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Our experienced orthopaedic consultants are supported by an expert team of nursing staff and allied health professionals.

Pathway for recovery

Recovering from your joint replacement surgery has changed a lot over the years. We know the sooner we get you up and walking after your surgery, the better your outcomes will be. To help you do this, we have developed a pathway using the expertise of hospitals in this region and across the country.

This should allow you to get back on your feet sooner and return home to do the things you enjoy.

Returning home the same day as your operation

As a result of expert surgery and anaesthetics, and a highly skilled team of doctors, nurses and allied health professionals, many of you will not need to stay in hospital overnight and will be ready to go home the same day. This is the usual pathway in many orthopaedic centres across the country.

We have been successfully offering the patients of Devon and Cornwall this excellent standard of care, with very positive results and patient feedback.

However, some patients may not be ready to return home the same day and need a little longer. If this is the case, we would expect you to be able to go home the day after your surgery.

We will only discharge you once you are recovered and you are able to safely return home.

Managing and understanding the process

It’s important for you to have realistic expectations of having joint replacement surgery. You should have a clear understanding of what to expect at each stage. You must prepare appropriately for your surgery and work with the clinical teams you meet during your care.

It’s important to remember that your input will determine the quality of your recovery.

Prepare ahead 

The weeks leading up to your operation are as important as the operation day itself. After your surgery, you will either be returning home on the same day or staying for just one night in the hospital. Therefore, you should plan ahead before your surgery and think about how things might be for you when you return home.

You must also attend all of your appointments before your surgery date.

Arrange for transport

You should arrange for a family member or friend to collect you after your surgery. The hospital does not routinely provide transport for your return home.

Assistance for after your surgery 

You have probably been living with joint pain for some time before your operation and will already have ways of adapting to certain situations at home. However, when you are recovering from your operation you may also need some extra help with general tasks, cooking, shopping, and cleaning initially.

You need to make sure you organise this help before your operation date.

To ensure that your return home is successful and safe, you should ideally have someone at home with you for the first few days, and this is essential if you are to go home on the day of surgery.

Care agency support

Very few people require professional care support at home. If your personal choice is to have this help, you must arrange this privately, you may find your local council helpful for further information. The NHS can only provide professional care based on specifically assessed need and cannot arrange convalescent care.

You can contact a charity such as the British Red Cross or your local Age UK to see whether they can offer home help to support domestic duties and shopping (they may not be free).

Plymouth Plymouth City Council: 01752 668000 or visit www.plymouth.gov.uk Age Uk: 01752 256020 or visit www.ageukplymouth.org.uk

Devon Devon County Council: 03451 551007 or visit www.devon.gov.uk Age Uk: 0333 2412340 or visit www.ageuk.org.uk/devon

Cornwall Cornwall County Council:01736 756655 or visit www.cornwall.gov.uk Age Uk:01872 266388 or visit www.ageuk.org.uk/cornwall

Prepare your home

Preparing your home environment in advance is really helpful for when you get discharged.

For example, you can

• Freeze some simple-to-cook meals or have some ‘ready meals’ on hand

• Move any regularly used items that are heavy, or out of reach, to more accessible places eg: move the saucepans you use frequently up from any low shelves or cupboards.

• Avoid potential trip hazards by removing any loose rugs or obstacles from the floor such as excess furniture or things that would be easy to trip over

• Make arrangements for someone to care for any pets including walking dogs after your surgery.

Keep fit and healthy

The fitter you are before your operation, the less likely you are to have complications during and after your surgery.

You should seek to make some lifestyle improvements, such as

• Reducing alcohol intake

• Stopping smoking

• Keeping as mobile as possible and exercising

• Losing weight 

If you have long term health conditions you should aim to control these as well as possible before your operation to help prevent any complications and to avoid your operation being postponed.  It would be really helpful for you to check your own blood pressure if you are able to do so or get it checked at your GP.  If it is above 160/90 you are likely to require medication and the sooner this is started the sooner we will be able to go ahead with your surgery.

Similarly, if you suffer from Diabetes and your HbA1c has not been checked for 6 months or was over 69mmol/mol the last time it was checked, please arrange to have this checked again and work with your diabetic adviser to improve it.  It is very unlikely that your surgery will be undertaken if your diabetes is not well controlled and your HbA1c is above this value. 

