Joint replacement operations

Some patients may need replacement of the back of the knee cap (patella).

Most patients need a total knee replacement but you may only need one part or one side of your knee joint replaced. It’s known as a partial, or unicompartmental knee replacement.

When will I need knee replacement surgery?

It’s usually necessary if you have a worn or damaged knee joint. Your mobility may be reduced and you may feel pain in your knee when you rest.

We may offer you knee replacement surgery if you have:

• severe arthritis, including osteoarthritis and rheumatoid arthritis
• haemophilia
• gout
• a knee injury
• knee deformity
• death of the bone in the knee joint following blood supply problems.

You may have knee replacement surgery if other treatment options don’t reduce your pain or increase your mobility.

What are the benefits?

In the long term, the majority of people who have surgery will eventually feel free from pain and knee arthritis disability. Some people may still have some pain when twisting or kneeling.

You will feel more independent but may find it difficult to do everything you were once able to do to start with.

What happens during knee replacement surgery?

Your operation will usually last 1 to 2 hours.

You’ll have an anaesthetic for your operation. The most common is a spinal anaesthetic but some people may need a general anaesthetic.

The surgeon will make a cut (incision) on the front of your knee and remove any excess arthritic bone. This helps to make a smooth base for your new implant.

When satisfied with the position of the implant, the surgeon will close the incision with metal clips (skin staples) or stitches. They may use a drain to allow any collection of blood or fluid to drain out.

You may experience numbness over the outside of your knee.

Find out more about what happens during knee replacement surgery.

Recovering from your knee replacement

Learn how to do knee exercises to help your recovery.

You may have chosen to have hip replacement surgery because of degeneration such as arthritis.

When will I need hip replacement surgery?

It’s usually necessary if you have a worn or damaged hip joint. Your mobility may be reduced and you may feel pain in your hip when you rest.

We may offer you hip replacement surgery if you have:

• osteoarthritis
• rheumatoid arthritis
• septic arthritis
• a hip fracture
• disorders that cause bone growth (bone dysplasias)

You may have hip replacement surgery if other treatment options don’t reduce your pain or increase your mobility.

Benefits

Surgery stops most, if not all pain in your hip. The majority of people who have surgery feel free from pain and hip arthritis disability. They also feel more independent.

What happens during surgery?

You will have an anaesthetic for your operation. This may be a spinal anaesthetic but some people may need a general anaesthetic.

Sometimes you may have an epidural which is similar to a spinal anaesthetic.

The surgeon will make a cut (incision) into your hip, removes the damaged hip joint and replaces it with an artificial joint or implant.

The surgery usually takes around 1 to 2 hours to complete.

Find out more about what happens during hip replacement surgery.

Watch this video to find out what happens during hip replacement surgery.

Recovering from your hip replacement

Watch this video on hip exercises to help your recovery.

Find out about looking after your new hip.

Benefits

People who have joint replacement surgery may benefit from:

• increased mobility
• freedom from pain
• improved sleep
• improved quality of life
• ability to carry out everyday tasks that were difficult or impossible before surgery
• ability to work again and socialise.

Risks

As with all operations, there are risks involved. There’s a low risk of serious complications, estimated to be less than one in 100 people.

Your surgeon will answer any questions you have and discuss the risks with you before your surgery to make sure you fully understand them.

These risks include:

Blood clots

Also known as Deep Vein Thrombosis (DVT). Blood clots can form in the veins, usually your leg, after surgery. Because you’ll be moving less than normal after your operation, you’re at a higher risk of developing DVT.

You may need to take medication to reduce this risk.

The blood thinning medication can cause your leg to swell ​and bruise. The swelling and bruising may extend all the way to your foot and ankle area. If you have pain in your calf from the swelling, please see your GP. They may refer you for a scan to check for a blood clot in your leg veins.

More information about DVT

Watch these videos about how to prevent DVT.

Learn more about DVT including symptoms and how to treat it.

