When can I get back to my normal life? Or to sports?

Palak: “Are you curious what you should expect after hip/knee replacement surgery – and when you can get back to normal life and sports? Your surgeon’s case management team will help you with your immediate post-op care plan. In regards to physical therapy, you can receive outpatient physical therapy at your home right after your joint replacement surgery. The post-op care plan’s focus is on managing pain and swelling along with adequate movement of your new joint. The better train and mobilize your joint, the faster you recover. A physical therapist will also progress your exercises and activity levels. They will also monitor any signs that might need to be escalated to your surgeon. Return to sports depends on mobility levels before your surgery and the sport you are trying to get back to. Generally, mobile patients can return between 4-6 months post-surgery. If you were very active before surgery, you may be able to return sooner – but the issue is best discussed with your surgeon/physical therapist.”

How do I know I have a great PT treating me after joint replacement surgery?

Palak: “How do you know if a great physical therapist is treating you after joint replacement surgery? A great PT is someone who educates you well. It starts with knowing your condition before surgery and discussing your goals of function after surgery. Once a PT evaluates you, they will provide you with a personalized plan on what physical therapy will look like for you (how many times a week, for how long, the treatment plan to achieve your goals, etc.). Therapists love to educate – so feel free to ask your physical therapist lots of questions. Patients at Luna receive 1:1 time from a licensed physical therapist for 45-55 minutes at home, hence allowing a better experience of physical therapy.”

What’s the difference between home health and outpatient PT with Luna? 

Palak: “Are you curious what the difference is between home health and outpatient physical therapy with Luna? Home health includes nursing and occupational therapy in addition to outpatient physical therapy. Some patients may only qualify for home health for a limited number of visits and have to make other arrangements – lots of patients don’t complete care do to this inconvenience, which leads to poor outcomes. Luna provides an amazing opportunity to receive physical therapy in the comfort of your home before and after surgery for pre-hab and post-surgical rehab. And you can complete your care with Luna with the same therapist. Luna is covered by insurance and will verify your benefits before you start.”