The right questions before a joint replacement are the ones whose answers would change what you do.

Questions about whether, and when

The academy's list opens with the question most people are afraid to ask: do I have to have surgery, and if I do not, what are the short-term and long-term risks ¹? It follows with a request for outcomes and complication rates for the procedure being recommended ¹.

Those two questions do most of the work of the decision. A surgeon who can say which findings on your exam and imaging support the recommendation, what has not yet been tried, and what usually changes with a year's wait has given you what the guidance describes as the basis of the recommendation: pain and disability, not an X-ray alone. Our page on when joint replacement is worth it sets out that evidence.

Questions about the surgeon and the setting

The academy asks patients to put the question of experience directly: do you regularly perform total joint replacement, and how many do you perform each year ¹? It asks the same of the facility: how many hip or knee replacements does your hospital or surgery center perform per year ¹? And it asks a sharper question than most patients think to: is the skill and experience of the surgeon more important than the procedure, device, or technique they use ¹?

Technique questions come next. Which surgical approach do you use, and does it make a meaningful difference in the result or pose unnecessary risk ¹? Would you use robotics, and what are the pros and cons ¹? What are the pros and cons of a minimally invasive incision ¹? The evidence on approaches, implants and robotics is on our hip replacement and knee replacement pages; the volume and fellowship literature is on our page about choosing a surgeon; and the comparison of surgery centers and hospitals has its own page.

Questions about the operation day

The academy describes the choice of anesthesia as a major decision that deserves discussion with both the surgeon and the anesthesiologist, and lists what goes into it: past experiences with anesthesia, current health, reactions to medications, and the risks of each option ². The question to ask is which anesthetic is planned for you and why. The evidence comparing spinal and general anesthesia is on our anesthesia page.

The rest of the day's questions are practical, and the academy lists them: how long will I be in the hospital, and can I go home the same day; how much pain should I expect and how will it be managed in the hospital and at home; will my dressing let me shower, and when is it removed; will I have stitches or staples, and when and where are they removed ¹?

Questions about recovery

The academy's recovery questions are about function and time: will I be able to bear weight and walk after surgery; will I need a walker, crutches or a cane, and for about how long; is physical therapy necessary; what will I be able to do and not do afterward; and how long will the replacement last, and what can I do to make it last ¹? It adds two that are easy to forget: who do I contact after surgery if something is wrong, and by what route; and will I need antibiotics before dental work ¹?

The answers to the first group are on our week-by-week recovery pages for the knee and the hip; the dental question has its own page.

The question the studies say to ask: do we expect the same result?

A study at a specialist hospital gave 68 patients scheduled for hip or knee replacement a validated questionnaire about their expected pain relief, function and well-being, and had the surgeon complete the same questionnaire for each patient independently ³. More than half of the patients expected more than their surgeon did: 52.5 percent of knee patients and 60.7 percent of hip patients exceeded the surgeon's expectations by a clinically meaningful margin, and the gap was driven by expectations of high-level activities and extreme range of motion ³.

The American Association of Hip and Knee Surgeons draws the conclusion for patients: expectations set too high lead to dissatisfaction with the final result, expectations set too low may hold back the best possible function, and the two sets of expectations should be aligned before surgery ⁴. Its guidance reports the same finding, that recovery expectations were not aligned in at least half of patients having elective joint replacement ⁴.

The stakes are measurable. In a study of 1,703 knee replacements, about one in five patients was not satisfied with the outcome, and the strongest predictor of dissatisfaction was expectations that were not met ⁵.

• What do you expect me to be able to do at three months, and at a year?
• Which of the activities I care about most do you expect to come back, and which may not?
• What pain relief do you expect for me, and how would you describe a good result for a joint like mine?

Questions about risk that are yours to ask

The academy's list ends with risk: what are the major and most frequent complications, am I at greater risk for any specific complication, what can I do to decrease my risk, and which signs or symptoms after surgery may mean something is wrong ¹?

Those questions have honest answers that differ from person to person, which is why they belong in the visit rather than on a page. Write the answers down, or bring someone who will. Our page on when to call after joint replacement lists the general warning signs; your surgeon's answer to the last question is the one that applies to you.