Watch this video on Deep Vein Thrombosis.

Bleeding

This is usually minor which your surgeon stops during the operation.

Pain

Your hip will feel sore after the operation but we’ll give you painkillers. Pain normally improves with time and for most people the hip will become pain free.

Implant wear and loosening

With modern operating techniques and implants, we expect your new hip to last more than 15 years. In some cases the implants may wear or loosen and may need further surgery for infection or instability.

Known as revision surgery, the surgeon will remove your original joint implant and replace it with a new one.

Joint dislocation

The muscles and ligaments around the hip hold the two sides of a hip replacement together. They can dislocate, particularly in the first few weeks after surgery. If this happens, the joint can usually be put back into place under general anaesthetic.

Infection

To minimise the risk of infection we use ultra clean air theatres. Our surgical team take special precautions including gowning and draping but some infections can still happen. If the wound becomes red or hot, it may be a sign of infection. If you develop any of these symptoms please contact the orthopaedic ward on 01736 758812 or call your GP.

Nerve damage

In rare cases, surgery can cause damage to the nerves around the hip joint including injury, stretching or cutting.

You’ll also need to attend our joint school before your operation. It’s an educational session that will help you prepare for your surgery and learn more about what to expect.

It’s a session run by the clinical team to help you prepare and learn more about your joint replacement surgery. We recommend attending joint school a few weeks before your operation.

We’ll book your joint school session when we arrange your surgery date.

During the session you’ll meet other hip or knee replacement patients. You’re welcome to bring a relative or carer with you so that they can support you at home after your operation.

What are the benefits?

You’ll find out what to expect and how to maximise your recovery. It will help you leave hospital more quickly after your operation.

You should attend joint school even if you have already had hip or knee replacement surgery.

What will happen?

The clinical team will explain what will happen before, during and after your stay in hospital. It’s really important that you understand what to expect and how to recover so please ask as many questions as you need to.

What will I learn?

You’ll learn exercises that will help speed up your recovery. If they’re not too painful, you should start them before your operation to help strengthen your muscles.

You’ll find out how to use crutches, especially on stairs so that you can move confidently when you return home.

We’ll also show you how to manage everyday tasks including:

• getting dressed
• getting in and out of bed
• getting in and out of a car.

You’ll find out how to do these tasks without bending or twisting. It’s important to familiarise yourself with these new techniques before your operation so that you can speed up and maximise your recovery time.

Tell us about your experience at joint school

Your feedback is really important to us. Ask your care team for a ‘friends and family form’ at the end of your joint school session, or you can fill it in online. In the box labelled ‘ward’, scroll down and choose ‘SMH Joint School.’

It’s important to plan your discharge from the hospital before surgery to prevent any delays in getting home.

• crutches
• operation booklet
• loose night and day wear.

We’ll give you the relevant equipment before your admission to hospital.

Preparing for enhanced recovery after surgery

The rapid recovery programme helps you prepare for your surgery, recover more quickly and let you get back to normal life and activities as soon as possible.

Watch this introductory video which explains what to expect from the rapid recovery programme for joint replacement.

Watch the following videos which will help you prepare for your surgery:

• getting fit for your operation and managing your lifestyle
• how to make preparations at home before your surgery

Before your stay in hospital

We’ll send you an admission letter. It will tell you:

• what you need to bring with you
• what you need to do before you leave for hospital
• which ward you need to go to
• what happens when you arrive.

We’ll also send you a booklet about your operation, and any mobility aids you may need when you return home (such as a long-handled grabber and shoe horn for total hip replacements).

You can find out more about what you need to know before your stay in hospital.

Regular medication

When you come in for your operation, please bring in all of your regular medications in their original boxes. If you usually have blister packs, please ask your GP or local pharmacy to have the medicines in boxes for your hospital admission.

How long will I stay in hospital?

You should be able to go home 1 to 3 days after your operation.

Where do I need to go for my surgery?

