Winnipeg Regional Health Authority, Joint Replacement Resource Centre
University of Manitoba, Section of Orthopaedics
The Canadian Orthopaedic Association
American Academy of Orthopaedic Surgeons
Patients, surgeons and family doctors are partners in the health care team. There are several other members who play equally important roles. Some of the other members of the team who will assist you are:
Nurses are at the front lines of care. They are responsible for all aspects of the patients’ wellbeing while in hospital. This means caring for the whole person –the physical, intellectual and social needs.
For more information visit the Canadian Nurses Association.
The Orthopaedic Nurse is a registered nurse who, in addition to his/her general nursing knowledge, brings to his/her practice specialized knowledge about care of clients with challenges from conditions affecting the bones and joints.
For more information visit the Canadian Orthopaedic Nurses Association.
Your family doctor may refer you, or you may refer yourself to a physiotherapist (physical) for non-surgical management of your orthopedic problem. Physiotherapists are health care professionals trained to assess, diagnose, treat and prevent orthopedic diseases or conditions. They use their expert knowledge of anatomy and human movement to treat conditions using exercise, education, manual therapy and other physical techniques.
In addition, if you do require surgery, the physiotherapist will help you return to full physical function following your procedure. Discuss your goals and expectations with your physiotherapist who will help you understand your condition, your options and what you will need to do to achieve your goals for recovery. Your physiotherapist works closely with your surgeon and your family doctor in every aspect of your care.
For more information visit the Canadian Physiotherapy Association and Manitoba Physiotherapy Association.
Occupational therapists assist in identifying and resolving challenges that prevent or limit you from participating in your daily activities of living. Treatment includes education, suggesting assistive devices or alternative approaches for self-care, homemaking, work tasks and leisure activities, making splints and orthotic devices to aid in the restoration of function.
For more information visit the Canadian Association of Occupational Therapists.
Physician Assistants (PAs) and Clinical Assistants (CAs)are highly skilled health professionals who practice alongside and under the supervision of a physician. They perform tasks similar to those of their supervisors, including examination, diagnosis, testing, referrals and treatment including prescribing of medications.
In Canada, the PA role was developed within the Canadian Forces Health Services to provide a full spectrum of medical care to its members. In 2003, the Canadian Forces PA program was accredited by the Canadian Medical Association. In Manitoba, there are training programs outside of the Canadian Forces for PAs and several are employed in the Winnipeg Regional Health Authority including working with the arthroplasty surgeons. In addition to the PA program, the arthoplasty program has several CAs which function in the same role as PAs, but are foreign trained physicians that are ineligible for licensure in Manitoba based on the location of their training. By acting as extension of the supervising surgeon, they are able to bring their vital skills to the people of Manitoba.
For more information visit the Canadian Association of Physician Assistants.
Pharmacists are professionals responsible for the optimal use of drugs. A pharmacist works with the health care team and their patients to determine if any drug-related needs exist which are preventing the patient from attaining their desired quality of life.
For more information visit the Canadian Pharmacists Association.
Before your operation you will meet the anesthesiologist. This doctor has the responsibility for your medical welfare when you undergo surgery and is a vital member of the surgical team. Anesthesiologists are physicians who have completed medical school and then five or more years of specialized (residency) training in anesthesiology.
Anesthesiologists train extensively in human physiology (how the body works), particularly the brain, heart, lungs, kidneys and liver and are experts on the drugs that are used in anesthesia and intensive care medicine.
For more information visit the Canadian Anesthesiologists’ Society.
A rheumatologist is a specialist in the medical (non-surgical) treatment of arthritis and rheumatic diseases. A rheumatologist’s training includes four years of medical school, three or four years of internal medical training and at least two years of sub-specialty training in rheumatology. Not everyone sees a rheumatologist, but you may depending on your condition.
For more information visit the Canadian Rheumatology Association.
Residents are doctors who are in the midst of their orthopedic training. They are undertaking many hours of practical training to become a specialist. Fellows are fully trained orthopedic surgeons who are doing further training so that they can focus in a specific area, such joint replacement. You may have residents and/or fellows involved in your care as Concordia Hospital is a teaching facility for orthopaedics and all of the surgeons of the Concordia Joint Replacement Group are academic surgeons dedicated to training the joint replacement surgeons of tomorrow.
For more information visit the Canadian Orthopaedic Residents Association.
The Surgical Office Assistant (SOA) is the person who supports the surgeon in clinical matters. The SOA books clinic appointments, and looks after the surgeons clinical office schedule. This is the person having the most contact with patients before and after their hospital stay.
The Concordia Joint Replacement Group is extensively involved in advancing the practice of orthopaedics through research. To this end, they employ a large research staff. You may be contacted by research staff regarding participation in research studies.
There are a variety of non-surgical treatment options that should be considered before proceeding with a joint replacement.
