Frequently Asked Questions

You may be a candidate for joint replacement if you experience persistent pain that limits daily activities — such as walking, climbing stairs, or sleeping — and conservative treatments (physical therapy, injections, medications, bracing) have not provided adequate relief. X-rays showing bone-on-bone arthritis, along with pain that affects your quality of life, are the most common reasons patients proceed with surgery. Dr. Lupo will evaluate your imaging, physical exam, and functional limitations during your consultation to determine if surgery is appropriate.

Robotic-arm assisted surgery uses a CT scan of your joint to create a precise 3D model before surgery. Dr. Lupo plans the exact implant position on this model, and during surgery, the robotic arm provides real-time guidance and haptic (physical) boundaries to ensure the plan is executed with sub-millimeter accuracy. The surgeon controls every movement — the robot does not operate independently. It is a tool that enhances the surgeon's precision, similar to how GPS enhances a driver's navigation.

No. Dr. Lupo performs the surgery. The robotic arm is a precision tool that provides real-time feedback and physical boundaries to ensure the surgical plan is followed exactly. Think of it as power steering — the surgeon is always in control, but the technology makes the movements more precise. The robot cannot move on its own or make decisions.

Most joint replacement surgeries are performed under spinal anesthesia (a numbing injection in the lower back) combined with sedation so you are comfortable and relaxed. This avoids the risks of general anesthesia and often results in less nausea and a faster recovery. The anesthesiologist will discuss options with you before surgery and recommend the safest approach based on your health history.

A typical robotic knee or hip replacement takes approximately 60 to 90 minutes of surgical time. You will be in the operating room for approximately 2 hours total, which includes preparation, anesthesia, and post-operative monitoring. Robotic planning is done before surgery using your CT scan, so it does not add significant time to the procedure.

95% of Dr. Lupo's patients go home the same day. You are fully weight-bearing immediately and will do stairs before you leave the hospital. You will initially use a walking aid — not because you can't walk, but to rest the muscles around your hip or knee as they heal. Most patients are off all walking aids within 1 to 4 weeks, depending on the individual.

Yes. Physical therapy is a critical part of your recovery. Generally, a therapist will come to your home for the first two weeks. After that, you begin outpatient therapy 2–3 times per week for approximately six weeks. The exercises focus on restoring range of motion, building strength, and returning to normal activities. Your commitment to physical therapy directly impacts your outcome.

Modern joint replacement implants are designed to last 20–30 years or more. Advances in materials (highly cross-linked polyethylene, ceramic, and cobalt-chrome alloys) have significantly improved implant longevity. The precision of robotic-arm assisted placement — ensuring optimal alignment and reducing abnormal wear patterns — may further extend implant life. Factors that affect longevity include activity level, body weight, and implant positioning.

As with any surgery, there are risks. Common risks include infection (less than 1%), blood clots, nerve or blood vessel injury, implant loosening, stiffness, and leg length discrepancy. This is not an exhaustive list — Dr. Lupo will discuss all potential risks specific to your situation during your consultation. However, joint replacement is one of the most successful and well-studied surgeries in medicine, with over 95% of patients reporting significant pain relief and improved function. Dr. Lupo takes specific precautions to minimize each risk, including antibiotics, blood thinners, and robotic guidance for precise implant placement.

There is no strict age limit for joint replacement. The decision is based on your pain level, functional limitations, and overall health — not your age alone. Patients in their 50s through their 90s have successful outcomes. For younger patients, the primary consideration is implant longevity, which is why precise robotic placement is especially valuable — better alignment means less wear and a longer-lasting implant.

Being overweight increases stress on your joints and can affect surgical outcomes. However, many patients with elevated BMI still benefit significantly from joint replacement. In some cases, Dr. Lupo may recommend weight loss before surgery to reduce risks and improve outcomes. Each patient is evaluated individually — weight alone does not disqualify you from surgery.

Modern implants may or may not trigger airport security scanners. You should inform security before you go through a scanner that you have a joint replacement. Wear loose, comfortable clothing that can be easily patted down, or be prepared to show them a surgical scar. We do not use joint replacement cards, as they do not work. This is a minor inconvenience that most patients find easily manageable.

No. The current guidelines no longer recommend prophylactic antibiotics before dental work for joint replacement patients. This is a change from previous recommendations. You do not need to take antibiotics before dental procedures. Simply inform your dentist that you have a joint replacement, but antibiotics are no longer necessary.

