Joint Surgery: Insights for Better Outcomes

Released May 26, 2026 

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Trina Wilcox: Welcome to the Live Yes! With Arthritis podcast. I'm your host for this episode, my name's Trina Wilcox. And as I sit here with my cast from my joint fusion, we are going to be talking about surgery. Hip and knee replacement surgeries are some of the most common surgeries performed in the U.S. They've got a great track record. But with any surgery, it can be scary. Plenty of people with arthritis do have joint surgery. Today, we're going to take a closer look at what joint surgery involves, who should get one and when, what to expect and how to best prepare. Dr. David Mayman, chief of the Adult Reconstruction and Joint Replacement Service at Hospital for Special Surgery is here to talk with us. Welcome. Could you please tell us a little about yourself and why you chose to go into orthopedic surgery? 

Dr. David Mayman: Trina, thanks so much for having me. My name's David Mayman. I'm a hip and knee replacement surgeon at the Hospital for Special Surgery. I actually have been in practice for 21 years now. I was an athlete, I was a gymnast when I was young, so had lots of injuries and saw lots of people around me with injuries. I knew from a pretty young age that I wanted to get into medicine. And then once I decided I wanted to get into medicine, orthopedics seemed to be the right fit for me. I did my residency in Canada. Then I came to New York City and did a joint replacement fellowship at the Hospital for Special Surgery, and then actually spent a year in Boston at Mass General doing a sports fellowship there, so more arthroscopic surgery there. And I've been working back at HSS now since 2005, exclusively doing hip and knee replacement surgery. 

My dad is actually a retired engineer. And when I started in practice, he couldn't believe the instruments, the tools, that we used for joint replacement surgery. In his field, people were using computerized guides and robotics and advanced tools already 20 years ago. And the tools that we used were still pretty primitive. So, one of my real interests over the years has been the way we do the surgery, the tools we use for the surgery, how we can make the surgery a little safer, a little faster, a little more precise. 

Trina Wilcox: What would be a tool we'd be surprised to know and learn that you actually use in the OR? 

Dr. David Mayman: Most people don't really want to know the sort of tools that we use in the operating room. We use a lot of power drills and saws in the operating room. 

Trina Wilcox: Oh, goodness. Yeah, you might be right. Ignorance may be bliss at that point. (laughs) 

Dr. David Mayman: That's right. 

Trina Wilcox: Well, hip and knee replacements are some of the most common surgeries in the country. Is osteoarthritis the main reason that people have them? 

Dr. David Mayman: Today osteoarthritis is by far the main reason that people need hip and knee replacement. I tell people it's sort of like the treads on the tires of the car. So, some tires are made out of good rubber, that's our genetics. Some tires not so good rubber, that's also our genetics. I see some patients who are quite young that have just worn out their joints. And then I see the 90-year-old who falls and breaks his or her hip and the articular... the surface cartilage is totally normal. Activity can help cause arthritis to develop more quickly. And injuries along the way do it as well. People that have torn their ACL, people that have had multiple injuries to their hips or knees, are more likely to need joint replacement. Historically, we've done a lot of joint replacements on people with inflammatory arthritis. But as the medical care has gotten better over the years for inflammatory arthritis, we see less and less of those people needing joint replacements. 

Trina Wilcox: What are some of the other replacements that you do for osteo or even rheumatoid? 

Dr. David Mayman: Other joints that are getting replaced… There are a lot of shoulder replacements that are being done these days. There are some ankle replacements that are being done, especially in the inflammatory arthritis population, some elbow replacements. Even newer but becoming more popular these days are disc replacements in the spine. So many, many joints that can be replaced these days, but hips and knees are by far the most common. 

Trina Wilcox: OK. So, when we go into the whole idea of replacing them, you can do total and partial. What exactly are the technical differences? 

