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For the most part, knee and hip replacement are elective procedures. This means these surgeries are done to provide relief for your pain, not for any other medical reason.

In most cases, delaying surgery should not make joint replacement less effective if you choose to have it in the future.
In some cases, the provider may strongly recommend surgery if deformity or extreme wear and tear on the joint affects other parts of your body.

Also, if pain is preventing you from moving around well, the muscles around your joints may become weaker and your bones may become thinner. This may affect your recovery time if you have surgery at a later date.

Your provider may recommend against knee or hip replacement surgery if you have any of the following:

• Extreme obesity (weighing over 130kg or a BMI >40) .
• Weak quadriceps, the muscles in the front of your thighs, that can make it very hard for you to walk and use your knee.
• Unhealthy skin around the joint.
• Previous infection of your knee or hip.
• Previous surgery or injuries that do not allow for a successful joint replacement.
• Heart or lung problems, which make major surgery riskier.
• Other health conditions that may not allow you to recover well from joint replacement surgery.
• Extreme frailty.

• If there is enough bone, the operation can be re-done.
• During initial surgery the surgeon is constantly aware of bone preservation, a most important consideration in the procedure.
• Patients must also be aware of bone preservation and look after the prosthesis by following instructions to the letter.
• When and if the prosthesis shows signs of failure, like limping and shortening, consult your surgeon immediately.
• Delay in having a revision operation performed when loosening occurs causes bone destruction.
• Remember, pain is not always a feature of loosening.

Some general rules for any activity you do are:

• DO NOT cross your legs or ankles when you are sitting, standing, or lying down.
• DO NOT bend too far forward from your waist or pull your leg up past your waist. This bending is called hip flexion. Avoid hip flexion greater than 90 degrees (a right angle).

When you are getting dressed:

• DO NOT dress standing up. Sit on a chair or the edge of your bed, if it is stable.
• DO NOT bend over, raise your legs, or cross your legs while you are dressing.
• Use helpful devices so that you do not bend too much. Use a reacher, a longhandled shoehorn, elastic shoe laces, and an aid to help you put on your socks.
• When you are getting dressed, first put pants, socks or pantyhose on the leg that had surgery.
• When you undress, remove clothes from your surgery side last.

When you are sitting:

• Try not to sit in the same position for more than 30 to 40 minutes at a time
• Keep your feet about 6 inches apart. DO NOT bring them all the way together.
• DO NOT cross your legs.
• Keep your feet and knees pointed straight ahead, not turned in or out.
• Sit in a firm chair with a straight back and armrests. Avoid soft chairs, rocking chairs, stools, or sofas.
• Avoid chairs that are too low. Your hips should be higher than your knees when you are sitting. Sit on a pillow if you have to.
• When getting up from a chair, slide toward the edge of the chair, and use the arms of the chair or your walker or crutches for support.

When you are bathing or showering:

• You may stand in the shower if you like. You can also use a special tub seat or a stable plastic chair for sitting in the shower.
• Use a rubber mat on the tub or shower floor. Be sure to keep the bathroom floor dry and clean.
• DO NOT bend, squat, or reach for anything while you are showering. Use a shower sponge with a long handle for washing. Have someone change the shower controls for you if they are hard to reach. Have someone wash the parts of your body that are hard for you to reach.
• DO NOT sit down in the bottom of a regular bathtub. It will be too hard to get up safely.
• Use an elevated toilet seat to keep your knees lower than your hips when you are using the toilet, if you need one.

When you are using stairs:

• When you are going up, step first with your leg on the side that did not have surgery.
• When you are going down, step first with your leg on the side that had surgery.

When you are lying in bed:

• DO NOT sleep on the side of your new hip or on your stomach. If you are sleeping on your other side, place a pillow between your thighs.
• A special abductor pillow or splint may be used to keep your hip in the proper alignment.

When you are getting into or riding in a car:

• Get into the car from street level, not from a curb or doorstep.
• Car seats should not be too low. Sit on a pillow if you need to. Before you get into a car, make sure you can slide easily on the seat material.
• Break up long car rides. Stop, get out, and walk about every 2 hours.
• DO NOT drive until your health care provider says it is ok.

When you are walking:

• Use your crutches or walker until your doctor tells you it is ok to stop using them.
• Put only the amount of weight your doctor or physical therapist told you was okay to put on your hip that had surgery.
• Take small steps when you are turning. Try not to pivot.
• Wear shoes with nonskid soles. Avoid wearing slippers as they can make you fall. Go slowly when you are walking on wet surfaces or uneven ground.

