Frequently Asked Questions

Have a question about a specific hip or knee surgery? Visit our patient education section for information and answers to common questions about hip and knee procedures.

General Questions

Postop Care Questions

Basic Knee Anatomy

Basic Knee Anatomy

Basic Hip Anatomy

Basic Hip Anatomy

Do you perform “minimally invasive” or “MIS” procedures?

This is among the most common questions patients ask, and it is complicated to answer. First, there is no true medical or scientific definition of a “minimally invasive procedure”. To be honest, I don’t really like the term because it can mean so many different things to different people. For example, we perform a lot of partial knee replacements. Partial knee replacements involve less bony work inside the knee and hence you might consider that “less invasive”. We also perform hip resurfacing which takes away less bone but require a larger skin incision; does that mean it is less invasive or more invasive?

Further, the operations we perform have real risks associated with them and we prefer patients to be realistic and informed about the surgeries they are having as opposed to “minimizing” these issues. At the end of the day, I think what most people want (and what I would want for myself or my family) would be a procedure that is safe, associated with minimal pain and a quick recovery. The trick is, how to make that happen and again, do so safely. So lets break it down into several different parts that may (or may not) be important:

Skin Incision Size

This is probably not important, and in fact, may be in some ways harmful. If the incision is too small, the first problem is that the surgeon may stretch or tear the skin, damaging it and leading to a higher risk of infection or a scar that does not heal as well. When you think about it logically, preparation of the bony surfaces is probably much more painful than the skin incision. Second, a limited skin incision may interfere with the surgeon’s ability to see and perform the procedure safely. It could lead to a higher risk of putting the hip or knee components in the wrong alignment or breaking one of the bones during component insertion.

Hence, I prefer a common sense approach. I make an incision that is large enough to perform the procedure safely but small enough to not cause unnecessary damage to the soft tissues. While I start with what many would consider a smaller incision, I make it larger if needed to perform the procedure safely. In patients who are thinner, smaller and more flexible the incision is usually smaller. In patients who are larger, heavier, more muscular or stiff, the incision may need to be larger. I still like perform a relatively small incision, however I just don’t think it is the most important part of achieving our stated goals of a safe procedure with a fast recovery and minimal pain. In general skin incisions are in the range of 4” to 8”.

Surgical Approach

Another common question. Please see more information under each specific procedure. In general there are several generally accepted ways to expose the hip and knee joint with the scientific data showing few important differences between them. They all have advantages and disadvantages.

Patient Education

Thorough preoperative education is probably among the more critical parts of a rapid recovery. If patients know what to expect, they have less anxiety and a faster recovery. Similarly, patient expectations are important and patients with a positive attitude generally recover more quickly!

Anesthesia

This is probably among the most important parts of a quick recovery with minimal pain and side effects. Please see individual procedures for more specifics on the type of anesthesia used.

Pain Medications

Again, this is probably quite important and the goal of our perioperative pain regimen is to use several different medications together, to make patients comfortable while minimizing side effects such as nausea and constipation.

Physical Therapy

Early ambulation and good physical therapy after surgery is a key component to a quick recovery. We do our best to get people out of bed (safely) and walking as fast as we can after surgery.

So what is the bottom line?

Well, I think a rapid recovery is achieved by a combination of things. It is not just the skin incision, the surgical approach or any of the other things listed. It is a comprehensive approach to care to achieve our stated goals; a safe procedure that minimizes the risk of complications with excellent pain control, minimal side effects and a rapid recovery.

How long before I can walk?

Our goal is to get you up and walking as soon as it is safe to do so after surgery. In some cases this will be the day of surgery and in others, it will be the morning after.

How long will I need to stay in the hospital?

To be honest, it depends! Factors to consider include your general health, if you have a good support system at home and how well you are able to tolerate postoperative pain.

For some of our healthier patients, we offer procedures at a surgery center and can avoid the hospital completely. If you prefer to be in the hospital, many procedures can be done with a short hospital stay. For patients with more complex medical problems, a three day stay in the hospital is more appropriate.

For more information, please visit our Outpatient Hip and Knee Replacement page, North Shore Surgical Suites page and Munster Specialty Surgery Center page.

Can you tell me about surgery at the Munster Specialty Surgery Center?

Dr. Della Valle performs outpatient hip and knee replacement at Musnter Specialty Surgery Center in Munster, IN. Please click here for more information on outpatient procedures and the center in Munster, IN.

Can you tell me about surgery in Pleasant Prairie WI at North Shore Surgical Suites?

Dr. Della Valle performs outpatient hip and knee replacement at North Shore Surgical Suites in Pleasant Prairie, WI. Please click here for more information on outpatient procedures and the center in Pleasant Prairie, WI.

What type of anesthesia is used?

At Rush University Medical Center you will have spinal anesthesia. The anesthesiologist will give you some mild sedation and then perform an injection into your lower back that will make you numb for the operative procedure. If you are having knee surgery, you will also get an injection into your thigh (a nerve block) to help with pain after surgery.

This type of anesthesia provides not only great pain control, but is also associated with less bleeding at the time of surgery and may lower the risk of blood clots after surgery.