Dr. David Mayman: For knee replacement, we divide the knee up into three areas. There's the medial compartment of the knee, that's the inner part of the knee; the lateral compartment, the outer part of the knee; and then the patellofemoral, which is behind the kneecap. Some people come in, and they've only worn out one part of their knee, they haven't worn out the whole knee. The most common area would be the medial compartment. But if you've only worn out one part of the knee, then a partial knee replacement is an option. 

There are advantages and disadvantages to partial knee replacements. The advantage to a partial knee replacement: It's a smaller operation, it's a faster, easier recovery. It feels a little bit more like your natural knee, because most of your knee is still your natural knee. The downside of a partial knee replacement is it leaves the rest of your knee, which is still your own natural knee. And there's always a chance you wear out another part of the knee in the future and need to come back and have something else done. 

If we look at the long-term outcomes of partial knee replacements today, we expect — 95% of people having a partial knee replacement — for the knee to still be good at 10 years. And as we get into the second decade, we expect about 1% of people per year to need another operation on their knee. Where, if we do a full knee replacement: bigger operation, longer, harder recovery. But total knee replacements today are very, very durable. We're expecting 30 years or longer from a full knee replacement these days. 

Trina Wilcox: So, what kind of materials are they made out of that you're using? 

Dr. David Mayman: The materials are metal and plastic, and those materials have advanced over the years. Although the last big advance was back in the early 2000s, to a plastic called cross-linked polyethylene. That's really one of the biggest changes we've made in joint replacement surgery. When I started, we were telling people to expect 10 years, maybe 15 years, out of a joint replacement. And I still hear that from a lot of patients today that are apprehensive about going ahead with surgery, because they're worried that it's only going to last 10 or 15 years, and then they're going to need to do it again, and it's going to be harder. And so they really want to wait as long as they can. When I tell people that these days we expect hip and knee replacements to last 30 years or longer, they're really often surprised and pretty happy with that. Because it means that we can go ahead with things sooner, earlier in their life, so they can get back to their activities without worrying about wearing these joints out. 

Trina Wilcox: That's excellent. What about metal though? Is there any concern or worry to having metal in your body? 

Dr. David Mayman: This was in the news a few years back, especially with hip replacements. There were some hip replacements that were what we called metal-on-metal hip replacements. The socket part of the hip and the ball part of the hip were metal, and they rubbed against each other. And we could actually, in some of these, measure elevated levels of cobalt and chromium, so metal ions in your blood. And that could cause some damage to the tissues around the joint. And if the levels got really high, we worried that it could cause some systemic issues as well. Now, those implants don't exist on the market anymore, so we don't have to worry about that anymore. Most hip replacements these days have a ceramic ball and a plastic liner, and those have proven to be very, very safe in our body. We've been using those materials for hip and knee replacements since the late 1960s. 

Trina Wilcox: OK. Now, I know joint replacement is brought up a lot, but there's so many other things involved in orthopedics like fusions, tendon replacements, et cetera. Can you speak to some of those? I mean, I've had two fusions and a tendon replaced, and it brings me to being so thankful that people donate tissue, that you don't even think about how your life quality can be impacted by all of this. 

Dr. David Mayman: That's right. So, we'll start with fusions. Fusions are really used in areas where we don't have joint replacements, or we don't have joint replacements that work well and have good, long-term outcomes. A lot of these fusions are done in the hands, they're done in the feet, they're done in these small joints. They're also done fairly frequently in the spine. The other operation that we sometimes talk about is something called an osteotomy. An osteotomy is actually where we cut a bone, and we shift the position of the bone. And what that does is: It takes stress off of one area of a joint and adds... moves that stress to another area. So, if you've got one area that's arthritic, it can actually alleviate some of the stress on that area and put some of the stress on another area. 

Now, that was quite common previously, when we didn't have knee replacements that lasted as long as they do today. We would do osteotomies to try to kind of buy some time before people needed the joint replacement. And they're still done these days in young patients and very, very active patients. They're also done sometimes by the sports surgeons if we're trying to regrow cartilage in one part of the knee. 