Blood thinners (warfarin, Eliquis, Xarelto), aspirin, anti-inflammatory medications (ibuprofen, naproxen), and certain supplements (fish oil, vitamin E, turmeric) typically need to be stopped 5–14 days before surgery. Do NOT stop any medication without specific instructions from Dr. Lupo's office. Your pre-operative appointment will include a detailed medication review with specific stop dates for each drug.

Remove throw rugs and tripping hazards. Place frequently used items at counter height. Consider a raised toilet seat and shower chair. Stock your kitchen with easy-to-prepare meals. Arrange for someone to help you for the first few days at home. If your bedroom is upstairs, consider setting up a temporary sleeping area on the main floor for the first 1–2 weeks.

No. Dr. Lupo uses the same MAKO robotic technology available at any major medical center — combined with an enhanced robotic workflow and muscle-sparing technique that most robotic surgeons don't offer, regardless of location. Staying local means recovering at home surrounded by family, follow-up appointments minutes away, and physical therapists who know Dr. Lupo's protocol. There is no advantage to driving 30 minutes or two hours away for surgeons who don't use robotics, don't use muscle-sparing techniques, or don't use both — when a more advanced technique combining both is readily available right here in Erie.

No. Some practices charge thousands of dollars in out-of-pocket concierge fees for joint replacement. Dr. Lupo provides the same level of personalized attention — direct access, unhurried consultations, and individualized robotic surgical planning — as part of your standard care. You should never have to pay extra for a surgeon who takes the time to plan your surgery properly.

The subvastus approach is a surgical technique that accesses the knee joint from beneath the vastus medialis muscle — the inner portion of your quadriceps. Unlike the traditional medial parapatellar approach, which cuts directly through the quadriceps tendon, the subvastus approach lifts the muscle and works underneath it. Because the quadriceps tendon and muscle remain intact, patients typically experience less pain, faster return of muscle strength, and quicker functional recovery.

In a traditional (medial parapatellar) knee replacement, the surgeon cuts through the quadriceps tendon to access the knee joint. This is the muscle responsible for straightening your knee — critical for walking, stairs, and getting out of a chair. Cutting it means weeks of healing before it functions normally again. Dr. Lupo's modified subvastus approach works around the quadriceps muscle, leaving it completely intact. This means: • Less post-operative pain • Faster ability to perform a straight leg raise • Earlier return of quadriceps strength • Quicker return to walking without assistance • Same-day or next-day discharge in most cases

Yes — this is one of the key advantages. Because the quadriceps muscle and tendon are not cut, most patients can perform a straight leg raise within hours of surgery. With traditional approaches that cut the quadriceps tendon, this milestone can take days or even weeks to achieve. The straight leg raise is an important indicator of quadriceps function and early recovery progress.

The robotic system uses a CT scan to create a 3D model of your unique knee anatomy before surgery. Dr. Lupo plans the exact implant size, position, and alignment on this model. During surgery, the robotic arm provides real-time feedback and haptic boundaries that prevent deviation from the plan. This results in: • Sub-millimeter accuracy in implant placement • Optimal limb alignment • Balanced ligament tension • More natural-feeling knee movement • Potentially longer implant life due to reduced abnormal wear

When arthritis affects only one compartment of the knee (typically the inner/medial side), a partial knee replacement resurfaces only the damaged area while preserving healthy bone, cartilage, and all ligaments (including the ACL). This is a less invasive procedure with faster recovery, more natural knee feel, and better range of motion compared to a total knee replacement. Robotic guidance ensures the partial implant is positioned with the same precision as a total replacement. Not all patients are candidates — Dr. Lupo will determine if your arthritis pattern is appropriate for a partial replacement.

You are fully weight-bearing immediately after surgery. You will initially use a walking aid — not because you can't walk, but to rest the muscles around your knee as they heal. Most patients are off all walking aids within 1 to 4 weeks, depending on the individual. You will do stairs before you leave the hospital.

For right knee replacement: typically 2–4 weeks, once you can comfortably control the brake pedal and are off narcotic pain medication. For left knee replacement with an automatic transmission: often 1–2 weeks, as your left leg is not needed for driving. Dr. Lupo will clear you to drive at your follow-up appointment based on your specific recovery.

Most patients return to low-impact activities like golf, swimming, cycling, and doubles tennis within 6–12 weeks. The muscle-sparing approach often allows earlier return to activity compared to traditional techniques. High-impact activities like running, basketball, and singles tennis are generally discouraged as they can accelerate implant wear. Dr. Lupo will provide specific guidance based on your activity goals.

