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Orthopaedic Surgical
Procedure Techniques |
"South Africa has an excellent medical reputation and the recuperation accommodation is a big plus as well."
Susan, Boston, USA
Information by Dr Glen Vardi
Edited for the website by Lorraine Melvill
Total Knee and Hip Replacement
Patient Information Sheet
What to expect pre-operatively
Consultation with 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 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 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 Surgery:
- Admission to private hospital
- No eating or drinking from midnight onwards
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 following the operation.
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 longer.
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.
Dr Mark Ferguson – Knees, Shoulders and Sport
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