Not only have hip and knee replacement operations become more common, less invasive and more effective, the recovery has gotten better too. And patients play an important role in that recovery.

Dr. Ryan Harrell, an orthopedic surgeon at Novant Health Orthopedics & Sports Medicine - Brunswick, estimates 20% of a successful outcome for knee or hip replacement surgery comes down to the surgery itself, and 80% is based on how the patient recovers. Those who play what he calls an “active” role have a much greater chance for a successful outcome.

When patients are more passive and fall behind in their physical therapy, scar tissue can build up. In a worst-case scenario, the patient could need more surgery.

Harrell said the typical knee replacement requires three months for a patient to get back to 90% strength, while hip replacement patients typically need one month.

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There was a time when joint replacement patients used to spend three days in the hospital and often went directly to a rehabilitation center for two weeks afterward.

“Now you’re typically home the same day, within a few hours,” Harrell said. “And most of the recovery is done at home.”

Here's what to expect during recovery and what gives you the best chance for a successful outcome.

Better pain management

Harrell said joint replacement operations are often done with spinal anesthesia, rather than general anesthesia, which cuts down on recovery time and allows patients to get moving sooner.

And after surgery, pain can often be managed with minimal narcotics, using an assortment of nerve blockers, Tylenol, NSAIDs, and Lyrica, a medication for nerve pain.

“We've gotten away from using narcotics, which makes you drowsy and lethargic and not want to participate in therapy,” Harrell said. And some people are afraid of narcotics for their addictive qualities and side effects, he said.

Hip replacement patients now require considerably fewer prescription narcotics. Even knee replacement patients only require about half of what they used to for post-operative pain control.

Different surgical procedures makes for faster recovery

Two new approaches to hip and knee surgery are helping reduce pain and increase function during the recovery, Harrell said. One is based on where the hip incision is made for hip replacement, and the other is eliminating the use of a tourniquet to limit blood flow during knee replacement.

“The hip surgery itself is a direct anterior approach, which became more popular in the last five to 10 years,” Harrell said. “It goes between muscles instead of cutting through muscles like, in the posterior approach, which takes more time to heal.”

Harrell said patients who have had severe arthritis tend to notice instant improvement right away and are that much quicker to begin their recovery.

On both knee and hip replacements “they're usually walking within an hour after surgery,” Harrell said. “And they're usually going home after two hours.”

New physical therapy app promotes self-discipline

Harrell is hoping to implement a physical therapy app, which patients can download on their phones. They can use it to track their exercises, range of motion and milestones. They can also use it to communicate with the doctor’s office, by sending pictures, for example, if they’re concerned about their surgical incision.

The app also provides guidelines for recovery and sets goals to meet, so if a patient falls behind, he or she knows when it’s time to go see the doctor or physical therapist.

Harrell said even patients who might not be so technologically savvy like using the app.

“They feel like they have more control,” he said. “They understand the recovery more. They can interact on the app. If they have a question, they can just type it in on the app. It goes to the nurse of the surgeon, and they answer the question, or sometimes the questions will go to a physical therapist.”

Post-op patients used to go to outpatient physical therapy offices about three days a week after surgery. Harrell believes those visits led to a more passive approach in recovery, because patients were tempted to limit their exercise to only those outpatient sessions.

“Even in the hospital, when they were there for three days, the only time they ever really got that exercise was once or twice a day,” Harrell said. “Now it's encouraged that we want you to get up and go to the kitchen, go to the bathroom, walk around throughout the day.”

He followed mom into the hospital

Orthopedic surgeon Dr. Ryan Harrell got his first taste of hospital life by volunteering at the hospital where his mother was a social worker.

As a student at Tabb High School in Yorktown, Virginia, Harrell had been looking for ways to beef up his college applications when his mother mentioned they needed volunteers at Riverside Hospital in nearby Newport News.

He took her up on it, and his first assignment was the “ortho” floor, where he handed out lunch trays, transported patients to X-ray and relished the chance to get to know patients.

He also got to help out in the emergency room, where he realized he was falling in love with medicine.

“I’d say I was coming home at 10 p.m., and next thing I knew it would be 11 o’clock and I just wanted to stay longer – I didn’t care what time it was,” Harrell said. “My parents would call me and say, ‘Are you coming home tonight?’”

After getting his undergraduate degree at Virginia Tech in mechanical engineering, he attended the medical school, called VCOM, on the same campus. When it came time to do his clinical rotations during medical school, he applied to Riverside, where his mom was still working. He was born there, and now he was coursing the halls as a physician in training.

“She was proud to see me walking around in my white coat,” Harrell said. “It was a full-circle moment.”

As a social worker, his mother helped patients prepare to be discharged from the hospital. Much of her time was spent on the orthopedics floor because those patients often needed the most help, getting moved into rehabilitation centers or sent home with crutches, walkers and other equipment. Harrell said he honed his bedside manner from watching his mom interact with patients.

“I enjoy doing that too,” he said. “Getting to know their story. They’re not just my patients.

They’re people who are ready to get back to the lives they love. And he’s helping them get there.