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Hip/Knee Replacements

If you have been advised by the medical team caring for you that you may benefit from having a hip or knee replacement then the following information and associated links will help ensure you are as prepared as you can be for your surgery and recovery.

Most total hip and knee replacements take place at Glasgow Royal Infirmary. If you are having a Uni-compartmental knee replacement (‘Half-knee’) then you may be advised that you can have your operation carried out at Stobhill hospital if the surgeon feels this would be appropriate for you. If this applies to you then please follow the Stobhill Hospital information where relevant. 

[ Given the current unprecedented pressures on our NHS and orthopaedic services at Glasgow Royal Infirmary, we would like to offer you the possibility of remote support via the NHS Joint School App for detailed information on your condition, planned procedure and ways of managing your symptoms whilst awaiting your surgery.]

Your Joint Replacement Pathway

Pre-Op Assessment

You will be invited to attend the pre-operative assessment clinic before your operation. You will meet one of the specialist nurses who will ask you questions about your health and arrange appropriate tests such as blood tests and an ECG (heart tracing).

If any issues are identified that may require further investigation or advice the pre-assessment nurses will then speak to an Anaesthetist. You will be advised of any changes or further tests following this and may be asked to come back for a second appointment to meet an Anaesthetist in clinic. This is generally to explore your health further and discuss the anaesthetic options or risks in more detail. Occasionally an issue is identified that warrants further investigation or treatment before you proceed to surgery. If this is the case the nursing staff will explain what is required and how to let them know when this has been done and you are ready to move forward to surgery.

This process is designed to make sure you are as physically ready for surgery as possible and also gives you information about what to expect so you can take time to think about whether you still want to go ahead.

Please bring your medication with you to the pre-operative assessment clinic or a complete list of these with your prescription. Most medications should be taken as normal up to and including on the morning of surgery. There are a few specific medications that may need to be stopped prior to surgery or not taken on the morning of surgery. These are usually ‘blood thinning’ medications such as clopidogrel, warfarin, and aspirin. Your pre-operative assessment nurse will give you specific instructions.

Download our specific Covid related Pre-Op Self-Isolation Advice leaflet here

Preparing for Your Surgery

If you can improve your general fitness, strength and well-being prior to surgery you will find that your recovery is easier and quicker. It may also reduce the risk of complications. A hip or knee replacement is a major surgical procedure that places physical demands on your body during the surgery and anaesthetic and during the healing process. It also requires effort on your part to recover well and get maximum benefit from your new joint such as performing regular physiotherapy-guided exercises. 

Watch the video to see what you can do to prepare for surgery.

Click here for more videos on how to improve your fitness before and after surgery.

If you are Overweight

Reducing your weight will reduce many of the risks of having an anaesthetic. Importantly, it will also reduce the load carried by your hip or knee and can reduce the pain in the joint even prior to surgery. It will make your recovery and physiotherapy easier after surgery too. There are multiple sources of information and local groups to help you learn about healthy eating and lose weight.

The NHS inform website can provide a useful starting point (https://www.nhsinform.scot/healthy-living/food-and-nutrition). Your local GP surgery may be able to point you in the direction of nearby groups or services if you wish.

If you Smoke

Giving up smoking as far in advance of the surgery as possible will reduce the risk of breathing problems both during and after your anaesthetic and reduce the risk of problems such as a chest infections. If you need help or advice with this from a trained advisor please contact Quit Your Way on 0800 84 84 84. Lines are open Monday to Friday 8.00am until 10.00pm and Saturday to Sunday 9.00am until 5.00pm. You can also visit the Quit Your Way website to find a local Quit Your Way Pharmacy Service.

Eating and Drinking the day before surgery

Please follow the advice below.

Note: ‘Clear fluids’ includes water, black tea or black coffee (no milk).

