Joint Replacement Surgery

Knee replacement surgery is usually necessary when the joint is worn or damaged, making it difficult to carry out normal daily activities and causing severe pain even when resting.

You may need a replacement if:

• you are in regular pain which makes it difficult to carry out every day activities, or is having a disabling effect on your ability to move normally,
• you cannot walk very far or find stairs difficult and require the use of a stick, and
• your knee is becoming stiff and cannot bend easily or without causing pain.

If you are suffering from these symptoms, we would advise you to contact your GP in the first instance, who may refer you to an Orthopaedic Surgeon to discuss possible treatment options.
 
In knee replacement surgery, the damaged knee joint is removed and replaced with an artificial joint (also known as a prosthesis) made of a metal alloy or ceramic. The full surgery usually takes between 45 and 90 minutes to complete. 

The Orthopaedic Pre-Operative Assessment Clinic is run by experienced nurses and healthcare assistants. 

The aim of the clinic is to determine if you are medically fit to undergo surgery. The full process will usually take two-three hours. We aim to have everything done in one visit, but some patients may have to come back another day.

Bring all medication that you are taking in its original packaging.

You will receive a comprehensive education, exercise and advice booklet. You should read your booklet and begin the exercises and healthy living advice before your operation. 

You will be seen by:

• Nurse – The nurse will examine you and ask you questions about your medical history, they will also take blood samples and start the paperwork that will follow you through your journey as a patient.
• Occupational Therapist – The Occupational Therapist will discuss and advise you on how you will manage everyday activities, including washing, dressing, getting around, bathing, preparing and eating meals, and any other enquiries you may have. They will assess your individual needs to determine any equipment requirements and arrange for them to be delivered to your home, to make sure they are ready for you to discharge.
• Anaesthetist – You may also see an anaesthetist, who will explain anaesthetic and pain relief choices available to you.

You will attend:

• Joint School – This is a group session with other patients having hip or knee surgery that is aimed towards educating you about the process of your surgery and how you can be actively involved in your recovery.

You may be required to undergo the following tests:

• Blood tests – It may be necessary for the team to perform blood tests during your visit. This may include a full blood count, clotting tests and kidney function tests. This can tell us what is normal for you and identify any conditions, such as anaemia, that may need corrected before surgery.
• X-ray –​​​​​​​ We may need to get an up to date X-ray of your Knee when you come to clinic.
• Urine test: The team may require a urine test to screen for infection. If positive, a course of treatment will be given and you will be re-tested again before surgery. Infections can delay your operation and it is important to get them treated.
• MRSA and Carbapenemase-producing Enterobacteriaceae (CPE) tests – Infections can delay your operation and it is important to get them treated.  If positive, a course of treatment will be given and you will be re-tested again before surgery. 
• ECG –​​​​​​ You may undergo an ECG: this is used to detect problems with the heart such as abnormal heart rhythm. This may need to be carried out before your operation if you are over 60 with chest pain or a history of heart disease and are undergoing major surgery.

Our Orthopaedic Wards are 4 East and 2 West.

Some patients are admitted to the ward the day before surgery and some are admitted to 4 West and the Surgical Day Unit on the day of surgery. Your letter will tell you what time to come in and where you will be admitted.

The discharge planning process begins at the pre-operative clinic. We will ask about your home circumstances and transport arrangements at clinic and again when you come in for your operation. After you have been to clinic this is a good time to start planning who will help at home and who will take you to and from the hospital.

The occupational therapists will assess what equipment and aids you may need at home and arrangements can be made to ensure this is delivered to your home before you are discharged from hospital.

When you have met the discharge criteria found in your patient booklet, for example, you have achieved your therapy goals and have adequate pain control you will be discharged home. Patients normally go home two to three days after their operation, however please be aware that your stay may be extended: patients will only be permitted to discharge home when it is safe for them to do so.

All necessary medication will be given to you before you go home.

At home it is important that you continue with all the exercises and precautions given by the physiotherapists and occupational therapists. This will help you get back to fitness and get the best from your new joint.

Your booklet is also a good resource to help you remember your exercises and precautions. Your booklet contains a helpful frequently asked question section that may answer any questions or worries you have when you get home.

A member of the Arthroplasty Outcome Team (AOT) will contact you 10-14 days after the operation. 

You can contact them directly if you are experiencing any problems:

• Arthroplasty Outcomes Team Helpline: 0141 951 5521
• Out of hours (urgent): call switchboard on 0141 951 5000 and ask for page 0257

You will be seen by a member of the Arthroplasty Outcome Team to review your new joint. You will either attend in person at the Golden Jubilee National Hospital or remotely via secure video link:

• Hip replacement patients: 12 weeks after your surgery. 
• Knee replacement review: Six weeks after your surgery.

You will attend the GP practice nurse, or a district nurse may visit you, approximately 10-14 days after the operation to remove sutures or staples.