If you have severe arthritis of your spine or have had prior spine surgery this may not be an option for you. Please ask us if this is a concern, and we can arrange to have you see our anesthesia colleagues prior to surgery.

If you are having outpatient hip or knee replacement surgery at Munster Specialty Surgery Center or North Shore Surgical Suites in Pleasant Prairie, WI the techniques are somewhat different so that you will be able to leave the facility comfortably and safely within a few hours of your surgical procedures.

Will my muscle be cut at the time of my hip or knee replacement?

This is a common question and understandably causes much confusion for patients. As far as I can ascertain, it is impossible to perform a hip or knee replacement without some damage to the surrounding muscles; whether they are cut of not is probably not important. Interestingly, when you think about it, there may be MORE potential for muscle damage if the surgeon uses a smaller incision and has to “force” things to get the job done. Our goal as stated is to provide you with a safe procedure, minimal pain and a faster recovery. We always do our best at the time of surgery to avoid unnecessary damage to the surrounding soft tissues but I don’t think that it is possible to perform a hip or knee replacement without detaching or cutting some muscle. Please see the articles below for some more information on this topic.

Journal Article: Muscle damage during minimally invasive total hip arthroplasty: cadaver-based evidence that it is significant »

Journal Article: Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach »

Journal Article: Anatomy of the extensor mechanism in reference to quadriceps-sparing TKA »

Am I going to go to a rehabilitation center after surgery?

Ideally, our preference is for patients to go home after surgery. Even patients who live alone can oftentimes be safely discharged to home. Most of the literature suggests that inpatient rehabilitation stays are associated with a higher risk of complications (particularly infection) and higher costs.

There are some situations, however, where an inpatient rehabilitation stay is appropriate. This is generally for patients who have two diagnosis; for example a history of rheumatoid arthritis or Parkinson’s disease and have had a hip or knee replacement.

There are also some patients for whom it is unsafe to go home and in these cases, a skilled nursing care facility may be appropriate. We would ask that you “keep an open mind” and allow our physical therapists and discharge planner help you to make the right decision once you are in the hospital.

I have diabetes. Will this affect my surgery?

The short answer is “yes”. Diabetes has been shown to be a risk factor for infection as well as blood clots after surgery. To minimize your risk it is very important to control your blood sugars carefully both prior to and immediately after surgery.

At the time of booking your surgery, we will obtain a blood marker called “hemoglobin A1C” which is a marker of your blood sugar control over time. If this is not in a safe range, your surgery may be delayed to allow you to work with your primary care doctor to get your diabetes under better control to decrease your risks for surgery.

I am overweight. Will this affect my surgery?

Yes, in general people who are overweight have been shown to have a higher risk of problems and complications after surgery. In general we use something called the “body mass index” to gauge your risks. Patients with a body mass index of over 40 are at greatest increased risk and those risks are even greater if your body mass index is over 50.

We understand that weight loss with an arthritic joint is difficult. While healthy weight loss can be helpful (generally considered as one to two pounds per week), it is important to maintain healthy nutrition. We routinely asses nutrition, and if you are malnourished (yes people can be overweight and malnourished) your surgery may be delayed. Please ask us for more information on healthy weight loss and nutrition. The prevention center at Rush is an excellent resource for healthy weight loss. Rush also has several experts on weight loss surgery which may be appropriate in some cases.

Journal Article: Obesity and total joint arthroplasty: a literature based review »

Will I have sutures or staples used to close the skin that need to be removed after surgery?

Dr. Della Valle prefers to use a “plastic surgery” layered wound closure with sutures underneath the skin. In our experience this leads to a better looking incision, but one that also heals more quickly and avoids the pain associated with staple or suture removal.

Can I shower after surgery?

At the time of surgery, a waterproof bandage will be placed on your incision and you can shower right after surgery. This special bandage has been shown to decrease the risk of wound healing problems and infection after surgery by providing an optimal environment for wound healing.

This dressing stays in place for one week and then must be changed. You can purchase a replacement dressing for the second week after surgery in our Durable Medical Equipment store. We recommend purchasing this either on the day of your teaching class or to have a family member or friend get one for you before you leave the hospital. Just let the people at the store know you are my patient and they will help you pick out the right bandage.

If you do not purchase this bandage, a dry dressing can be placed over the incision for one more week, however you cannot get it wet.

At two weeks after surgery, you can leave the incision open to air and you can shower, but not submerge the incision. The incision can be submerged in a pool or bath at approximately 3-4 weeks after surgery, once it is fully healed with no scabbing present.

Journal Article: Aquacel surgical dressing reduces the rate of acute PJI following total joint arthroplasty: a case-control study »

How long will my replacement last?

This is a common question and concern, particularly for younger patients. To be honest, it is hard to predict but a good general guideline is the risk of failure is about 1% per year. That means at 10 years after surgery 90% of patients should have a hip or knee that is still working well.

While many patients are most concerned about their replacement “wearing out”, that is only one reason why a hip or knee can fail. The data actually suggests that infection is the most common cause of failure after knee replacements done in the United States and dislocation is the most common cause of failure of a hip replacement.

