3. Discuss success rates for the procedure
Discussion Points
Assure the patient that knee replacement is one of the most successful orthopedic surgeries performed
Discuss success rates for the procedure
Solucient. National Patient Profile: knee replacement. Evanston, Ill; 2004.
National Institutes of Health. Consensus Statement on Total Knee Replacement. December 8-10, Available at: Accessed March 18, 2004.

4. Review the specific goals of knee-replacement surgery
Discussion Points
Review the specific goals of knee-replacement surgery
Mention that after successful surgery, it is usually possible to return to normal daily activities WITHOUT pain
Joint Replacement Institute (JRI). The goals of total knee replacement. Available at: Accessed March 18, 2004.

5. Discussion Points
Review how a healthy knee works
Explain what happens to the knee joint with arthritis
Describe the basic components of an artificial knee joint
Discuss the differences between a cemented and a cementless knee replacement
Summarize the clinical results of the implant chosen for the patient’s knee-replacement surgery and explain why the surgeon thinks this implant is the best choice

7. Talk about how many people have hip-replacement surgery each year
Discussion Points
Assure the patient that hip replacement is one of the most successful orthopedic surgeries performed
Talk about how many people have hip-replacement surgery each year
Discuss success rates for the procedure
Solucient. National Patient Profile: hip replacement. Evanston, Ill; 2004.
University of Iowa Department of Orthopaedics. Total hip replacement: a guide for patients. Available at: Accessed January 21, 2004.

8. Review the specific goals of hip-replacement surgery
Discussion Points
Review the specific goals of hip-replacement surgery
Mention that after successful surgery, it is usually possible to return to normal daily activities WITHOUT pain
JointReplacement.com. Rehabilitation timeline after hip joint replacement. Available at:
joint_nm./tp.search/qx/default.htm. Accessed December 18, 2003.

9. Discussion Points
Review how a healthy hip works
Explain what happens to the hip joint with arthritis
Describe the basic components of an artificial hip joint
Discuss the differences between a cemented and a cementless hip replacement
Summarize the clinical results of the implant chosen for the patient’s hip-replacement surgery and explain why the surgeon thinks this implant is the best choice

11. Discussion Points
Reassure the patient that once the new joint has completely healed, there are many benefits from joint-replacement surgery
Take this opportunity to remind the patient that they have a big role in making the surgery a success—that they will have to work hard, but that the effort is worthwhile
Arthritis Foundation. Benefits and risks of joint replacement surgery. Available at: Accessed March 18, 2004.

12. Discuss ways to reduce the risk of complications
Discussion Points
Describe the most common complications and how often they occur following joint replacement
Discuss ways to reduce the risk of complications
Encourage the patient to take notes in case he/she wants to discuss these risks in more detail with family, friends, or primary care provider
Remind the patient that this is not intended to be a complete list of the possible complications, but these are the most common
American Academy of Orthopaedic Surgeons. Total joint replacement. Available at: Accessed March 18, 2004.
Joint Replacement Institute (JRI). Risks and potential complications. Available at: Accessed March 18, 2004.

13. Discuss pain medications the patient will receive after surgery
Discussion Points
Reassure the patient that managing their pain and discomfort is one of the surgeon’s highest priorities
Discuss pain medications the patient will receive after surgery
Explain PCA and its benefits (if this is used)
Discuss the benefits of other treatments, such as using ice, in managing pain after joint replacement
Mention that in addition to providing comfort, proper pain management helps improve mobility and enables the patient to participate in therapy and begin rehabilitation as quickly as possible
American Academy of Orthopaedic Surgeons. Total joint replacement. Available at: Accessed March 18, 2004.
ArthritisInsight.com. Pain control after surgery. Available at: surgery/painafter.html. Accessed March 18, 2004.

14. Describe DVT, its incidence, risk factors, and possible consequences
Discussion Points
Describe DVT, its incidence, risk factors, and possible consequences
Stress that one of the most effective ways to help reduce the risk of DVT is to get moving as soon as possible!
Talk about anticoagulants the patient will receive in the hospital and at home
If the patient is going to receive low-molecular-weight heparin after discharge, talk about self-administration techniques
Discuss the warning signs of DVT and when to call the doctor
American Academy of Orthopaedic Surgeons. Deep vein thrombosis. Available at: fact/thr_report.cfm?Thread_ID=264&topcategory=Hip. Accessed March 18, 2004.

15. Discuss the incidence of reactions to anesthesia
Discussion Points
Discuss the incidence of reactions to anesthesia
Discuss who is at risk for an anesthesia reaction
Your anesthesiologist will see you before surgery and explain the risks involved
Have the patient write a reminder to himself/herself to tell both the surgeon and the anesthesiologist if he/she has ever had a reaction to anesthesia or pain medication in the past
Joint Replacement Institute (JRI). Risks and potential complications. Available at: Knee_Risks.htm. Accessed March 18, 2004.

