Patient Information & Support

To give yourself the best chance of a smooth recovery, it is important to prepare well before your operation.

• Stay active with light exercise to maintain strength and mobility
• If you smoke, stopping before surgery reduces lung and circulation risks
• Eat a balanced diet and try to maintain a healthy weight
• Make sure your teeth are healthy — infections in your teeth can increase the risk of joint infection
• If you are overweight, ask your GP for advice on safe weight reduction
• Prepare your home: remove loose rugs, ensure stairs have rails, and place frequently used items at waist level
• Consider arranging help with shopping, cooking and household chores for the first few weeks after surgery

An excellent guide to preparing for surgery is the Active Wait programme, set up following a successful collaboration between Sheffield Teaching Hospitals and the University of Sheffield. While recruitment into the original study has closed, the 12-week programme remains the gold standard of preparation before surgery: view the Active Wait guide →

You will be invited to a pre-operative assessment clinic before your surgery, to ensure you are fit and well enough for your operation.

Tests may include:

• Blood and urine tests
• ECG (heart tracing)
• Chest X-ray
• MRSA screening swabs

Most patients are admitted on the day of surgery. Please follow the fasting instructions you are given:

• No solid food for 6 hours before surgery
• Clear fluids (such as water) until 2 hours before surgery — once in hospital, the nursing team will explain if you may continue drinking clear fluids closer to the time of surgery

On the day:

• Have a bath or shower before you come in
• Remove jewellery, make-up, nail varnish and contact lenses
• Wear loose, comfortable clothing
• You will meet your surgeon, anaesthetist and nursing team before the operation

Hip or knee replacement surgery usually takes 1–2 hours.

Most patients have a spinal anaesthetic — you are awake but numb from the waist down — which may be accompanied by sedation; the level of sedation can be discussed with your anaesthetist. Andrew's experience is that most patients initially expect to want heavy sedation, but in practice most have very limited or no sedation once in theatre. Dr Stuart Smith is the anaesthetist Andrew regularly works with, and can explain the steps of the surgery and describe progress as it happens, should you wish.

The alternative to a spinal anaesthetic is a general anaesthetic, where you are asleep. Your anaesthetist will discuss the best option for you.

To supplement pain relief after the operation, injections are given into the operative area during surgery, which may include local anaesthetic agents, anti-bleeding agents and analgesics. For a total knee replacement, you may also receive local nerve blocks that specifically target pain nerves without affecting the muscles, helping to enhance recovery.

After your operation you will be taken to the recovery room, where your blood pressure, pulse, breathing and wound will be closely monitored.

You may have:

• A drip for fluids
• Oxygen through a mask or nasal tubes
• Support stockings and blood-thinning injections to help prevent blood clots

Pain relief is given regularly — please let the nursing team know if you are in discomfort.

Early movement is vital to your recovery. Most patients will get out of bed with physiotherapy support on the same day as surgery.

• You will be taught exercises to strengthen your muscles and improve movement
• You may use crutches or a walking frame at first
• For hip surgery, avoid sudden or extreme movements and follow any hip precautions you are given
• For knee surgery, regular exercises are important to avoid stiffness and improve bending and straightening

Your physiotherapist will give you a booklet of exercises — please continue these at home.

Andrew is a strong advocate of daycase surgery, which may be an option you are willing to consider. Daycase surgery can offer the advantages of early mobilisation — helping you return to your normal activities and reducing the length of your hospital stay, which in turn can lower the risk of complications including blood clots and infection. Many patients also welcome their own bed and surroundings on the night of surgery. The painkillers you receive on discharge are the same as those given in hospital, and the ward and senior team are available 24 hours a day should you have questions once home.

The decision to plan for daycase surgery is discussed at your outpatient visit. However, on the day of surgery, three criteria need to be met for you to go home the same day: the nursing and ward medical staff must be satisfied you are medically fit for discharge, the physiotherapists must be satisfied you are safe for discharge, and — most importantly — you yourself must feel confident this is the right decision. There is no pressure to be a daycase patient, and if you are not, you will usually be discharged the following day, once it is safe to do so.

Before going home, you will be given:

• A supply of pain relief medication
• Blood-thinning medication, usually for 10–30 days depending on which joint has been replaced
• Instructions on wound care
• A combined wound check and physiotherapy appointment, usually 2 weeks after surgery
• An outpatient appointment, usually 8 weeks after surgery

Tips for home:

• Arrange transport home — you will not be fit to drive
• Have meals prepared or stocked in advance
• Use chairs with arms and avoid low seating
• Aids such as raised toilet seats or long-handled sponges are not mandatory, but may help — especially if your toilet seat at home is low

Recovery time varies, but most people are mobile with sticks within 2–6 weeks. Building up full stamina may take 6–12 months.

• Driving: there is no fixed time limit in UK law. You can drive once you are safe and in control of the vehicle, able to perform an emergency stop, and not impaired by pain, weakness or medication.
• Work: office-based work may be possible after 6–8 weeks; heavy manual work may take longer.
• Sport: walking, swimming and cycling are encouraged; avoid high-impact sports unless cleared by Andrew or your physiotherapist.
• Flying: avoid flights for 6–12 weeks after surgery due to blood clot risk — as a general rule, short-haul flights are possible from around 6 weeks, and longer-haul flights from around 12 weeks.

All surgery carries risks, and these will have been discussed with you at your outpatient clinic appointments.

Early possible complications include:

• Wound infection (redness, swelling, discharge, fever)
• Blood clots (pain or swelling in the calf, sudden breathlessness)
• Joint stiffness or dislocation (especially after hip surgery)
• Slow wound healing (more common in smokers and people with diabetes)

Andrew and the team at Spire take great pride in their standard of care. If you experience any of the above, please contact the hospital team directly as your first point of call — they are experienced in triaging these rare complications and will direct you to the most appropriate and safe care, which may include contacting your GP or attending A&E if needed.

You will be reviewed in clinic around 8 weeks after surgery. Your physiotherapist and consultant will monitor your progress and adjust your rehabilitation plan as needed. Clinical Nurse Specialists are also available for advice during your recovery — their contact details will be given to you on discharge.

Will I need a raised toilet seat?

Sometimes recommended after a hip replacement, though it isn't needed by everyone.

Can I kneel after a knee replacement?

It may be uncomfortable at first — wait several months and try using a cushion.

Can I have sex after surgery?

Yes, once comfortable. If you have had a hip replacement, avoid extreme hip positions in the early stages.

How long will swelling last?

Several weeks for knees, and sometimes months after a hip replacement.

Is hip or knee replacement major surgery?

Yes, but outcomes are very successful for most patients.

There are many websites offering advice and guidance on hip and knee replacement surgery. Andrew's patients have found the following useful, including his own National Joint Registry surgeon profile (final link):

• Sheffield Aches and Pains — Patients ↗
• Sheffield Orthopaedics Ltd ↗
• Patient Information — British Hip Society ↗
• Hip replacement — NHS ↗
• Knee replacement — NHS ↗
• Supporting Patients — NEC ODEP ↗
• Mr Gordon's NJR Surgeon Profile ↗