Bathroom Setup

• Raising the toilet seat height will keep you from flexing your knee too much. You can do this by adding a seat cover or elevated toilet seat or a toilet safety frame.
• You can also use a commode chair instead of a toilet.
• You may need to have safety bars in your bathroom. Grab bars should be secured vertically or horizontally to the wall, not diagonally.
• DO NOT use towel racks as grab bars. They cannot support your weight.
• You will need two grab bars. One helps you get in and out of the tub. The other helps you stand from a sitting position.

Keep tripping hazards out of your home.

• Remove loose wires or cords from areas you walk through to get from one room to another.
• Remove loose throw rugs.
• Fix any uneven flooring in doorways. Use good lighting.
• Have night lights placed in hallways and rooms that can be dark.
• Pets that are small or move around may cause you to trip. For the first few weeks you are home, consider having your pet stay elsewhere (with a friend, in a kennel, or in the yard).
• DO NOT carry anything when you are walking around. You may need your hands to help you balance.
• Practice using a cane, walker, crutches, or a wheelchair.

It is especially important to practice the correct ways to:

• Sit down to use the toilet and stand up after using the toilet
• Get in and out of the shower
• Use the shower chair
• Put non-slip suction mats or rubber silicone decals in the tub to prevent falls.
• Use a non-skid bath mat outside the tub for firm footing.
• Keep the floor outside the tub or shower dry.
• Place soap and shampoo where you do not need to stand up, reach, or twist.
• Sit on a bath or shower chair when taking a shower.
• Make sure it has rubber tips on the bottom.

Please consult with the doctors office to confirm the level of cover from your medical aid and what you should do to obtain authorisation from your medical aid. Different procedures and underlying diseases and the possibility of complications may have different cost implications. Mediclinic Paarl hospital can give you a fixed price quotation, please enquire at our office or at the hospital.

If you choose not to have the operation, your arthritis may get worse.

• Arthritis usually progresses very slowly, often over many years.
• A prolonged delay may complicate the situation.
• The muscles surrounding the joint are likely to weaken, making rehabilitation after surgery more difficult.
• Having arthritis can make your life more difficult, but it is unlikely to make it shorter.
• There can be increasing deformity in hip arthritis the leg length can shorten as cartilage and bones wear away.
• It can make surgery more difficult.
• It may require your surgeon to use specialised implants or to use more specialised surgery to correct a deformity.

Research suggests that in hospitals that do lots of knee replacement operations things are less likely to go wrong.

• Other health problems must be under control. If you have a heart condition or lung problems, surgery may be too strenuous for you.
• Infections should be cleared up before surgery as they could cause serious complications.
• Blood clots could develop. Your doctor will advise you on how to reduce this risk.
• Being overweight can add extra stress on your heart and lungs during surgery. If you are overweight consider losing weight before the operation.
• Leg-length inequality. May occur or may become or seem worse after a hip replacement operation.
• Aseptic loosening. Over years, your hip prosthesis may wear out or loosen. This problem will likely be less common with newer materials and techniques. When the prosthesis wears out, bone loss may occur because of the small particles produced at the wearing surface. This process is called osteolysis.

Other complications. Dislocation, nerve and blood vessel injury, bleeding, fracture and stiffness can occur.

The hospital stay is 3-5 days. Walking usually begins the first day after surgery. A walker or crutches are used for 4-6 weeks, and full recovery takes 4-6 months. Pain relief is usually noticed within 3 weeks during walking. It usually take up to a year to fully recover. In some cases, the symptoms of knee arthritis may disappear as early as two to three weeks after surgery, but it may take up to six months to achieve full recovery. Usually throughout this time pain steadily decreases.

Recovery takes time and will require a commitment from the patient. There are exercises and a strict treatment plan that the patient should follow after the operation. The patient’s willingness to put effort into the recovery process will make a big difference in how well he or she recovers. The patient must be ready for several weeks of work after the operation to make it a success. With the preoperative education, combined with physiotherapy most patients return to everyday activities within two to three months.

Your hospital stay will typically 3 (2 – 5) days for total knee replacement or total hip replacement. Most of our patient are discharged directly to their own homes.

Walking and light activity are important to your recovery and will begin the day after your surgery. Most joint replacement patients begin standing and walking with the help of a walking support and a physiotherapist the day after surgery. The physiotherapist will teach you specific exercises to strengthen your jont and restore movement for walking and other normal daily activities.
Depending up-on the type of procedure and implant used weight bearing will differ from partial weight to full weight bearing.

As in any major surgical intervention, bleeding may occur and you may need a blood transfusion.