And then you talked a little bit about tendon stuff. So, tendons are hard. Tendons are soft tissue. They don't heal as well as bones heal. And we see injuries to tendons, like an Achilles tendon injury, that need surgery to repair. We also see degenerative issues with tendons, especially around the hands and around the feet. There are surgical options for that. And then if we talk about ligaments, the big one that everybody hears about is an ACL injury to the knee, the anterior cruciate ligament in the knee. That's typically a sporting injury that we either reconstruct or replace these days. 

Trina Wilcox: Are surgeries due to autoimmune and inflammatory types different than joint surgeries for osteo? 

Dr. David Mayman: Often people with inflammatory arthritis are on pretty potent medications to manage their inflammatory arthritis. And those medications can increase the risk of infection at the time of surgery. So, when we talk about doing hip or knee replacement in particular, we really worry about infection. Having an infection in a joint replacement is probably the complication that I worry about the most. We often have to work with the patient's medical doctor or their rheumatologist to manage these medications. And we often try to stop the medications for a period of time prior to surgery to minimize the risk of infection. And then wait until the incisions are healed in order to restart those medications. 

Now, we also have to balance that, because we don't want people's arthritis to flare  if they come off of these medications. And, in fact, prednisone is probably the worst medication in terms of risk of infection. So, it's a little bit of a balancing act. In terms of the surgery itself, people with inflammatory arthritis are more prone to having osteoporosis as well. And if you have osteoporosis, if your bones are weak, that can affect what we do in surgery. I think for everybody who's got inflammatory arthritis, it's just important to understand that bone health is an important part of your care as well, and making sure that that's being monitored and that's being treated as needed. 

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Trina Wilcox: How effective is the replacement in eliminating the pain and restoring function? 

Dr. David Mayman: I'm going to separate hips and knees here for a second, because they're a little different. Hip replacements are fantastic. The huge majority of patients who undergo hip replacement surgery recover from their surgery, and they almost forget about the fact that they ever had a problem. They can get back to every activity. All of their pain is gone. It literally just feels like their normal hip. That is a very large majority of people undergoing hip replacement surgery. 

Knee replacements are a little different. The rehab and recovery from a knee replacement is a little harder than the rehab and recovery from a hip replacement. There's more physical therapy involved after a knee replacement than there is a hip replacement. And it's not uncommon, even after people have recovered, they still have some issues with their knee. My knee swells a little bit every once in a while. My knee still feels a little stiff. I have a little clicking in my knee. So, those things are not uncommon, even after you've fully recovered from knee replacement. The other thing that's not uncommon after a knee replacement is to still have a little bit of pain in the front of their knee going up and down stairs. I would say knee replacements are really good. They get rid of the large majority of pain that people have and allow them to really improve their level of activity. They're not quite as good as hip replacements. 

Trina Wilcox: What about with the other surgeries we talked about? 

Dr. David Mayman: I would say hip and knee replacements are probably the best of the group. These osteotomies that shift the bone and shift the loads on the joint, they're not designed to be perfect. They're designed to help take load off of one part of the joint in order to put load on another part of the joint. And really hopefully delay the need for hip or knee replacement, really knees we're talking about with these osteotomies. With fusions... Fusions get rid of pain, right? Fusions are really good for getting rid of pain. But fusions can limit function because the joint doesn't move anymore. Often what we say with a fusion is we're taking somebody who has a painful and stiff joint and giving them a painless and stiff joint. 

But if it's in the foot, then people often need special footwear because they don't have the same mobility in their foot. If you have a fusion in your spine, that can put more stress on the levels above or below, so it can predispose you to having more issues at other levels in your spine down the road. And that's really been part of the push for more joint replacements, is to give people more normal function. 

Trina Wilcox: And I do want to add that, even though your joint is fused, oftentimes you will actually have better function, even though it's a fixed position. 