16. Talk about the incidence of infection after joint-replacement surgery
Discussion Points
Talk about the incidence of infection after joint-replacement surgery
Discuss possible causes of infection
Mention the antibiotics that will be given before and after surgery to prevent infection
List things the patient can do after discharge to prevent infection
Review the warning signs of an infection and when to call the doctor
American Academy of Orthopaedic Surgeons. Total joint replacement. Available at: Accessed March 18, 2004.
Joint Replacement Institute (JRI). Risks and potential complications. Available at: Accessed March 18, 2004.
Vanderbilt University Medical Center. Knee and hip replacement home care instructions. Available at: Accessed March 18, 2004.

17. Discuss what happens if an artificial joint loosens or is dislocated
Discussion Points
Talk about what causes loosening and dislocation of an artificial joint
Discuss what happens if an artificial joint loosens or is dislocated
Assure the patient that they will be instructed on things to do after surgery to protect the new joint
American Academy of Orthopaedic Surgeons. Total joint replacement. Available at: Accessed March 18, 2004.
Knee-Replacement-Info.com. Life after knee replacement surgery. Available at: Accessed October 24, 2003.
American Academy of Orthopaedic Surgeons. Activities after a hip replacement. Available at: =274&topcategory=Hip. Accessed December 18, 2003.

18. Discuss possible reasons why revision surgery might be needed
Discussion Points
Mention that artificial joints are built to last 15 to 20 years and that more than 90% of people who have joint-replacement surgery will not need revision surgery
Discuss possible reasons why revision surgery might be needed
Discuss the incidence of revision surgeries in your practice
National Institutes of Health. Consensus Statement on Total Knee Replacement. December 8-10, Available at: Accessed March 18, 2004.
American Academy of Orthopaedic Surgeons. Knee implants. Available at: Accessed December 19, 2003.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and answers about hip replacement. Available at: Accessed March 18, 2004.
American Academy of Orthopaedic Surgeons. Improving musculoskeletal care in America. Available at: Accessed January 13, 2004.

20. The new femoral component is secured onto the prepared femur.
Discussion Points
The operation takes about 2 hours. The surgeon starts by making an incision from above your kneecap to below. Soft tissue, such as muscle, is moved to expose the knee joint. The surgeon then carefully cuts away the damaged cartilage and bone.
The new femoral component is secured onto the prepared femur.
Arthritis Foundation. Total knee replacement. Available at: Accessed March 18, 2004.
American Academy of Orthopaedic Surgeons. Total knee replacement. Available at: Accessed March 18, 2004.

21. Discussion Points
3. The lower surface of the joint (tibia) is prepared using a special saw to cut the bone to the required shape. The top surface of the tibia is cut flat to provide proper alignment of the leg.
4. The tibial component of the artificial joint is then secured onto the prepared tibia. A plastic plate is then attached to the tibial component, which will allow the femur to move over the tibia smoothly.
Arthritis Foundation. Total knee replacement. Available at: Accessed March 18, 2004.

22. Discussion Point
5. If the kneecap (patella) needs to be replaced, its rear surface is reshaped and a recess is made in the patella to accommodate the patellar component, which is usually disc shaped.
Arthritis Foundation. Total knee replacement. Available at: Accessed March 18, 2004.

23. Discussion Point
6. Once all the components are secured, the surgeon checks that a good range of motion has been achieved. The surgery is then complete.
Arthritis Foundation. Total knee replacement. Available at: Accessed March 18, 2004.

25. Discussion Points
1. The surgical procedure takes 2 to 4 hours. First, the surgeon will take a number of measurements to ensure proper prosthesis selection, limb length, and hip rotation. After making the incision, the surgeon works between the large hip muscles to gain access to the joint. The femur is pushed out of the socket, exposing the joint cavity. The diseased femoral head is removed.
2. The acetabulum (hip socket) is prepared by cleaning and enlarging with circular reamers of gradually increasing size.
University of Iowa Department of Orthopaedics. Total hip replacement: a guide for patients. Available at: Accessed January 21, 2004.
Arthritis Foundation. Total hip replacement. Available at: Accessed March 18, 2004.

26. Discussion Points
3. The new acetabular shell is implanted securely within the prepared socket. The plastic inner portion of the implant is placed within the metal shell and fixed into place.
4. The femur is prepared to receive the metal stem. The hollow center portion of the bone is scraped and the canal is enlarged, creating a cavity that matches the shape of the implant stem. The top end of the femur is planed and smoothed so the stem can be inserted flush with the bone surface. If the ball is a separate piece, the proper size is selected and attached. Finally, the ball is seated within the cup so the joint is properly aligned and the incision is closed.
Arthritis Foundation. Total hip replacement. Available at: Accessed March 18, 2004.

27. Discussion Point
5. Once the new joint has healed, you should be able to realize the benefits of your surgery. These include reduced joint pain, increased movement and mobility, correction of deformity, increased leg strength (if you exercise), an improved quality of life, and the ability to return to some recreational activities such as walking, bicycling, or playing golf.
Arthritis Foundation. Total hip replacement. Available at: Accessed March 18, 2004.