Thanks to advances in medication technology, we are able to keep you very comfortable after surgery. After surgery, any temporary discomfort does not compare to the pain of arthritis endured by most people in months and years before surgery.

Our goal is to manage your pain effectively with the necessary medication.
We use a multimodal pain relief program and we minimise the use of Opoid medication.

We use long acting local anesthetics injections to delay pain sensations for up to 8 hours after the operation.

A through physician and cardiac check is done prior to the operation. A member of the anaesthesia team will evaluate you after your all tests are over. The most common types of anaesthesia for hip replacement surgery are spinal and epidural anaesthesia (which allows you to breathe on your own but anaesthetises your body from the waist down) or general anaesthesia (which puts you to sleep throughout the procedure and uses a machine to help you breath). The anaesthetist team will discuss these choices with you and help you to decide which type of anaesthesia is best for you.

Both hip and knee joint replacements are recognised as miracles of modern surgery. It has allowed countless people with arthritis to get back on their feet and resume an active lifestyle. Since the new surfaces are artificial, mobility is painless.

Joint replacement is the most successful operation for acute arthritis if the following three requirements are met:

• the operation is properly carried out by experienced and specially trained surgeons;
• the operation is performed in a well-equipped center with the necessary facilities; and
• It is executed on a motivated patient who understands its limitation.

Modern knee replacements have a 90-95% survival rate at 15 years.  In 9 out of the 10 cases the results are very well and hold for 10 to 15 years or longer.

• Before the operation, your doctor will give you a complete physical examination to ensure that you do not have any conditions that will interfere with the operation and its outcome. Routine tests, such as blood tests and X-rays are usually performed a week before surgery. Tell your doctor of all other preexisting deceases that you may have including all previous infection incidents.
• Discuss any medications you are taking with your orthopaedic surgeon to see which ones you should stop taking before the operation, tell your doctor if you are using Warfarin or Cortisone.
• Losing weight before the operation will help decrease the stress you place on your new joint. However, you should not diet the month before your operation.
• If you are taking aspirin or anti-inflammatory medications, you will need to stop taking them one week before the operation to minimise bleeding.
• If you smoke, you should stop or cut down to reduce your operation risks and improve your recovery.
• Have any tooth or gum problems treated before the operation to reduce the risk of infection later.
• Eat a well-balanced diet, supplemented by a daily multivitamin with iron.
• Report any infections to your orthopaedic surgeon. No surgery can be performed until all infections have cleared up.

The main benefit is a substantial improvement in your quality of life.

• Improved movement and use of a joint.
• Surgery can replace or stabilise a joint allowing you to move more easily.
• Joint replacement surgery can help relief pain that does not respond to other treatment options.
• Improved alignment of deformed joints.
• Re-alignment of joint can help improve the function of other joints as well.

The decision to have joint replacement surgery should be made very carefully after consulting your doctor and learning as much as you can about your condition and the surgery.
Most patients who undergo a joint replacement are between the ages of 50 and 80 although people of all ages can undergo this procedure.
Recommendations for surgery are based on your level of pain and disability, rather than your age. After an orthopaedic evaluation, you and your surgeon should decide if joint replacement surgery is the best possible treatment.
If you have any of the following signs you should speak to an orthopaedic surgeon about the possibility of a joint replacement operation:

• Difficulty to sleep at night because of pain
• If your activity is restricted to the point where you have trouble getting out of a chair, climbing stairs, getting up from the toilet or the floor
• Medications you’ve been using no longer helps to alleviate pain
• You can no longer enjoy regular outings such as visiting friend or going on holiday because of pain.
• Stiffness in a hip limits your ability to move or lift your leg.
• Other treatments such as physiotherapy or the use of a walking aid such as a cane don’t relieve your hip pain.

The consequences of injuries in a post operative time.

• Can be extensive and wide ranging.
• Injuries have physical, emotional, and financial consequences that can impact the lives of individuals, their families, and society.
• Some injuries can result in temporary or long-term disability.
• Falls are known to form a substantial economic burden

Joints are composed of two or more bones, cartilage that cushions and separates the bones, and ligaments that attach the bones together. For example, the knee joint refers to the point of connection between the femur, or thigh bone, and the tibia, or shin bone. Joints also contain a variety of fibrous connective tissue such as ligaments, which connect the bones together and tendons which connect muscle to bone and cartilage, which covers the ends of bones and provides some cushioning.
Joint types

• ball and socket joints
• hinge joints
• condyloid joints
• pivot joints
• gliding joints
• saddle joints