Dr. David Mayman: That's right. So, you know, the pain is hopefully gone, and the function is often better. Because any deformity has been corrected at the same time. 

Trina Wilcox: Right. I know it's frustrating for people to have that possibly in their future, but there is a little bit of light and hope that you'll have better function. Which brings me to when to have surgery. A lot of people struggle with the idea of a joint replacement or any surgery. What's your guidance on that? 

Dr. David Mayman: That's a great question. People always ask me, "When is the right time to do this?" And my answer today is different than my answer was when I started in practice 20 years ago. And that's really because of how well these joint replacements are working and how long they're lasting. And we're really letting people get back to pretty much any level of activity once they've recovered from a joint replacement. Basically today I tell people: When you stop doing the things that you enjoy doing, that's when you should have your joint replaced. Because if I'm telling somebody that we're expecting 30 years, or 30 years plus, out of a joint replacement, then it doesn't really matter if you have it done at 58 or 62, or 55 or 58, or 62 or 65, right? Who knows what life is going to bring in the future, especially 30 years in the future. 

What can frustrate me sometimes is when I see people in the office and they say, "We went on vacation. I didn't walk with my family. We changed the vacation that we went on because I wasn't going to be able to do this. I don't do this activity anymore. I don't ski anymore. I don't golf anymore. I don't play tennis anymore. I don't do any of these activities anymore. And I haven't done them in years." And I think to myself, if they would've just had their hip or their knee replaced, they would've been able to do this stuff. And they've now missed years of their life of things they enjoy. So, I think once you start giving up activities because of that joint, we've got good answers for you these days. 

Trina Wilcox: That's so good. What's a list of questions someone should bring to the consultation when they're thinking about surgery? 

Dr. David Mayman: I think that there are a number of important questions that people should ask. And when you're having hip or knee replacement surgery, I think probably the number one most important thing is to have it done at a facility that does a lot of these, at a hospital that does a lot of joint replacement. Joint replacement is just like anything else in life: The more you do it, the better you get at it. So, having a facility where a lot of these are done have been shown to have better outcomes, lower infection rates, lower complication rates. Those are some of the other questions to ask — are things like infection rates. You also want to have it done by a surgeon who does a lot of these joint replacements. It's the same thing. 

Typically, when we do a hip or a knee replacement, things go very smoothly. But every once in a while — it's surgery — something can happen during the surgery. And you want to have a surgeon who's seen all of those things go wrong and knows how to fix them. Patients ask a lot about surgical techniques, about the implants that are being used. Those are much less important than going to a good hospital to have it done and having it done by a surgeon that does a lot of them. 

Trina Wilcox: OK. How about preparing for the surgery? Prehab is something that people are talking more about. What would you suggest? 

Dr. David Mayman: I think there are two different parts to this. When we talk about preparing for surgery, there is preparing medically for surgery: optimizing your medical condition prior to surgery. And then there's physical preparation for surgery. If we talk about the medical side of this, it's important to be as healthy as possible going into surgery. People that are diabetic need to have their diabetes controlled. People who are smokers should stop smoking before surgery. People who are obese should try to lose weight before surgery. Not easy things to do necessarily, but things that we can do these days. People that have ulcers or sores on their legs. All of that should be taken care of before you go into surgery in order to minimize your risks of surgery. If you've got any infection in your mouth, that should be taken care of before surgery. 

Then there's the physically being prepared for surgery. And I would argue that a majority of people coming in for surgery don't really need to do a lot beforehand. You can't exercise… That's why you're having the joint replaced. And it doesn't seem to make a big difference whether you do that physical therapy prior to surgery or not. Much or most of the physical therapy, the rehab, the strengthening, is done after surgery. Now, for people who are really deconditioned, making sure you're in the best physical condition you possibly can be beforehand, I think is important. But it's not worth it if it's just painful every time you try to do anything. 

Trina Wilcox: When it comes to being in the hospital or an outpatient surgery center, is there really a difference? What does that mean for me as the patient? What should I know? 