Your hip or knee replacement surgery will take place at St Michael’s Hospital in Hayle or Royal Cornwall Hospital in Truro. You admissions letter will tell you where to go.

Your operation

Your joint replacement surgery usually takes around 1 to 2 hours under a spinal and light sedation. After the operation, you’ll wake up in the recovery area before being moved to the orthopaedic ward.

What happens after my operation?

You’ll be encouraged to move around as soon as possible on the day of your operation to prevent DVT and maximise your recovery.

We will encourage you to wash and dress almost straight after surgery and you will be encouraged to do this independently where possible.

You will need to have an X-ray and a blood test before you go home.

A physiotherapist will make sure you can walk, climb stairs (where appropriate) and can do your exercises independently.

An occupational therapist will discuss your home circumstances with you to make sure you can manage and have enough support in place. They will give you any equipment you need.

Find out more about what happens during your stay in hospital

Watch this video about what happens during your stay in hospital.

Pain Relief and Medication

We recommend taking Paracetamol and a weak opiate to help with any pain you may have after your operation. We will give you a small amount for you to take home. If you already take regular pain relief at home we may advise to continue with what you have. Each patient will experience pain differently and we will make sure you are given the most appropriate pain relief.

You are also likely to be given a blood thinner to prevent a blood clot from forming. This may be a tablet or injection and depending on the type of surgery you have had. You’ll need it for between 2 and 6 weeks. If you already take a blood thinner we will assess the best options for you individually.

Moving around

During the first 6 weeks after your hip or knee replacement surgery, you must take extra care with your new joint and follow advice from our clinical team.

Crutches

You’ll need to use crutches to help you walk for around 6 weeks after your operation.

Sexual Intercourse

Please discuss this with your surgeon or therapist as it will be different for everyone.

6 to 12 week follow-up appointment

You’ll see your consultant or a member of their team 6 to 12 weeks after your surgery. You will normally have an X-ray which we’ll review at this appointment. If the consultant is happy with your X-ray, you will not usually need any further follow up.

Your surgeon will also talk to you about returning to:

• driving
• household chores
• hobbies and leisure activity
• work and employment

You will not need to see a physiotherapist or occupational therapist after you leave hospital. If you need more support, we will assess this based on your individual needs.

Find out more about what to expect when you leave hospital and how to access help if you need it when you return home.

Feeling low after your joint replacement

It’s common for people to experience depression after joint replacement surgery. It is really normal to feel low at times, but if these symptoms become severe or go on for a long time, please talk to your GP.

Who can I call for advice about my knee or hip replacement surgery?

For concerns about your knee or hip replacement and signs of infection after your operation, please call St Joseph’s Ward at St Michael’s Hospital on 01736 758812.

Your information and privacy

We recognise the importance of protecting personal and confidential information in all that we do, and take care to meet our legal and other duties. Find out more about our approach to privacy and data protection.

Consent

You are in control of your treatment and care. We are committed to the principle of ‘no decision about me without me’, so please feel free to ask any questions at any time about your consent to treatment and care.
Find out more about what consent means.

Read the National Institute for Health and Care Excellence (NICE) guideline which covers care before, during and after a planned knee, hip or shoulder replacement.

Urgent, Emergency and Trauma Care Group

Clinical Director

Mike Butler

Specialty Lead

Shaun Sexton

Governance Lead

Palakkad Easwarran

General Manager

Jo Floyd

Trauma Lead Manager

Janine Webster

Matron

Kate Schroeder Hockey

Fracture Clinic Sister

Anita Beckerleg

Elective Orthopaedics at St Michael’s Hospital

Clinical Director

Governance Lead

Sean Dixon

Manager – St Michael’s Hospital

Chloe Parr

Matron – St Michael’s Hospital

Nicola Goddard

Clinical Admin Lead

Kate Ford

Other useful numbers

Fracture Clinic

01872 253091

Plaster Room

01872 253234

For concerns or questions about boots, braces and splints

01872 252880