Fast track hip and knee replacements

Welcome to our evidence-based approach to lower limb joint replacement. We want to enhance your experience with us, but also make your surgery as safe as we can for you. Please do ask any questions or voice any concerns that you may have when you see Miss Gill in clinic.

Before your surgery

All patients undergoing joint replacement will have a pre-op assessment performed by our specialist nurses. During this visit you may be seen by a physiotherapist and an occupational therapist, whilst a pharmacist will make sure that all of your regular medicines are accurately prescribed ready for your admission.

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On the day of surgery

You can drink water up to 2 hours before your admission time.

We will provide you with a warming jacket or blanket to help prevent heat loss before surgery, this has many benefits, including reduction in infection rates and helping to prevent clotting or bleeding problems during surgery.

You will walk from the ward to the anaesthetic room, where the anaesthetist will perform a spinal anaesthetic, this involves a single injection into your back which will make your legs feel numb. Traditionally this injection has used morphine, which can make you feel sick, dizzy and, in some cases, itchy in the post-operative period. We will plan to avoid using morphine in your anaesthetic. You may then be given a sedative to make you sleepy.

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Surgery

The surgical procedure is unchanged. At the end of surgery Miss Gill will inject local anaesthetic into the wound along with a drug called tranexamic acid, which will help to reduce bleeding at your operation site.

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In the theatre recovery area

From theatre you will be taken to the recovery area where you will be given a high calorie drink before being transferred back to the ward.

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On the ward

Once back on the ward you will be dressed in your own, loose fitting clothes. The spinal anaesthetic should wear off within 2-3 hours of your surgery, once this has happened and you have full use of your legs the physio team will get you out of bed and walk you a short distance with a walking frame before sitting you in a chair. The first time you get up you may feel a little light headed but this should pass fairly quickly.

If you are having a knee replacement a cold cuff will be placed on your knee.

Once you have been up for the first time, we would like you to get up and walk a short distance every 45-60 mins to prevent stiffening, this will help to reduce your pain. The nursing staff will walk with you initially, but most people find they are confident to walk on their own with the frame quite quickly.

If your surgery is in the morning you may progress from a frame to crutches during the day. Some patients will be safe to go home in the evening on the day of their surgery. Most people are safe to be discharged on the day after surgery. We would ask that someone stays with you overnight on the day of discharge.

The day after surgery you will feel a bit stiffer, this is normal and will ease with gentle mobilisation.

After discharge

You will be given pain killers to take home. You will also be given up to 28 days of blood thinners to help prevent blood clots.

One of the team will call you 24-48 hours after your discharge to make sure you are getting on alright.

It is normal for you to develop bruising and some swelling, which can cause increased stiffness, in the week after your surgery.

If you have any concerns after going home, please contact the ward who will be able to help you, or contact Miss Gill and her team.

Stitches or clips are removed 2 weeks after surgery.

A post operative check X-ray will normally be requested in the outpatient department at 6-8 weeks after your procedure.