Dr. David Mayman: More and more, hip and knee replacements are done at freestanding ambulatory surgery centers. The advantages: It's often close to home, they're convenient for patients and they're very specialized. So many of these centers just do hip and knee replacement, compared to a hospital where it's a multi-specialty hospital, where you've got all sorts of different people treating different medical problems. Now, the potential downside is: It is an isolated ambulatory surgery center. Which means if there are any more complicated medical issues or surgical issues, they can't necessarily be dealt with at that freestanding ambulatory surgery center. Typically, the people coming to these ambulatory surgery centers are healthy patients that are having straightforward, predictable surgery. And for those patients, their results have been safe. The experiences have been fantastic, and that's why these centers are growing. For anybody, if they've got medical complexities, or if they're having a more complicated surgery, that should be done in a hospital. And then the one that's kind of in between is… A lot of hospitals now have what we call hospital outpatient departments. So, it's an area in the hospital that's almost like an ambulatory surgery center, but it's still part of the hospital.  

Trina Wilcox: OK, very good. Thank you. 

Dr. David Mayman: I can tell you that more and more patients are having surgery and going home the same day. At the Hospital for Special Surgery, over 50% of people that are having their hip or knee replacement are now going home on the same day. There are three things that have to happen before you leave the hospital, whether you're going home the same day or whether you're staying in the hospital. Number one, the patient needs to be comfortable. We need to make sure that your pain is under control, that you're comfortable going home. Number two, our nurses or physical therapists need to say that you're safe. We don't want you going home and falling and then injuring yourself because you've fallen. You have to prove to the nurses or physical therapists that you're going to be safe at home. And number three, our anesthesiologists need to say that there's no medical contraindication to leaving the hospital. 

What I'll tell you, especially for knees, is you're more comfortable that day of surgery than you are the day after surgery. The anesthesiologists do nerve blocks; we put local anesthetics in the joint. We do things that make you pretty comfortable for the first 24 hours after surgery. So, if you have to travel home, if you’ve got to walk, and you’ve got to get in a car, and you’ve got to go upstairs, and you’ve got to get into your home, it's actually often easier the day of surgery than it is the day after surgery. 

Now, the other thing that has changed over the last decade is: We're much less aggressive with the physical therapy in the week after surgery. We really focus on icing, elevating, minimizing inflammation in the joint. If you go home the same day, while those nerve blocks are still working, you're comfortable. And the next day, you're laying in bed with your ice packs or your ice machine, your leg elevated, rather than having to leave the hospital just as all the nerve blocks are wearing off. A lot of people like to go home on the same day, be in their own bed and not have to worry about getting to or from wherever they’re going the day after surgery. 

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Trina Wilcox: We know there's newer techniques and technologies that surgeons use. Are there certain questions as patients that we should be asking about? And how they may affect our experience and outcome? 

Dr. David Mayman: There is definitely newer implants that are on the market, there are newer surgical techniques, there are different surgical techniques. And this has all been an evolution over time. Now, what I will tell you is by far the most important thing is to find a surgeon that you're comfortable with who does a lot of hip or knee replacements, and let the surgeon do this the way that they do it every day. Because trying to get the surgeon to do something that they don't do all the time, you're not going to have as good an outcome as if you just let them do it the way that they do it all the time. 

You'll hear all sorts of information about computerized guides in the operating room, robots in the operating room, all of this advanced technology. And I'm a big fan of this advanced technology. We've shown we can be a little more precise in terms of how we put the implants in. We can actually be a little faster in the operating room. But we have not shown that patient outcomes a year after surgery are better with the robot than they are without the robot. I have many colleagues at HSS that don't use robotics, and their outcomes are just as good. So, it's not a reason to pick one surgeon versus another. If we look at hip replacement on the other hand, using these advanced tools, where we can plan a little bit better where we're putting the implants and be more precise putting them in, we can actually lower some of the complications. The technology's actually panning out a little bit better on hips than it is even in knees. 

