Prior to surgery you may be asked to make some lifestyle changes to reduce the risk of complications. If you smoke, you will need to stop smoking as it can increase the risk of infection and slow your recovery. If you are overweight, losing weight could help to reduce strain on your new joint and reduce the risk of complications.
Joint replacement is a major surgical procedure and you will undergo extensive tests to ensure you are well enough. These include blood tests, urine tests, X-rays and an electrocardiogram to check the health of your heart. You may need to make some simple adaptations to your home prior to surgery, such as removing trip hazards and ensuring you have appropriate chairs to avoid putting strain on your new joint.
Knee and hip replacement surgery is generally performed under general anaesthetic, which means you will be asleep throughout the procedure, or you may be given an epidural which numbs you from the waist down. If you have a general anaesthetic, you will not be able to eat or drink for several hours beforehand.
In hip replacement surgery, an incision of around 20-30cm is made along your hip and thigh. The surgeon will cut away worn parts of the joint and position an artificial implant in its place. The ball at the top of your thighbone will be removed and an artificial one on a stem attached to the bone. The implant may either be fixed in place with bone cement or it may be left uncemented and given a special coating to encourage new bone to grow around it. The incision will then be closed with stitches or clips and covered with a dressing. In some cases, it may be possible to have keyhole hip replacement surgery. Your surgeon will discuss this with you as it is not suitable for everyone.
There are two types of knee replacement – total and partial. In partial knee replacements, only part of the knee is damaged (normally the inside) and will be replaced with an artificial implant. Most knee replacements are either carried out under general anaesthetic or epidural which numbs you from the waist down. An incision is made down the front of the knee and the damaged sections are cut away. The artificial joint is inserted and the surfaces of the thigh and shinbones are shaped around it. In some cases, an artificial kneecap may be fitted (patellar resurfacing). The incision is closed with stitches or clips.
Immediately after surgery you will be moved to the recovery area and monitored while you recover from the anaesthetic. A physiotherapist will normally visit you after your operation and recommend exercises to build strength and flexibility in your new joint. You will normally stay in hospital for four to eight days.
During hip or knee revision replacement, the artificial joint will be removed and the surgeon may need to reconstruct some of the surrounding bone, which can make this a more lengthy surgical procedure.