Pre-Admission Clinic

The purpose of this visit is to ensure you are fit for surgery and have all the necessary information you need to prepare for surgery and therefore assist your recovery.  This visit could take up to three hours and will involve assessment from nursing and medical staff.  You will have your blood pressure, ECG, urine, blood test as well as an x-ray.  You may be assessed by other members of the team, such as the occupational therapist.

Arthroplasty preparation session

Once you are placed on the waiting list for surgery you will be invited to attend a group preparation class which will last about an hour.  During this time you will be provided with in depth information about your forthcoming hospital stay.  Any questions or concerns can be answered at this stage.  You will be given an patient notebook which is your to keep and read at your leisure. This will reinforce any information given about your care.  During this session you will meet the ward physiotherapist and be provided with simple muscle strengthening exercises.

Your hospital stay

Most patients except in certain circumstances come into hospital the day of surgery.

You should contact the ward on the eve of your surgery to confirm bed availability, the ward staff should inform you that you should arrive on the ward between 7.30am-8am  Please ask the ward staff what time you should have nothing to eat or drink from (usually midnight).

For patients having a hip replacement it is anticipated you will need to stay in hospital five to seven days.  You will need to ensure that you have transport to bring you into hospital and also to take you home when discharged.  It will help if possible to ensure you make any necessary arrangements regarding help at home on discharge.

On the day of surgery

• Have a bath or shower using anti bacterial soap
• Do not wear any make-up, deodorant, perfume, lotion, talc, nail varnish or jewellery, however a wedding ring is accepted.
• Do not bring any valuables or large amounts of cash, credit cards etc, as we cannot ensure their safety
• Do bring a 14 day supply of your regular prescribed medications with you but leave any ‘controlled drugs’ for example morphine at home.
• You will also need nightwear, toiletries, and a change of comfortable clothes and suitable footwear.  (Patients wear normal outdoor clothing whilst in hospital and recovering from surgery).

On the ward

• When you arrive on the ward you will be asked to wait in the day room until one of the nurses can show you to your bed.
• You will be asked to change into a gown and the nurse will check that you are correctly prepared for your operation.

On return from surgery

• When you return from theatre you will have an intravenous drip and may have patient controlled analgesia (PCA) along with oxygen.
• You may also have drains inserted at the site of surgery these will remain in place for the first 24 hours; your limb may feel numb and heavy if your anaesthetist has chosen to provide you with a nerve block.  You will be wearing impulse boots which will help assist your circulation and help prevent the development of blood clots.
• Nurses will check your recovery and you will be allowed to start drinking small amounts of water.  A light diet may be offered if the nursing staff feel you have recovered from the anaesthetic.
• You will remain in bed for the rest of the day and you will be helped to change position regularly.

Day 1

• Your drains will be removed and a lighter dressing applied. If you have a PCA will be stopped along with your oxygen.  Oral pain relief will be prescribed.
• If you are able to drink then your intravenous drip will also be taken down.  You will be taken to x ray on your bed and you will be assisted out of bed once your x-ray has been checked, by either a nurse or physiotherapist.  You will be instructed about the type of exercises to do (see attached exercises at rear of booklet).
• Once out of bed you will no longer require your pulsation boots and will be fitted with knee high elasticised stockings
• All patients having joint replacement surgery will receive intravenous antibiotics as a precautionary measure.  Once the course is given your cannula will be removed

Days 2 to 3

• Over the next couple of days your physiotherapy will continue and you will progress from Zimmer frame to elbow crutches and possibly walking sticks.
• You will be encouraged to start wearing comfortable loose fitting clothes.  Your elasticised stockings will be changed every other day and your legs will be washed, you will be supplied with a spare pair of stockings to allow one pair to be washed.
• You will be allowed to have a shower as your wound will be covered with a waterproof dressing and will remain undisturbed as far as possible to prevent contamination.
• You will start to practise bed transfers today with the assistance fro the physiotherapist.

Days 4 to 7

• You may well be ready to leave hospital following assessment from nursing and physiotherapy staff.  You may have to demonstrate your ability to manage the stairs.
• The physiotherapist will practise car transfers with you to ensure your safety.
• If your wound is clean and dry and you have reached the desired goals and your consultant is happy with your progress you will be allowed home. It is hoped that where possible you have transport home with the necessary support you require at home.
• You will be provided with pain relief to take with you.  A district nurse will be contacted to remove your clips two weeks following surgery.
• All equipment such as a toilet seat raise should already be in place ready for your discharge.

Day of discharge

Everything should now be organized for your safe discharge.  You may be asked to vacate your bed area early morning in order for the bed area to be cleaned for a new patient.  You will be assisted into the dayroom where you will receive your breakfast with other patients going home that day.  It is aimed that everything will be ready for your discharge at about 10-10.30 and providing you have your own transport there should not be any delay.  Your wound will be redressed and final checks from the physiotherapist and occupational therapist will be made to ensure you are prepared.

• You will be reviewed in the Musculo Skeletal outpatient department, usually six weeks after surgery.  At this visit you will be seen by either your Consultant, a member of his team or the Arthroplasty Nurse Practitioner (a specialist nurse in joint replacements).
• At these visits you may ask any questions about your recovery and the care of your new joint replacement or the need for further surgery.
• Physiotherapy is not usually be arranged unless necessary. 
• It is important that you continue to take your analgesia (pain relief) and make sure that you do not stop this too early.
• You should continue to use your elbow crutches until your six week review appointment.

It is very important that you keep your outpatient review appointments and inform the outpatient department if you are unable to attend or you require an alternative date.  Please contact the Musculo Skeletal outpatient department on:

Telephone:  (0191) 233 1109 within office hours (8.30am-5.00pm) regarding any changes in your appointment.

Other useful contacts:

Ward 19, Freeman Hospital:  (0191) 213 7019
Ward 20, Freeman Hospital:  (0191) 213 7020
Physiotherapy:  (0191) 244 8219 or 223 1024
Occupational Therapy:  (0191) 213 7677