Trina Wilcox: OK. You brought up complications. What are some of those that people should watch for and know about? And how likely are they to even happen? 

Dr. David Mayman: Yes. The biggest thing that we worry about is infection. And not just a little skin infection, but an infection that's deep inside the joint, either the hip or the knee, that's basically having an abscess in the joint. And the only way to treat an infection is with more surgery. Now, if we look at national averages, the risk of a deep infection is somewhere in the ballpark of 1%. Other things that we worry about: Fractures of the bone around the implants that can happen in, again, less than 1% of people. In the hip specifically, we worry about dislocation, so the ball popping out of the socket. We've done all sorts of things to lower that risk. If we go back to 1980, that risk was 5%. 

Many people will know these hip precautions: Don't bend your hip more than 90 degrees; don't twist; don't cross your legs. For most of us, those precautions have gone away now because, with our surgical techniques, we've gotten the risk of dislocation well under 1%. Which means that I let people reach down for their foot right away. I let them sit on whatever chair they want, sleep in whatever position they want, right after surgery. 

If we're talking about knees, scar tissue formation in the knee is a big one we talk about in knees. Something called arthrofibrosis, which is scarring of the joint. There can be two different types of arthrofibrosis. One is: The whole joint scars, and it's very difficult to get back the range of motion. And then every once in a while, somebody can just get a little piece of scar tissue that's formed in the wrong place, gets caught in the joint and can cause some pain. We used to talk a lot about long-term wear of the implants, loosening of the implants. Those aren't issues that we see very much anymore. 

Trina Wilcox: Good. What would make someone not a great candidate for the replacement? Or health conditions that would also keep them from getting a surgery? 

Dr. David Mayman: I think some of the stuff that we discussed already. People need their diabetes to be controlled. People need to work with their primary care doctor, their endocrinologist, to make sure that their diabetes is well controlled to minimize the risk of infection. Smokers should stop smoking. It's been shown that, even if you stop smoking for 10 days prior to surgery, your wounds heal better, so we can lower your risk of infection. People that have morbid obesity, the GLPs now have been wildly successful in helping people that have had difficulty losing weight their whole life lose weight, and that lowers the risk. It also makes the surgery easier to do if these people lose some weight prior to surgery. 

Trina Wilcox: Will insurance cover it typically? 

Dr. David Mayman: Yes. Insurance does cover joint replacement surgery. Often, we have to show the insurance companies that people have tried other treatment options first. And then we need to see on X-rays that the arthritis is severe enough that you need a joint replacement. But yes, insurance does cover these joint replacements. 

Trina Wilcox: What about someone who's terrified or heard a story about someone waking up during surgery? Now, does this happen often? Tell us how we can be OK with this. 

Dr. David Mayman: Typically the surgery is done with either a spinal or epidural anesthetic. But you are sedated during the surgery. This is the same sedation that you'd get for a colonoscopy or something like that. Now, that does mean that sometimes during surgery, people can be awake. In fact, I have patients every once in a while that want to be awake through the whole surgery. I can tell you if I was going through this operation, I would not want to be awake through the operation, but there are some people who do. I think it's just really important, especially if you're the person that says, "I absolutely don't want to be awake," you speak to the anesthesiologist beforehand. Because they're there with you, they're using medication to sedate you. They can always give you a little bit more to sedate you if they need to. You just have to have a conversation with your anesthesiologist. 

Trina Wilcox: OK, very good. How long does recovery typically take? What's post-surgery look like? I mean, how limited is the patient going to be right away? 

