Information for Patients

Information for patients photo

Before your surgery

 

By the time you have got to the position of being offered joint replacement surgery, you will have gone through the alternatives of treatment.

 

Prior to the surgery it is preferable if you can

 

1 Stop smoking. This lessens the likelihood of complications with the anaesthetic and the post-operative mobilisation.


2 Lose weight. There is no doubt that an overweight patient is harder to operate on, more prone to peri-operative complications, and will put the replaced hip at more risk afterwards.


3 General health. It is essential to continue taking tablets for blood pressure etc to keep you as fit as possible for the operation.


4 Exercise. It is often difficult to exercise before the operation because of the pain and immobility that the arthritic joint brings. It is however beneficial if possible for you to do whatever exercise that you can manage.


Pre-operative assessment


A pre-op assessment will be carried out on you. This is an opportunity to meet and discuss with nurses and physiotherapists your future care. You will be assessed particularly with a view to your general health and you will need further tests including blood tests, a urine test and possibly further X-rays. The pre-operative assessment clinic is an opportunity for you to ask questions about your surgery. You will be given further information about the surgery and about the hospital. If any problems come to light during this time you will be advised on how it can be treated. You may be advised to visit your General Practitioner or you may be asked to see the anaesthetist.

 

Anaesthetic assessment
Occasionally it is necessary for you to formally meet with an anaesthetist prior to the surgery. It is however more normal that you will see the anaesthetist on the day before the surgery or if you have been admitted on the day of the surgery, just prior to the surgery. The anaesthetist will discuss with you the options for the anaesthetic. In general terms this may either be a General Anaesthetic or a regional block. This usually involves an injection into the back that will make your legs feel numb but leave you awake. It is customary in this situation that you will have a sedative so that effectively you sleep through the operation. The decision of which type of anaesthetic to have is something that is made between you and the anaesthetist. From a surgical point of view it will not make any affect to the operation that you have.

 

The surgery


If the operation is in the morning, it is likely that you will be admitted during the afternoon prior to the day of surgery. If the operation is in the afternoon, it is likely that you will be admitted on the morning of surgery. You will be given details of eating and drinking prior to coming into hospital.

You will be prepared for surgery on the ward by being asked to have showers and then the limb will be prepared for the surgery. The consent will have been taken and at this time it is an opportunity to both go through the possible complications of surgery as well as making sure that the side of the operation is marked accurately.


Recovery


Initially you are recovered in the recovery room of the operating theatre but as soon as your condition is stable after the operation you will be moved to the ward once more.

 

The day following the surgery you will have an X-ray and a blood test. These are routine. You will be asked to mobilise on the first day post-operatively with the help of the physiotherapist.


Post-operative out-patient care


Following your discharge home, arrangements will have been made for your stitches to have been removed. I will normally see you six weeks after your operation and an out-patient appointment will be sent to you for this.

 

NHS – In Warwick Hospital we have developed an accelerated discharge policy. You will probably go home on the third day after your surgery. You will be supported in the house by a nurse and physiotherapist who will visit you on the day of surgery and on each day following that for as long as you require help from them. This is usually a further two or three visits. The system has been in place now since 2005 . It has proven very popular with the patients as it allows you to get out of the hospital and home quickly. It has worked well for us and is actually now becoming a template used by other trusts around the country.

 

Privately – In Warwickshire Nuffield Hospital you would normally stay in for five nights. During your stay in hospital you will have physiotherapy but when you go home you will not have a nurse or physiotherapist coming to the house. By that stage it is usually not necessary for you to require further help from them. If further physiotherapy looks like being required, this will be arranged as an out-patient. You will be seen at approximately three weeks by the physiotherapist to check that you are making good progress and you will be seen at six weeks by me.

 

Advice post-operatively


Post-operatively, there are certain “do’s and dont’s” which I insist upon to aid in your recovery.

 

Firstly, you will be asked to walk using crutches for a period of three weeks. Occasionally if people have other joint problems this will be changed to adapt to this and sometimes for example, people will find sticks easier to use than crutches. You will however have some support for a period of three weeks.

 

You will be asked to sleep on your back for a period of six weeks. This avoids the leg getting into a bad position when you are sleeping.

 

You will be asked to wear TED stockings for a period of six weeks. This helps with circulation and preventing DVT.

 

You will be asked not to sit in low chairs or bend to the floor over the first six weeks. Again this helps in preventing dislocation.

 

You will be asked not to drive for a period of four weeks.

 

You will not be able to lie in the bath for a period of six weeks.

 

In general you will find that you do progress quite quickly and the general rule of thumb at three months, you will be able to take part in all activities. Many patients after their surgery want to take part in more physical activities. In general I advise low impact activities such as cycling, swimming and walking on the treadmill to be fine. I advise against prolonged high impact activities such as long distance running.