Pre-operative assessment 

The pre-operative assessment process is important as it helps the hospital plan your care.

You will be asked by the hospital to provide some information about your general health and current medications. You may need to provide this information via

• A computer or mobile app

• A telephone consultation

• A video consultation, or

• A face-to-face appointment

This allows us to inform and advise you about your procedure, for example, we can provide you with instructions about medications and fasting times before your operation.

What details will be checked?

At your pre-operative assessment appointments, we will check various medical details, such as

• Your general health status

• Your blood pressure

• Your blood count to see if you are anaemic

• Your kidney function

• How well you are controlling your diabetes

Medicines

We will also review your medicines. It is fine to continue taking most medicines, and to take them on the day of your surgery. However, there are certain medications we may need you to stop taking for a few days before your operation, such as

• Blood thinning/ anti-clotting medication, or

• Some blood pressure medications

We will give you clear instructions if this is needed and tell you when you should start these medications again after your surgery.

Do your physiotherapy exercises

The exercises in section 5 of this booklet are to be completed both before and after your surgery. Doing these exercises before your operation will strengthen your muscles and will help you to recover more quickly after surgery.

On the day of your operation

You will be given a specific time to arrive. This may be 7.00 in the morning, or later on depending on the time of your operation.

Eating and drinking before your operation 

You must follow the instructions about fasting times. It is important that you follow the fasting instructions correctly or your operation may be at risk of being cancelled on the day. You must not have any food or milky drinks within 6 hours of your surgery. 

We encourage you to continue to drink plain, still water up to the time of your operation.

What to bring with you to the hospital

• All your current medication in original packaging, please do not bring your medication in dosette/pill boxes.

• Wear loose, comfortable day clothes to get dressed back into after your operation. Your leg may be swollen after your surgery so make sure this is an appropriate size.

• Flat, sturdy footwear with a back in it, for example no mules

• Small overnight bag in case you are not ready to return home on the same day

• Glasses, hearing aids or walking aids that you might have

• Phone, charger, headphones (+/- music device) if you would like to listen to music during your operation

• It is also a good idea to bring something to read/keep you occupied in case you have to wait. Wi-Fi coverage can be variable.

• Contact details of the person who will be picking you up

• Any letters you receive from the hospital giving you arrival instructions for the day of surgery.

Please try to avoid bringing in a large number of items with you and minimize items of high value or cash.

Arriving at the hospital 

When you arrive onto the admission ward, you will be greeted by a member of the reception team. They will book you in and confirm some details with you. You will then be seen by one of the nursing team who will run through some additional questions.

Confirming your consent form 

The surgical team will confirm with you the operation that they are planning to perform and check your consent form with you. They will mark an arrow with a pen on the leg that is going to be operated upon. 

They will also be able to answer any last-minute questions that you may have.

Meeting your anaesthetist 

Before your operation, you will meet your anaesthetist. They will explain the type of anaesthetic that is going to be used, and answer any questions you may have about the anaesthetic.

Your anaesthetist will also give you some pain relief tablets to help manage your pain after the operation.

Getting ready for your operation 

When it is time for your operation, you will be asked to change into a theatre gown. You will then walk to the operating theatre with one of the team. There, you will be greeted by your anaesthetist and you will also meet the operating department practitioner, who works with the anaesthetist, helping to look after you.

Routine checks

Some routine checks will be carried out to confirm your identity and to check if you have any allergies. We will also once again confirm your operation with you, and the side on which you are having the operation.

Attaching monitoring equipment and a drip

One of the team will attach some standard equipment to monitor your heart, blood pressure and oxygen levels while you are having your anaesthetic and operation. 

Your anaesthetist will also be giving you various medicines through a drip in the back of one of your hands. These include antibiotics, anti- sickness medicines and fluids.

Spinal anaesthetic 

In most cases, your anaesthetist will give you a spinal anaesthetic. This is very safe, and avoids the need for having a general anaesthetic, which may cause unpleasant side effects.

Spinal anaesthetic also helps you to recover quickly and receive the best post-operative pain relief.