Dr. David Mayman: I'll walk you through hip replacement and knee replacement separately, because the recoveries are quite different. So, hip replacement: We get people up with physical therapy right away, fully weight-bearing on the leg right away, typically using a walker at first. And part of that is we want to make sure that you're not lightheaded and dizzy, we don't want you falling. We want to give you the confidence that you can actually take weight on your leg. Some people use that walker for the first couple of days. Some people even use the walker the first couple of weeks. But it's not uncommon for people to transition to a cane within a day. I tell people to expect the first two or three days to be pretty slow. You're getting out of bed to go to the bathroom, you're getting out of bed to go to the kitchen, you're getting up and you're walking around a little bit because you don't want to get stiff or you're bored. But you're not doing a whole lot physically in the first couple of days. 

By day four, day five after hip replacement, you're already starting to feel much, much better. And many people can walk a mile by two weeks after their surgery. So, hip replacement patients really do recover pretty quickly. Many people get rid of that cane three weeks after surgery, maybe four weeks after surgery. When we see people back six weeks after surgery, most people, after a hip replacement, walk in and say, "Wow, that recovery was significantly easier than I thought it was going to be." It does take three months for the bone to be fully healed into the implants. I don't let people do any high-impact running, jumping stuff, in those first three months. In the first three months, walking is good, an elliptical trainer's good, a bike is good, swimming is good once the incision's healed. Once we get past three months, there are really no restrictions at all. 

Knees are a little harder. The first two weeks after a knee is not a whole lot of fun. It's actually gotten a lot better in terms of pain, since we've backed off on the early physical therapy. Spending a lot of time icing, elevating, gently working on range of motion. We used to be much more aggressive with the range of motion after surgery. Most people, again, leave the hospital with a walker, transition to a cane. Everybody's a little different. Most people use that cane for four to six weeks after surgery. At six weeks, a typical patient is walking in, and they walk in and they say, "I'm OK. I'm doing pretty well. I'm still doing physical therapy. Day-to-day, I'm OK. If I push it, I know, right?" It gets more swollen, it gets more stiff, it gets more achy. There's still a lot of swelling and inflammation at six weeks. It takes about three months for most of that swelling and inflammation to get better. Each week you can push a little bit harder. Every month in the first year, you're better than you were the month before. You're stronger, you're more flexible, you're thinking about the knee less. So, full recovery from a knee can be a full year. Some people, it's a little faster, but it can be a full year. 

Trina Wilcox: Do they require PT and OT? And if so, when can that be introduced? And can they do it on their own? 

Dr. David Mayman: If they're doing hip replacements, we have our physical therapist prior to surgery give the patients a set of exercises. And if the patients can do those exercises on their own, just let the patients do those exercises on their own. Most patients still want to do some physical therapy. Walking is really the most important part of the rehab and recovery. Everybody wants to recover faster. And the fact is: Our bodies just take time to recover, so you need to be patient and let your body recover. With knees, I do think the physical therapy is more important. After the first week or so, we start pushing that range of motion once the inflammation starts improving. And it's nice to have a physical therapist working with you to work on that range of motion. 

I typically see people back six weeks after surgery, and then we have a discussion. Do they want to continue working with a physical therapist? Do they have a trainer at a gym that they love? Will they just do the exercises at home on their own? For your knee, you need to continue to work on it for at least three months. Whether it's with a therapist, on your own, with a trainer, whatever you choose. 

Trina Wilcox: What are some other things patients can do to improve their post-op recovery? 

Dr. David Mayman: I think there are a couple things that... Again, that first week of icing, elevating, anything we can do to minimize the inflammation and swelling. After that, you've got to let your body heal. People try to push too hard, and when they push too hard, often things get more inflamed. It's actually harder to make steps forward. It's like having a chronic overuse injury. If you don't let it heal, it never heals. People will come in, and they'll say, "Oh, I saw this person beside me at physical therapy, and we had surgery the same day or around the same time. And they're ahead of where I am." The fact is, everybody's just a little different. Once you recover these days, there are really no limitations on what we allow you to do after joint replacement. 

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Trina Wilcox: We always reach out on social media, so we asked followers: If you had a joint replacement, what's one thing you think people should know before getting one?  

