Total hip or knee replacement

 

What to expect 

Consultation with Dr Verrier (orthopaedic surgeon):

Thorough history and clinical examination, focussing on the affected joint/s

Discussion about the cause of the joint disease and the proposed surgery

Explanation of the surgery that will be performed, including the following:

                        Anaesthetic

Surgical procedure

Potential complications or difficulties

Post-operative course expected

Xrays of the relevant joints

Signing of informed consent form

You will be provided with an information booklet regarding hip/knee replacement

Consultation with Dr Arnold (physician):

Thorough history and clinical examination, focussing on overall medical condition

General examination ie. blood pressure, ECG to assess cardiac function, chest XR

Blood tests- full blood count, electrolytes, glucose, others as required

Blood crossmatch if transfusion may be necessary

Consultation with Dr vd Merwe (anaesthetist):

Again thorough history and clinical examination and review of medical records

Assessment for fitness for surgery

Discussion regarding specifics of the anaesthetic to be given

Day before surgery:

Admission to Knysna private hospital the evening before the operation

Administration of first injection to thin the blood

No eating or drinking from midnight onwards

Day of operation:

Tablet given at around 6am (premed) to relax you prior to surgery

Taken to theatre complex at around 7am

Spinal and epidural anaesthetic administered by Dr vd Merwe

Operation performed at around 8am

 

What to expect post-operatively

You will sleep during the operation, but will not be fully anaesthetised

You will not feel any pain owing to the spinal anaesthetic

For a knee replacement you will lie on your back for the operation

For a hip replacement you will lie on your side for the operation

 

When the operation is completed you will be taken to the intensive care unit for observation overnight

You will have one-on-one nursing from a qualified intensive care sister

You will be fully awake and able to sit up partially to eat or drink

You will not have any pain owing to the epidural catheter, which will be left in place for 3 days

There will be many tubes and cables all around you, which may startle you somewhat. They are

routine and mostly serve for observation purposes. They include the following:

             A drip which will be running clear fluids into a vein on your arm

            An oxygen saturation monitor connected to your finger tip

            A blood pressure cuff around your upper arm, which inflates periodically

            A suction drain arising from the operated site, which drains any excess blood from the wound

            A pair of white below-knee stockings

            A pair of blue “booties”, which also inflate periodically

            A urinary catheter, which drains the urine from your bladder

            A thin epidural catheter, which will be stuck down to the skin on your back

           

            For hip replacements- a triangular pillow between your legs to keep them apart

            For knee replacements- the operated leg will be on a continuous passive motion machine,   which continually and slowly bends and straightens your operated knee

You will spend one night in intensive care, and will then be transferred back to the ward. In both the ICU and the ward you will have a physiotherapist who works with you at least twice daily. They work with your lungs as well as your limbs. They will get you to stand up after 24 hours, and to start walking after 48 hours. Initially you will need the aid of a Zimmer walking frame, and later a pair of crutches. You will be assisted with walking, stair-climbing, toilet and getting into and out of bed.

Over the week following surgery you will progressively be freed of the tubes and cables until you are totally independent from them. By the time you are discharged from hospital (mostly about one week), you will be able to function independently in terms of dressing, walking, going to the toilet and getting into and out of bed. You will be advised to use crutches for 6 weeks following the operation.

Following discharge you will have to leave your dressings untouched until I open them after 2 weeks. They need to be kept clean and dry (bed-bathing only). At the 2 week consultation I remove the dressings and check that the wound has healed well. I use absorbable sutures, which do not need removal. The thrombo-elastic stockings need to be worn continually for 2 weeks.

You will be provided with a raised toilet seat and your bed will be raised for you. This you need to continue for 3 months. The injections to thin your blood need to be continued for one month following surgery. You should have little or no pain by the time you are discharged. You will, however, be provided with adequate analgesia if required.

Most patients following total hip replacement experience very little or no pain from about day 5 onwards, and most patients are able to walk normally after only about 2 weeks. I still recommend using crutches for 6 weeks.

Most patients following total knee replacement take some time to settle down. The biomechanics of the artificial knee are not the same as the old knee, and most patients take about 6 months until they are completely pain free and happy.