Most patients report significant pain relief and greatly improved function. However, a replaced knee will feel different from a natural knee — most patients describe a slight awareness that something is different, particularly with deep bending. That said, robotic-arm assisted placement and the muscle-sparing approach produce a more natural-feeling result than traditional techniques because the implant is positioned to work with your specific anatomy and your quadriceps muscle is preserved.

Some patients notice occasional clicking or a sensation of movement in their replaced knee. This is normal and typically caused by the implant components moving against each other during certain activities. It is not painful and does not indicate a problem. Precise robotic placement can minimize these sensations by optimizing implant alignment.

The subvastus approach works well for the majority of knee replacement patients. However, it may be more challenging in patients with severe obesity, very muscular thighs, significant valgus (knock-knee) deformity, or very stiff knees with limited range of motion. Dr. Lupo will evaluate your specific anatomy during your consultation and recommend the approach that will give you the best outcome.

Some surgeons pay an exorbitant amount of money in licensing fees to use trademarked names for their knee replacement marketing. Dr. Lupo performs an enhanced medial oblique modified subvastus approach that he has developed specifically to work with robotic-arm assisted technology. This is a technique he has refined over years of practice for superior patient outcomes. He further enhances his results with an advanced robotic workflow that provides more data and information for accurately positioned implant plans, as opposed to the express workflow used by the vast majority of robotic surgeons. The focus is on surgical innovation and outcomes, not marketing trademarks.

The direct anterior approach accesses the hip joint from the front of the body, working between muscles and tendons rather than cutting through them. The surgeon enters through a natural intermuscular plane — the space between the sartorius/rectus femoris and the tensor fasciae latae muscles. Because no muscles are detached from bone, the hip's stabilizing structures remain intact, resulting in less pain, faster recovery, lower dislocation risk, and no post-operative movement restrictions.

The posterior (from the back) approach requires detaching the external rotator muscles and hip capsule from the femur. These structures normally prevent the hip from dislocating. After posterior hip replacement, patients must follow strict hip precautions for 6–12 weeks (no bending past 90°, no crossing legs, no internal rotation) while these structures heal. With the direct anterior approach: • No muscles are cut or detached • No hip precautions are required — move freely from day one • Lower dislocation risk (less than 1% vs. 2–5% posterior) • Faster return to walking, driving, and daily activities • Less post-operative pain • No need for elevated toilet seats or special pillows

No. Because the direct anterior approach does not cut or detach any muscles, there are no post-operative movement restrictions. You can bend, cross your legs, sit in low chairs, tie your shoes, and move freely as comfort allows from the day of surgery. This is one of the most significant advantages over posterior and lateral approaches, which require 6–12 weeks of strict movement restrictions to prevent dislocation.

The robotic system provides real-time data on three critical measurements during hip replacement: 1. Cup positioning — The socket must be positioned in a way that creates stability. Robotic guidance ensures this is achieved precisely. 2. Leg length — Unequal leg length after hip replacement is a common patient complaint. The robotic system measures leg length in real-time, allowing Dr. Lupo to work toward restoring your natural length as closely as possible. 3. Offset — This determines proper muscle tension around the hip. Correct offset means the hip feels stable and the muscles work efficiently. Dr. Lupo uses an enhanced robotic workflow that provides more data and information for accurately positioned implant plans, as opposed to the express workflow used by the vast majority of robotic surgeons. These three factors determine how natural your hip feels, how stable it is, and how long the implant lasts.

Leg length discrepancy is one of the most common complaints after traditional hip replacement. Dr. Lupo uses an enhanced robotic technique and does everything possible to make your leg lengths as close to even as possible. However, in severely shortened hips, there may be a limit to how far the leg can be lengthened. Additionally, if the hip is very loose, he may need to lengthen the leg slightly to create stability. Either way, Dr. Lupo does his best to achieve an unrecognizable leg length difference — a significant advantage over non-robotic techniques where leg length is estimated rather than measured.

It is common to have a small area of numbness on the outer front of the thigh after anterior approach hip replacement. This is caused by a small sensory nerve (the lateral femoral cutaneous nerve) that runs near the surgical approach. In most patients, the numbness resolves within a few weeks to months. If it persists, it is typically a small patch that patients describe as not bothersome. This is a cosmetic sensory issue only — it does not affect muscle function or strength.