Dr. David Mayman: All right, this will be great. 

Trina Wilcox: OK. Angela Willenberg said, "Recovery can take longer than expected. Being in shape helps, makes a difference. PT matters. Also, sometimes the end result isn't good. Lastly, research who to select as your surgeon. I wish I had done this." So, everything you said. 

Dr. David Mayman: That's right. I think that just highlights a couple of points we made. The hospital or facility that you're having it done at matters, the surgeon that you're going to matters. And you want to go to a place that's got a good reputation, that does a high volume of these procedures. Let your body heal afterwards. Everybody heals at a different rate, and that's OK. We're all different. That's OK. And the physical therapy does matter. You've got to put the work into it. 

Trina Wilcox: Alright. Linda Hill, who is a retired RN, said, "Make sure you check and get a bone density scan prior to replacement, to see if your bone mass will support the weight of hardware, as well as allow for complete fusion healing." 

Dr. David Mayman: That's a question near and dear to my heart. My wife is an endocrinologist who specializes in bone health. I think it's an important point for everybody, not just people having joint replacement surgery. The last thing you want to do is fall and break your hip or your wrist or have a fracture in your spine. So, a little plug for metabolic bone and bone health. But at the same time, I will tell you that we do hip replacements in people who are 95 years old who fall and break their hip with terrible osteoporotic bone. We can work around those things, but the stronger your bone is, the better. 

Trina Wilcox: Very good. Deborah Bernard McShane said, "Do PT and home exercise. Pain meds are important, along with stool softeners. Meal prep ahead of time." That's her advice. 

Dr. David Mayman: We didn't talk a lot about pain management after surgery, and it's a great point. When I was in medical school, we were basically taught that nobody should have any pain ever, right? And this was the beginning of what became an opioid epidemic across the country. And as happens in many things, sometimes the pendulum swings too far. Today, these opioid pain medications have such a terrible reputation because of all of the terrible things that have happened. And we need to remember that they're actually good medications when used appropriately. 

Everybody goes home taking Tylenol, everybody goes home taking an anti-inflammatory like meloxicam, as long as they don't have a medical contraindication to that. But most people need some sort of narcotic pain medication, at least for a short period of time. That can be Tramadol, that can be oxycodone, that can be Dilaudid. That doesn't mean you're going to get addicted to it. It doesn't mean that you're going to abuse these medications. Some people use them for a couple of days, some people use them for a week or two. It's not a weakness to say that you used an opioid pain medication. They are very good medications when used appropriately. 

Trina Wilcox: Excellent point. Thank you. This has been an excellent conversation. Give me your top three takeaways from everything we talked about today. 

Dr. David Mayman: Alright, my top three takeaways. Number one would be: Don't be afraid to do this when it's time to do this. Don't worry so much about what your age is. It's more about your function and your symptoms. So, that would be number one. Number two is: Let your body heal. Once your body has healed, we really put little to no restrictions on the activities that you can get back to. And number three, I would say, is: Take care of your health overall. We want to operate on people who have optimized their medical condition beforehand. If you have other what we call medical comorbidities — diabetes, smoking, obesity, cardiac disease — we want to make sure that those are controlled as best they can. And then putting the time with the physical therapy and strengthening afterwards to get the optimum result. 

Trina Wilcox: Very good. I think my takeaways would be, like you said, don't wait. Life is precious; enjoy it and feel good doing it. My second one would be: Talk to the anesthesiologist, talk about the bone density. Have all your questions answered, because a sound mind is going to prepare you for better healing. And lastly, like you said, everybody is going to heal differently. Give yourself a little grace, and you'll be back at it before you know it. So, Dr. Mayman, thank you so much for your time. You can find more information at arthritis.org. 

Dr. David Mayman: Trina, thanks so much. This has been great. 

Trina Wilcox: Thank you. We always welcome your feedback. If you have any questions or thoughts, please send an email to [email protected]. 

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