Where do you perform surgery?

Dr. Della Valle operates at Rush University Medical Center in Chicago, IL, Munster Specialty Surgery Center in Munster, IN and North Shore Surgical Suites in Pleasant Prairie, WI.

If I have arthritis of both hips or knees, can I do them both at the same time?

Most of the literature suggests a higher risk of complications and death if both joints are replaced at the same time. Hence, I prefer to perform them one at a time. If you need both joints replaced, they can generally be done two to three months apart.

How long will I be in the operating room?

Most of the procedures take between 90 minutes and three hours to perform, depending on the complexity of your procedure. However, the total time in the operating may be more as it takes time to perform the anesthesia and position you for the procedure.

Do I need to donate my own blood before surgery? Will I need a transfusion?

With the surgical and anesthetic techniques we use, combined with giving patients a medication called tranexamic acid, the risk of transfusion is very low (less than 5% or 1 in 20 patients will need a blood transfusion).

Hence, we do not recommend that you donate your own blood prior to surgery as most research shows that this strategy does not lower the risk of a blood transfusion from someone else, but it does increase the risk of getting a transfusion as many patients will get their own blood back. While this does not sound risky, it can be, as the most common complication of a blood transfusion is a “clerical error” which means getting the wrong unit of blood. It turns out that the risk of this type of error is much greater than the risk of getting a disease from a blood transfusion from someone else.

I am not interested in surgery and want to explore non-operative treatment for my arthritis such as an injection into the joint and the use of medication and physical therapy. Should I come in to see Dr. Della Valle?

We have several partners who are focused on non-operative care and, ideally, patients are encouraged to see those physicians first. You will be able to get an appointment to see them more quickly and this is the focus of their practice. We are happy to see patients to discuss both surgical and non-surgical options, however, if you are sure that you do not want surgery, we do recommend seeing one of our partners first.

Are there any questions I am forgetting to ask?

Probably the most important question you should be asking is how many procedures the surgeon performs annually. Most of the data that looks at the risks of complications (which most patients want to avoid) suggests that surgeon and hospital volume are both important in lowering the risk of complications and problems. This is no guarantee, but it does “stack the odds” in your favor. Dr. Della Valle has performed more than 9,000 hip and knee procedures and Rush performs thousands per year.

Unfortunately complications are inevitable. Much of my own research has looked at the diagnosis and treatment of complications after surgery and if you have a problem after surgery, our goal would be to recognize and treat it as quickly and effectively as possible.

Journal Article: Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population »

Postop Care Questions

Will I have sutures or staples used to close the skin that need to be removed after surgery?

Dr. Della Valle prefers to use a “plastic surgery” layered wound closure with sutures underneath the skin. In our experience this leads to a better looking incision, but one that also heals more quickly and avoids the pain associated with staple or suture removal.

How do I care for my dressing after surgery? Can I shower after surgery?

At the time of surgery, a waterproof bandage will be placed on your incision and you can shower right after surgery. This special bandage has been shown to decrease the risk of wound healing problems and infection after surgery by providing an optimal environment for wound healing. If you have leakage from around the bandage or you (or anyone else) has questions or concerns about the dressing or your wound, please call our office immediately.

This dressing stays in place for one week and then must be changed. You can purchase a replacement dressing for the second week after surgery in our Durable Medical Equipment store. We recommend purchasing this either on the day of your teaching class or to have a family member or friend get one for you before you leave the hospital. Just let the people at the store know you are my patient and they will help you pick out the right bandage.

If you do not purchase this bandage, a dry dressing can be placed over the incision for one more week, however you cannot get it wet.

At two weeks after surgery, you can leave the incision open to air and you can shower, but not submerge the incision. The incision can be submerged in a pool or bath at approximately 3-4 weeks after surgery, once it is fully healed with no scabbing present.

Journal Article: Aquacel surgical dressing reduces the rate of acute PJI following total joint arthroplasty: a case-control study »

What if I have a question after surgery, whom should I call?

We have two nurses and two administrative assistants who are available to help you before and after surgery to answer any of your questions or concerns. Ideally, we recommend that you call us at 708-236-2738 during normal business hours to have your questions answered by someone who knows Dr. Della Valle’s protocols and knows you as a patient! While other care providers are available 24hours per day and 7 days per week, we again strongly recommend calling us during normal business hours.

What if I have a question on the weekend or at night?

There is always a resident of fellow available to answer your calls, however they may not know your case personally and hence we recommend trying to reach us during normal business hours if you can.

Should I go to the emergency room if I have a problem?

In general, we strongly recommend against going to the emergency room unless you feel you have a true emergency. In general, the emergency room staff will not know you and may not be familiar with patients who have had a hip or knee replacement. Hence, we strongly recommend trying to contact us with any problems during normal business hours so we can see you if you are having any problems or if you have any questions or concerns.

If you do have to go to an emergency room, we strongly prefer you come back to RUSH where there will be a resident on call who can evaluate you and discuss your care with me.

Have a question about a specific hip or knee surgery? Visit our patient education section for information and answers to common questions about hip and knee procedures.