Local anaesthetic is placed around some of the nerves in your lower back. This numbs your pain nerves so that you do not feel pain during the operation. Once it is confirmed that the anaesthetic is working well, you will be taken into the operating theatre.

The operation 

Once you are in the operating theatre, your leg will be painted with some cleaning fluid and then covered with drapes. You will not be able to see the surgery and the spinal block will prevent you from feeling any of the operation. 

Some people find listening to music through their headphones to be a good distraction. It helps them to relax and this will be offered to you. You may wish to bring your own music on your phone or portable music device, and your own headphones. Some people prefer to have a small amount of sedation so that they have a light sleep through their surgery. Your anaesthetist will discuss and agree with you a plan depending on your medical history, and also your wishes.

The operation typically takes about 1½ hours. During this time, your observations will be continually monitored by your anaesthetist.

Collecting blood 

We usually collect any blood you lose during the operation via a machine called “cell salvage”. Should you lose a sufficient amount of blood, this allows us to return your blood to you. This will help improve your wellbeing and recovery after the operation. It also reduces your chances of needing a blood transfusion with donated blood.

After the operation 

At the end of your operation, you will be transferred to the recovery area where the nurses will monitor your observations. You will also be given a post-operative drink and food. 

When your spinal anaesthetic has sufficiently worn off, you will be assessed by the therapy team. Our nursing and/or therapy teams will help you get up off the trolley, stand, and practice walking with suitable walking aids. The team will practice with you getting on and off the bed, chair, toilet and give advice on how to dress. If you require any equipment to assist you this will be assessed and provided prior to your discharge. You will also be taught how to safely complete the stairs. 

In order for you to return home, the team needs to be happy that you can manage these activities at home with walking aids. You will also be encouraged to get dressed in home “day clothes” with supportive footwear.

Returning home 

Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or, if you need to stay overnight with us at the hospital.

Arrange for someone to collect you

When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital.

Arrange for support at home 

If you live alone you may find it helpful to arrange for a friend  or relative to stay with you for a few days after you return home. You  should arrange this before you come in to have your surgery.

Wound dressing

Your wound is covered by a water resistant dressing so you can wash as soon as you feel able but avoid water contacting the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound dressing removed. Please leave it in place until this appointment. 

It is your responsibility to book your practice nurse appointment, the nurses on the ward will advise of this.

Keep active after your operation

The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle.

Pain control 

Joint replacement surgery is painful - just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild- to-moderate pain on movement. It is not going to be 100% pain-free.

The pain relief package you receive has been specially designed to try and control your pain as well as possible. It starts from the day of your surgery, and continues after your discharge home. We will give you the same pain relief tablets whether you stay in hospital overnight, or return home on the same day as your operation.

The pain relief package requires you to take your medicines at specific times.

Additional medications

We will be asking you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses.

Digital support

Numerous recovery programmes after surgery are supported by the use of digital technology. Many centres now have a web or app-based software resource that can provide you important information. They can also collect key data about how things are going for you; for example: the amount of activity you are able to undertake, questions on pain medication usage, or side effects.

We would encourage you to use one of these resources if you are directed to do so. This information enables your physiotherapy team to track whether you are making the progress we would expect, or whether we should contact you to provide additional support.

What to expect when you get home

Swelling 

It is common to have some generalised swelling of the leg below your hip replacement. Swelling will often get worse if you sit for prolonged periods so we encourage you to remain gently active. To help reduce lower limb swelling you may need to rest for at least 20 minutes in the morning and/or afternoon on the bed initially. If you experience increasing swelling and pain, please seek medical advice.

Constipation 

Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain- relief package. However, please ensure that you take these as prescribed, along with plenty of water to drink. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP.

Pain

Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises. 

Please make sure that you follow the pain management programme you were discharged with in order to help control your pain.

Sleepless nights 

It is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. You can sleep in any position including lying on either side.

What to look out for 

Deep vein thrombosis (or DVT) Blood clots in the leg can occur after joint replacement surgery. If your leg becomes hard, swollen, hot and painful, especially in the calf area, then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms. 

Infection is very rare. However, if your joint replacement or scar becomes hot, red and/or increasingly swollen or if you feel unwell, then please do seek medical assistance at your GP or local Minor Injuries Unit.