For both the hip and the knee, the forces acting across the joint are a combination of body weight pressing down on the joint and the muscles pulling up to stabilize the joint. As these values combine, the hip and knee experience 3-4 times the body weight in pressure with each step. Loosing excess weight reduces the pressure on damaged joints and can relieve pain.
By stretching, strengthening and re-balancing the muscle- forces across the joint, the movement and control of the joint can be improve. Pain can also be improved with therapy in addition to the mobility of the joint.
Acetaminophen
Acetaminophen (Tylenol) containing products can be very useful analgesics in arthritis. Given its low cost and good side effect profile, it is a good first-line drug for treating arthritis. It should be avoided in some patients with a history of liver disease and care should be taken not to exceed the total daily dose of 4gm per day. This is especially true when a patient takes multiple different medications that contain acetaminophen.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications that block the COX receptors on cells and reduce inflammation which can play a significant role in both osteoarthritis as well as other inflammatory arthridities such and rheumatoid arthritis and lupus. Different versions of this type of drug have different side-effect profiles, but, in general, NSAIDS, when taken for extended periods, can play a role in stomach irritation, ulcers, and bleeding and kidney problems with elevated blood pressure. While these can be very helpful medications, their prolonged use should be done under the guidance of a physician.
Steroid injection (often referred to as a “cortisone shot”) is generally performed with a depot version of a corticosteroid that remains within the joint. Once in the joint, the steroid blunts the inflammation within the joint and can reduce the pain of the arthritis. This effect can last from a few days to 6 months. There is a small risk of infection with an injection which can be very debilitating and destructive if it were to happen. The risk of infection is less than 1%. There is no agreed upon number as to how many times an injection can be repeated if the most recent injection had benefit for multiple months. Most agree that multiple injections can be offered, the whether a limit should exist or how high the limit may be is unknown.
As arthritis progresses in the knee and joint space is lost, the leg becomes more bow-legged or knock-kneed. As this collapse occurs, increased load is applied to the already diseased and damaged section of the joint. By applying and unloader brace, the leg can be straightened and the load shifted back onto the more healthy area of cartilage remaining. This can reduce pain and suffering during activities such as walking, shopping and yard-work.
Viscosupplement injections inject a purified, viscous fluid into the joint. The injection frequently includes components of normal healthy joint fluid known to be reduced in arthritis. While the exact mechanism of benefit is not known, many patients, especially with early arthritis, can benefit from these injections for a variable period of time.
Many patients find the use of a cane, walking stick or walker to reduce their pain. By transferring weight to the walking aid, the effected joint can be off-loaded reducing the pain experienced and improving the distance that a patient can walk.
When can I resume driving after hip or knee replacement surgery?
It may take up to 3 months before you can return to driving. Your surgeon will assess your situation and advise you when you may resume driving. If you are taking narcotic pain medications, you should not be driving.
What shouldn’t I do after my THA?
For the first 3 months following surgery, you may be advised by your surgeon to not flex your hip past 90 degrees and to not cross your legs during this time. Not all patients will require this restriction and the assessment for needing these limitations will be made by your surgeon during your operation. High impact activities such as jumping and running for exercise should also be avoided for the long term.
When can I resume bathing?
After the wound has healed, about 24 to 72 hours after the stitches or staples are removed you can resume bathing.
How long will the surgery take?
The time varies depending on the case. However, the majority are completed in 45 to 90 minutes.
How long will I be in the hospital?
1 – 3 days
What is the implant made of?
Most implants are a combination of several materials and can include metal (Cobalt Chromium and Titanium), plastic (polyethylene) and/or ceramics.
Will it set off metal detectors in airports?
Yes, it will probably set off metal detectors, especially if more than one joint is replaced. Patients should allow for extra time when clearing airport screening due to their implants and should be prepared for additional screening procedures.
When can I resume driving after hip or knee replacement surgery?
It may take up to 3 months before you can return to driving. Your surgeon will assess your situation and advise you when you may resume driving. If you are taking narcotic pain medications, you should not be driving.
What shouldn’t I do after my TKA?
We advise against high impact activities such as jumping and running. Kneeling may become more difficult.
When can I resume bathing?
After the wound has healed, about 24 to 72 hours after the stitches or staples are removed you can resume bathing.
How long will the surgery take?
The time varies depending on the case. However, the majority are completed in 45 to 90 minutes.
How long will I be in the hospital?
2 – 5 days
What is the implant made of?
Most implants are a combination of several materials and can include metal (Cobalt Chromium and Titanium), and plastic (polyethylene).
Will it set off metal detectors in airports?
Yes, it will probably set off metal detectors, especially if more than one joint is replaced. Patients should allow for extra time when clearing airport screening due to their implants and should be prepared for additional screening procedures.