What Happens
on the Day of Surgery

0:00 · Start

Hi and welcome to our channel. I'm Dr Chien-Wen Liew, hip and knee replacement specialist at Orthopaedics 360. Today, I'd just like to run you through a little bit about what happens during and after the surgery for a hip or knee replacement.

0:24 · Workup before surgery

Now, for a hip or knee replacement, we've already done all of our workup before the operation. If you're one of my patients, you would have gone through a series of tests such as blood tests, urine tests, and ECG. In addition to that, we have performed a three-dimensional scan on your hip or knee replacement for our patient-specific technology. This technology aims to predict and allow me to perform the surgery in three dimensions prior to you coming into the operating theater, so we know exactly what we're going to achieve before you come in for your surgery.

It allows us to have constructed a specific set of jigs that are placed onto the joint during surgery that ensure accurate planning of the operation, and we take nothing to chance because we measure everything after we cut it. During the actual operation, we like to have imaging modalities to help us ensure that what we've achieved compares exactly to what we've planned.

1:18 · Type of anaesthetic I use

Now, as part of a hip replacement or knee replacement, you have to have an anaesthetic. Now, most of our patients will undergo a spinal anaesthetic. A spinal anaesthetic is just a small needle in the back and it's placed in one shot, and it allows the legs to go numb. It means that we only need a very slight amount of anaesthetic agent to actually put you out and to make you not aware of what we're doing.

Often, that's just a sedation or a very light general anaesthetic, but we often don't need to put a tube all the way into the lungs called a endotracheal tube. That's something that allows us to have that lower risk profile from the anaesthetic, but also for us to have a decreased risk of bleeding and blood clots, which is what a spinal anaesthetic has shown to achieve with a joint replacement operation.

Once the anaesthetic agent has worn off, then you'll be able to move and feel those legs. So, please don't feel alarmed if when you wake up, you can't do that. It is very normal and it's all part of the operation.

2:17 · Recovery room after surgery

You spend a period of time in the recovery room after the operation, and that allows us to monitor all of your vital statistics, but also to look at the level of the spinal. And we will only allow you to leave the operating recovery once the spinal level is starting to drop. Once we're sure that the spinal level is not increasing, but decreasing in its height, we can safely send you out of recovery and onto the ward.

You'll be monitored there on the ward for looking at things like your blood pressure, your pulse rate, and your oxygen saturation, as well as managing any discomfort that you might have as a spinal wears off. A spinal anaesthetic gives you great pain relief after the surgery. In addition to that, we utilise other things like ice packs or an ice machine on the knee, and ice packs or ice shorts on the hips to reduce the risk of swelling after the surgery.

Medications are something that we use to decrease the risk of things like blood clots. We give you things like aspirin to thin the blood or another agent if you're already on something from before the surgery.

3:22 · First night in hospital

In general, for all of our hip and knee replacement patients, you'll spend the first night with a little bit of a disrupted sleep. And that's because we like to check that you're okay for that first night. An anaesthetic will sometimes be still circulating around the system during that time, so checking that all of your vital signs are very good and that you're comfortable is critical for your own success and for your own comfort.

We like to start some pain relief early just in anticipation of your physio appointment, but also for the natural amount of discomfort that you'll receive after the surgery from the swelling. Now, majority of that swelling occurs in the thigh muscle. We like to use ice packs up and down the leg to reduce the amount of swelling that occurs, and that actually helps a lot with the discomfort more than anything else.

We have a series of medications that we can give you, including things like pain relievers like Panadol, stronger ones like Palexia or Endone, and even stronger ones if you're absolutely necessary. A lot of our patients, especially our hip patients, only need Panadol after the surgery. But please don't hold back on asking the nurses for pain relief after the surgery if you need.

4:33 · Hospital stay post op

After the operation and your hospital stay is completed, and normally for our hip and knee replacements, that's somewhere around the three-night mark that you stay in hospital. You can certainly go before then or stay in later, and we don't send a lot of our patients to rehabilitation after the surgery. Once you're up and walking, we won't let you out of hospital until a couple of things are achieved.

The first one is that your bowels need to be open. It's a funny thing to say, but we need to make sure that your bowels are open before we let you go home as some of the medications, and the fact that you're lying in bed a lot more than you normally are, will cause you to have a little bit of constipation and can slow down your bowels.

The second thing is that you need to be relatively independent with all of your normal activities. That means you need to be able to shower and go to the toilet by yourself.

5:18 · Driving post operatively

You need to be able to fix yourself some food and walk around to do your general duties within the house. Whilst you can't drive for the first two to three weeks, we anticipate that you should still be able to go out with your friends and get driven to locations to have a coffee, but to ensure that you're not put in situations where you have to walk long distances or up and down excessive flights of stairs. In general, you definitely will be able to negotiate stairs after the surgery, and we test that when you're an inpatient with us.

5:47 · First in rooms appointment post op

When it comes time for your first appointment after the surgery in the rooms, that's approximately 2 to 3 weeks after the operation, where I will normally see you with our nurse as well, and we'll prepare your dressing and change that to a strip on the skin that you leave until it falls off. During that appointment, we're really just checking that everything's going according to plan, and we probably would have touched base a few times before then anyway.

After that, we expect that you progress quite nicely naturally. Physiotherapist can certainly help you progress things along a bit quicker, but it's not 100% essential for you to have a physiotherapist with you every single day. I would say that for our hips, once a week, and for our knees, at the very most once or twice a week, is something that will progress you nicely. And our physios usually will tailor a plan to combine with what you're experiencing to get the best out of your hip or knee replacement. Everyone is a little bit different, so be guided by what they advise.

6:48 · Recovery expectations

When you get to somewhere between 4 to 6 weeks, many people start to notice improvements compared with before surgery. By 3 months, most people are 90% through the recovery for a hip replacement or 80% through the recovery for a knee replacement. And somewhere between 6 to 9 months is when most of our patients will start to feel that forgotten joint feeling.

Now, according to the literature, it can take up to 1 year or more for people to fully recover. So, in some cases, we do give you that time to get to your very best. You'll have a few x-rays along the way, such as at the 3-month mark, and we touch base multiple times to ensure that you're tracking well and everything is covered and nothing is missed. Hope that gives you a little bit of information about what to expect with a hip or knee replacement.

If you want to find out a little bit more about the nuances of how I personally perform hip or knee replacements, subscribe to our channel or follow us on Facebook. Thank you for watching and I'll see you for the next one.

Transcript edited lightly for readability.