You are fully weight-bearing immediately after surgery. You will initially use a walking aid — not because you can't walk, but to rest the muscles around your hip as they heal. Most patients are off all walking aids within 1 to 4 weeks, depending on the individual. You will do stairs before you leave the hospital.

Most patients return to driving within 2–3 weeks after anterior hip replacement. You must be off narcotic pain medication and able to comfortably operate the pedals. Because there are no hip precautions limiting your movement, the main factor is pain control and reaction time. Dr. Lupo will clear you at your follow-up appointment.

After full recovery, most patients return to walking, hiking, cycling, swimming, golf, doubles tennis, yoga, dancing, and even skiing (groomed slopes). The one activity generally discouraged is long-distance running, as the repetitive impact can accelerate implant wear. Many patients return to activities they haven't been able to enjoy for years. There are no permanent movement restrictions with the anterior approach.

The dislocation rate with the direct anterior approach is very low — typically less than 1%, compared to 2–5% with the posterior approach. This is because the anterior approach does not disrupt the posterior hip capsule and external rotator muscles that are the primary stabilizers against dislocation. Combined with robotic-guided cup positioning in the optimal safe zone, the risk is further minimized.

The direct anterior approach works well for the majority of hip replacement patients. It may be more technically challenging in patients with significant obesity, very muscular builds, or unusual anatomy. Patients who have had previous hip surgery through a posterior approach may also require a different approach for revision. Dr. Lupo performs approximately 95% of his primary hip replacements through the anterior approach and will recommend the best approach for your specific situation.

Some surgeons use specialized tables (like the HANA table) for anterior hip replacement, but they are not required. Dr. Lupo performs the anterior approach on a standard operating table, which provides flexibility and is combined with robotic guidance for precise implant positioning. The key factor is the surgeon's training and experience with the approach, not the table used.

During your first visit, Dr. Lupo will review your X-rays (or order new ones), perform a physical examination of your joint, discuss your symptoms and how they affect your daily life, and review your medical history. If surgery is appropriate, he will explain the procedure, expected outcomes, and answer all your questions. You will leave with a clear understanding of whether joint replacement is right for you and what the next steps are.

Pre-operative requirements typically include: • CT scan of the affected joint (for robotic surgical planning) • Blood work (complete blood count, metabolic panel, coagulation studies) • EKG (electrocardiogram) • Medical clearance from your primary care physician • Possible chest X-ray (depending on age and health history) • Urinalysis • Dental clearance (to rule out active dental infections) All pre-operative testing is typically completed 2–4 weeks before surgery.

Yes — patients who are stronger going into surgery tend to recover faster. Focus on: • Upper body strengthening (you'll use a walker initially) • Quadriceps and hip strengthening exercises • Range of motion exercises • Walking or cycling for cardiovascular fitness Dr. Lupo's team can provide a pre-operative exercise program. Even 2–4 weeks of consistent exercise before surgery can make a meaningful difference in your recovery.

If your BMI is significantly elevated, losing weight before surgery can reduce surgical risks, improve outcomes, and speed recovery. However, many patients with joint pain find it difficult to exercise enough to lose weight — which is part of why they need the surgery. Dr. Lupo evaluates each patient individually and will discuss whether weight loss is recommended or required before proceeding.

Blood thinners must be managed carefully before surgery. Typically: • Warfarin (Coumadin): Stop 5 days before surgery • Eliquis (apixaban): Stop 2–3 days before surgery • Xarelto (rivarelbaan): Stop 2–3 days before surgery • Aspirin: Follow Dr. Lupo's specific instructions NEVER stop blood thinners without explicit instructions from your surgical team. Some patients require bridging therapy. Your specific plan will be discussed at your pre-operative appointment.

You must not eat solid food after midnight the night before surgery. Clear liquids (water, black coffee, apple juice) are typically allowed up to 2 hours before your arrival time. Follow the specific instructions provided by the surgical center, as guidelines may vary. Taking your morning medications with a small sip of water is usually permitted — confirm with Dr. Lupo's office which medications to take the morning of surgery.

You will walk and do stairs before you leave the hospital. You will initially use a walking aid — not because you can't walk, but because we want you to rest the muscles around your hip or knee as they heal. Most patients are surprised at how well they feel — the muscle-sparing approach means significantly less pain than expected. 95% of patients go home the same day.

