It's true that operative techniques, surgical methods, and even the implants themselves have changed quite a bit in the last three decades. Improvements in all these areas has shortened the hospital stay and reduced the rehab time.
There is less blood loss during the operation. Long-term complications are fewer as well. But pain control is still an issue. Managing pain during the first few days and weeks post-operatively can be a challenge.
Right now it looks like we might be moving away from patient-controlled analgesia (PCA). PCA allows the patient to administer a small dose of narcotic drug as the last dose starts to wear off. Keeping control of the pain level helps improve recovery.
Efforts are being made to provide the same or better pain control while improving function and recovery. Injecting a combination of drugs into the surgical site before and after the implant is inserted may be the next step.
A study comparing results using PCA versus this new cocktail injection has been reported. The outcomes are very favorable. Patients receiving the injection were able to perform straight leg raises faster and better than the PCA group. Hospital and recovery time was shorter with fewer problems.
The next generation may not even need joint replacements. Gene transfers and cartilage tranplants may make it possible to heal joint damage. If they do need an implant, minimally invasive surgery will be combined with improved post-operative management. This should mean a faster, easier procedure.