Support after discharge

The Ward team will let you know what arrangements have been made for your follow-up appointments.  

Even though you may be discharged after your operation, you are not alone. There is always someone available whom you can contact for advice. You will be given information about whom to contact should you require any help.

You will receive a routine follow-up telephone call to check on you the day after you go home, if you are discharged day of surgery.

If you would like more information before your operation or have any questions in the first 7 days after you have been discharged home, please ring the hospital switchboard on 01752 202082 ask to be put through to your discharging ward, the nursing staff will be able to advise you directly or be able to contact  people from your surgical team for you.

For therapy related queries please contact 01752 432255 or 01752 432220.

If you are unable to contact one of the UHP team, please ring your surgical consultant’s secretary, who will be able to assist you with contacting one of the team.

Therapy advice following your Hip Replacement Surgery

Completing the following exercises will benefit your recovery, improve movement in the hip joint and develop the strength of the muscles around it.

These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery. Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.

Initially the exercises may feel difficult due to pain and weakness, so it is important that you take your pain medication regularly. It is normal to feel a stretch around the operation site when exercising. It is important to continue all the exercises once you have left hospital.

Foot exercises 

Move your feet up and down from the ankles when you are sitting or lying. Do this up to 10 times regularly throughout the day. This will help with reducing lower limb swelling which can take several months to settle down and it reduces the risk of blood clots.

Static Quadriceps 

Lying on your bed or on a flat surface with your legs out straight and toes pointing to the ceiling. Press the back of your knee on to the bed as firmly as possible to tense up the thigh muscle. Hold for 5 seconds and then relax. Repeat up to 10 times.

Gluteal Contraction

Lying hip flexion 

When lying on the bed, bend the knee of your operated leg whilst keeping the knee pointing upwards. Do not to let the knee point inwards. Slowly straighten your leg and return to starting position. Repeat up to 10 times.

Lying hip abduction

Continuing to lie on the bed, with your legs straight in front of you, take your operated leg out to the side, keeping the knee straight and toes pointed to the ceiling. Slowly return to the starting point. Repeat up to 10 times.

Once you are walking comfortably you can start the following exercises in standing.

Hip abduction in standing 

Stand and hold onto a solid support. Put your weight on your opposite leg and lift your operated leg sideways keeping your knee straight and toes forward. Do this in a slow and controlled manner. Try and keep looking forward. Repeat up to 10 times.

Hip flexion in standing 

In the same position holding onto a solid support, lift your operated leg bending your hip and knee up toward your chest. Lower slowly and try and repeat up to 10 times.

Hip extension in standing

Lastly from the same starting position, lift your operated leg backwards, clenching your bottom muscles while keeping your knee straight. Do not to lean forwards. Repeat up to 10 times

Once moving comfortably, you can repeat the standing exercises on the unoperated leg by standing on the operated leg. You can also practice standing still on just the operated leg.

Walking 

Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis and to steadily increase the distance as you recover. It is normal to be allowed to put full weight through your operated leg. 

As soon as possible try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking, continue to use your walking aids.

Stairs

The therapist will practice with you how to safely complete the stairs before going home. To go up and down the stairs, use a banister rail if there is one.

Go up leading with the unoperated leg first, followed by the operated leg and then the crutch.

Going down, put the crutch on the step below, then step down with the operated leg, followed by the unoperated leg.

Activity

Walking is good for your new hip but remember your hip is an artificial joint.   

Pace your activity, walk and exercise regularly, little and often. The risk of dislocation is greatest in the first six weeks following surgery. To reduce the risk whilst the tissues around your hip are healing, avoid forcing or overstretching movement.

To kneel, go down on the operated leg, taking your weight forward through the unoperated leg. To come up from the kneeling position, take your unoperated leg forward, take your weight through this leg and push up into a standing position.

Rest

It can take time to recover from a total hip replacement. You may need to rest for at least 20 mins in the morning and/or afternoon on the bed initially. This will help with reducing lower limb swelling.

Sleeping

You may sleep in any position including lying on either side. Initially when you lie on your non-operated side it may be more comfortable with a pillow between your legs to support the operated hip. When getting into bed position your bottom back towards the centre of the bed and then slide yourself around into bed lifting your legs onto the bed.