Dr. Lupo uses a multimodal pain management approach that minimizes the need for narcotic medications: • Ice therapy (20 minutes on, 20 minutes off) • Anti-inflammatory medications (as prescribed) • Acetaminophen (Tylenol) on a scheduled basis • Short-term narcotic medication for breakthrough pain only • Elevation of the surgical limb • Gentle movement and walking (motion reduces stiffness and pain) Most patients are off narcotic pain medication within 1–2 weeks. The muscle-sparing approach significantly reduces post-operative pain compared to traditional techniques.

Physical therapy begins the day of surgery in the hospital. After discharge, outpatient physical therapy typically starts within 3–7 days and continues 2–3 times per week for 4–6 weeks. Your therapist will focus on: • Restoring range of motion • Rebuilding muscle strength • Improving balance and stability • Progressing walking distance and speed • Returning to specific activities you enjoy Home exercises between PT sessions are equally important and should be performed daily.

Keep the incision clean and dry. The surgical dressing is typically removed 2–3 days after surgery. After that: • You may shower (let water run over the incision, do not scrub) • Do not submerge in a bath, pool, or hot tub until fully healed (typically 3–4 weeks) • Watch for signs of infection: increasing redness, warmth, swelling, drainage, or fever over 101°F • Steri-strips or surgical glue will fall off on their own • Avoid applying lotions or ointments to the incision unless instructed Contact Dr. Lupo's office immediately if you notice signs of infection.

Most patients can shower 48 hours after surgery once the initial dressing is removed. Use a shower chair for safety during the first 1–2 weeks. Let water run over the incision gently — do not scrub or soak. Pat dry with a clean towel. Do not take baths or submerge the incision in water (pools, hot tubs) for at least 3–4 weeks or until Dr. Lupo confirms the incision is fully healed.

Blood clot prevention is taken very seriously after joint replacement. Your protocol will include: • Blood-thinning medication (typically aspirin or a prescription blood thinner for 2–4 weeks) • Ankle pump exercises every hour while awake • Early and frequent walking • Compression stockings or sequential compression devices • Staying well-hydrated Call Dr. Lupo's office or go to the ER immediately if you experience sudden calf pain/swelling, chest pain, or shortness of breath — these could indicate a blood clot.

Return to work depends on your job: • Desk/office work: 2–4 weeks • Light physical work (standing, walking): 4–6 weeks • Moderate physical work: 6–8 weeks • Heavy labor (lifting, climbing, kneeling): 8–12 weeks The muscle-sparing approach often allows earlier return compared to traditional surgery. Dr. Lupo will provide specific clearance based on your recovery progress and job requirements.

Living alone is not a barrier to joint replacement, but you should plan ahead: • Arrange for someone to stay with you for the first 2–3 days • Prepare meals in advance (freeze portions) • Place essentials at counter height • Consider a temporary bed on the main floor if your bedroom is upstairs • Set up a recovery station with phone, medications, water, and remote controls within reach If you cannot arrange help at home, a short stay at a rehabilitation facility may be appropriate. Dr. Lupo's team will help coordinate this before surgery.

Recovery milestones vary, but a typical timeline is: • 1–2 weeks: Walking independently, managing daily activities • 4–6 weeks: Significant improvement, returning to most activities • 3 months: Most patients feel 80–90% recovered • 6–12 months: Maximum improvement achieved Most patients say they wish they had done it sooner. The muscle-sparing approach accelerates early recovery, but full tissue healing and strength restoration still takes several months.

Yes. Robotic-arm assisted joint replacement is covered by Medicare and virtually all private insurance plans. The robotic technology is considered part of the surgical procedure — there is no additional charge to the patient for the use of robotic guidance. Your out-of-pocket costs will depend on your specific insurance plan, deductible, and copay structure.

This depends on your insurance plan. Some plans (HMO) require a referral from your primary care physician, while others (PPO) allow you to self-refer to a specialist. Check with your insurance company or call our office at (814) 454-2401 and our staff will help verify your coverage and referral requirements.

Dr. Lupo performs robotic joint replacement surgery at Saint Vincent Hospital in Erie, Pennsylvania, in their state-of-the-art new orthopedic operating room suites. The facility is equipped with the latest robotic surgical technology and a dedicated joint replacement program with specialized nursing and physical therapy staff.

After your consultation and decision to proceed, surgery is typically scheduled 3–6 weeks out. This allows time for pre-operative testing, CT scanning for robotic planning, medical clearance, and home preparation. In some cases, surgery can be scheduled sooner depending on availability and medical readiness.