Hip & Knee Replacement Surgery at GoldPlayPot.com

Who Is a Candidate, and Who Should Wait

Replacement is built for cartilage that has worn through, not early arthritis. Standing X-rays should show joint-space narrowing, bone spurs, or bone on bone, usually Kellgren-Lawrence grade 3 or 4; knees also get a sunrise kneecap view and a bent-knee Rosenberg view. Strong candidates have pain limiting walking, stairs, or sleep despite at least three months of good non-surgical care. Rheumatoid arthritis, post-traumatic arthritis, and avascular necrosis of the hip can qualify too.

Reasons we pause:

• Active infection anywhere, such as a leg wound, dental abscess, or urinary infection
• Diabetes with an HbA1c above roughly 8%, which raises infection risk
• Nicotine use; we ask for four weeks nicotine-free before surgery
• Mild X-ray changes with severe pain, possibly referred from the lumbar spine or, for knee pain, from the hip
• A BMI above 40, which we work on together before scheduling

Non-Surgical Options That Come First

Many people stay at this stage for years. Surgery becomes reasonable when these stop keeping you active:

• Physical therapy targeting the quadriceps and hip abductors
• Weight loss: each pound lost removes roughly four pounds of force from the knee per step
• Topical diclofenac for knees, oral anti-inflammatories if your kidneys, stomach, and heart allow, or acetaminophen
• Corticosteroid injections, which help for weeks to months; we avoid them within about three months of surgery because they may raise infection risk
• A cane in the hand opposite the painful side, or an unloader brace for inner-knee arthritis

Partial vs. Total Knee, and the Anterior Hip

What the Implant Actually Is

A replacement resurfaces bone rather than removing the joint. In a total knee, a polished cobalt-chromium cap covers the femur, a metal tray sits on the flattened tibia, and a highly cross-linked polyethylene insert acts as the new cartilage. In a total hip, a titanium stem fits into the canal of the femur, a ceramic or cobalt-chromium ball sits on top, and a titanium cup lined with polyethylene or ceramic replaces the socket.

Parts are cemented with bone cement (PMMA), which holds immediately, or press-fit with a porous surface that bone grows into. The plastic liner is the usual long-term wear point, and modern cross-linked polyethylene wears much more slowly.

How Long a Replacement Lasts

National joint registries record every revision, meaning an implant removed or exchanged. Pooled registry data for total hips shows about 9 in 10 still in place at 15 years, about 7 in 10 at 20, and about 6 in 10 at 25. Total knees have done similarly or slightly better; partial knees are revised more often.

These are population averages. Age, activity, body weight, bone quality, and component position shift an individual's odds, and younger, active patients have more years in which a revision may be needed. "Still in place" means not revised, not guaranteed pain-free.

The Day of Surgery and Same-Day Discharge

You wash with chlorhexidine soap the night before and morning of surgery and follow the anesthesia fasting instructions exactly. Most cases use spinal anesthesia with sedation; knees also get an adductor canal block, which numbs much of the knee while largely sparing quadriceps strength. An IV antibiotic runs within an hour before incision, and tranexamic acid is usually given to reduce bleeding. Surgery takes one to two hours, and a therapist often has you standing with a walker within a few hours.

Same-day discharge requires all of these; otherwise you stay overnight:

• Stable blood pressure, heart rate, and oxygen levels
• Pain controlled with oral medication and no nausea
• Able to urinate once the spinal wears off
• Walking safely with a walker, including stairs if your home has them
• A responsible adult with you at least the first night

The 12-Week Rehab Arc

Knees usually take longer than hips. Typical milestones, not deadlines:

• Weeks 0-2: walker, then a cane as balance allows; quad sets and heel slides; knees aim for full straightening and about 90 degrees of bend; clot-prevention medicine, often aspirin; wound check at 10 to 14 days
• Weeks 2-6: outpatient therapy two to three times weekly plus a stationary bike; most hip patients are off the cane by week 4 to 6; driving often resumes at 2 to 6 weeks, once off opioids and able to brake hard
• Week 6 visit: X-rays and a motion check; a knee bending less than about 90 degrees may need manipulation under anesthesia, best done before 12 weeks
• Weeks 6-12: strength, balance, and stair training; knees typically reach 115 to 120 degrees
• Beyond 12 weeks: mild knee swelling and warmth can linger 6 to 12 months

Risks, Stated Honestly

No operation is risk-free, and no outcome can be guaranteed. The risks we review with every patient:

• Infection: about 1 in 100 patients develops a deep implant infection, usually requiring more surgery and weeks of antibiotics
• Blood clots: leg-vein clots and, rarely, a clot to the lungs; early walking and medication lower the risk
• Stiffness: some knees form excess scar tissue (arthrofibrosis) and lose bend
• Dislocation (hips): roughly 1 to 2 in 100, most often in the first three months
• Persistent pain (knees): about 1 in 10 to 1 in 5 knee patients still have bothersome pain a year out, even with a well-placed implant
• Less common: leg-length difference, nerve or vessel injury, fracture around the implant, late loosening

Frequently asked questions