If you are asked to come to the hospital for morning surgery

Eat your evening meal as normal on the day before surgery
Have a snack in the evening if you want
Do not eat anything after midnight
Drink only clear fluids after midnight
Drink clear fluids when you are thirsty until 0600
Have a drink of around 300ml of clear fluid at 0600 to help stop you getting thirsty and improve your comfort while you wait.
If you are asked to come to the hospital for afternoon surgery

Have a light breakfast before 0700 on the day of surgery to keep you feeling comfortable during the day ahead
Do not eat anything after 0700
Drink clear fluids when you are thirsty until 1100
Have a drink of around 300ml of clear fluid at 1100 to help stop you getting thirsty and improve your comfort while you wait.
The exact time of your surgery may not be confirmed until on the day as you will be part of a theatre list with other patients. We ask more than one patient to arrive for the start of the day to help ensure flexibility if there are last minute changes and to allow the theatre staff to see you before the surgical session begins. If there will be time for you to have a further drink of clear fluid on arrival at hospital the nursing team will be able to advise you of this on the day.

Your Anaesthetic for Joint Replacement Surgery

Anaesthesia allows you to be pain free and comfortable during your operation. In some cases, especially knee replacement surgery, your anaesthetist may place a longer lasting local anaesthetic around other nerves in your leg to help reduce the discomfort for a little longer after surgery. This is known as a “nerve block”. They will discuss this with you on the day of your operation.

There are occasions where, for medical or surgical reasons, a spinal anaesthetic is not suitable and your anaesthetist will be able to discuss the options with you. This often includes a general anaesthetic. Your preferences as to the type of anaesthetic you receive are also important so please take the time to consider these and ask your anaesthetist for advice. In some instances you may be asked to attend the hospital specifically to see an anaesthetist if the specialist nursing staff in the pre-operative assessment clinic feel this would be of benefit to you. In most cases you will meet your anaesthetist on the day of surgery.

You can download this patient information leaflet – Anaesthesia: What you need to know and watch this short video by your anaesthetist.

Your Anaesthetist

For further information https://www.nhsggc.org.uk/your-health/health-services/orthopaedics/anaesthesia/

Enhanced Recovery After Surgery [ERAS]

The ‘Enhanced Recovery After Surgery Programme’ simply refers to the processes that are in place to ensure you are prepared for your surgery and receive the care required to get you back to the comfort of your own home as quickly as possible.

Evidence tells us that a huge part of improving a patient’s recovery after surgery is making sure they have a good understanding of what to expect before coming into hospital. This website together with information leaflets and appointments with the staff in the hospital are all opportunities to find out about what will happen when you come into hospital and how to prepare.

The operation itself and healing process place high physical demands on your body. In the weeks and months before your operation you can take actions to improve your health and fitness in preparation for surgery. If you do this then you will be back to your normal self much more quickly and hopefully gaining the benefits of your new hip or knee as soon as possible.

We also aim to make sure all patients get the same high level of care during their anaesthetic and surgery and afterwards on the ward so we can get you back on your feet as soon as possible. Getting out of bed with the help of the physiotherapists and nursing staff soon after surgery, eating and drinking normally, getting dressed into your own clothes and getting home as soon as possible have all been shown to get your recovery off to the best possible start and do not increase the risk of any complications.

Evidence tells us that the sooner you can get your new hip or knee moving and back on your feet the better the result from your surgery. It also helps reduce the discomfort in your new joint. We will ensure you have plenty of medication available to help ease the pain when you need it. In most cases the discomfort significantly improves after only a few days.

You will be told how long your hospital stay is likely to be when you come into hospital so you know what to expect. The planned duration of stay will vary depending on the specifics of your operation and which hospital you are attending. You will be assessed regularly after your surgery to check how you are progressing and to monitor for any complications. You will be discharged home when you are ready even if this is earlier than the planned date. If you need a little more help don’t worry, you will not be discharged until you are ready.

Click here (https://www.nhsggc.org.uk/your-health/health-services/orthopaedics/hipknee-replacements/exercise/) for some videos on how to improve your fitness before and after surgery