Welcome to our patient portal

Thank you for choosing Joint Clinic Paarl for your health needs.  We are committed to providing you with the best possible service, and to make our working relationship a success. We are excited to start working with you to help you reach your personal goals to improve your mobility and to get rid of your pain.

Our goal is to deliver the highest standard of orthopaedic care and to give personal attention to each and every patient seeking our help, we will do our best to help you by diagnosing and treating your medical problem as effective as possible.  Our success in helping patients reach their goals, is what attracts people from all walks of life to our clinic. 

Please get accustomed to our protocol for joint replacements of the hip and knee.


Herewith a broad overview of what to bring and expect on your first visit to Joint Clinic Paarl.

To schedule an appointment, please call +27 (21) 872 3026, make an appointment at our consulting rooms or complete the form below to make an online appointment request.

  1. Your Dermographic data
  2. Referral letter
  3. Medical aid card
  4. List of current medication and dosage
  5. Consulting reports of previous illnesses/hospitalisation
  6. Laboratory results
  7. Available x-rays

We go over your medical history, covering the following topics:

  • Main complaint
  • Discuss the expectations and goals of the patient
  • Medical history
  • Surgical history
  • Allergies
  • Personal history

We perform a physical examination pertaining to your problem area:

  • Hip; knee; ankle; foot
  • Shoulder; elbow; wrist; hand
  • Neck; middle back; lower back
  • General physical examination
  • Special tests

We perform the following bedside tests:

  • BP
  • Pulse
  • Respiratory rate
  • Temperature
  • Urine analysis
  • Blood sugar

We peform the following special tests as needed:


  • Plain X-rays
  • Ultra Sound
  • CT Scan
  • MRI scan

Laboratory tests

  • Chemistry
  • Haematology
  • Endocrine metabolic
  • Tumor markers
  • Genetic tests
  • Allergy tests
  • Immunology tests
  • Medication tests
  • Micro biology tests
  • ECG and EEG
  • Isotopes studies
  • Osteoarthritis
  • Gout
  • Pseudogout
  • Rheumatoid arthritis
  • Sero-negative arthritis
  • Osteopenia
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  • Cardiopathy
  • Hypertension
  • Abnormal rhythm
  • Valve lesions
  • Heart muscle disease
  • Chronic lung disease
  • Chronic kidney disease
  • Liver disease
  • Diabetus mellitus
  • Patient who smokes
  • Excessive use of alcohol
  • Anaemic/blood disease
  • Peripheral vascular disease
  • Neoplasia/cancer
  • Sleep apnoea

1.  Conservative treatment:

  • Rest and observation
  • Adjustment to activities
  • Improved nutritional status – Dietitian
  • Therapy
  • Physiotherapy
  • Occupational therapy
  • Speech therapist
  • Psychotherapist
  • Chiropractor
  • Prosthesis / orthosis
  • Exercise therapy
  • Water therapy

2. Surgical treatment types:

  • Open/buttonhole surgery
  • Manual surgery
  • Computer assisted surgery
  • Robotic surgery

3. Indications:

  • Pain
  • Stiffness
  • deformity
  • Abnormal gait
  • Loss of function

4. Contraindications:

  • Infection
  • Poor circulation
  • Abnormal skin
  • Osteoporosis
  • Untreated underlying disease
  • Insufficiently treated disease
  • Bad structural disease
  • High thrombosis risk
  • Anemia
  • Problematic physic disease
  • High age

5. Alternative Treatment:

  • Conservative treatment
  • Surgical treatment

6. Risks and possible complications:

  • General complications
  • Specific complications
  • Infection
  • Stiffness
  • Continuous pain
  • Bone length difference
  • Dislocation
  • Blood clot
  • Fracture
  • Blood transfusion
  • Bleeding and hematoma
  • Nerve damage
  • Blood vessel damage
  • Oppression
  • Wear and Tear

7. Choice of technique:

  • Access
  • Type of prosthesis/components
  • Wound closure

8. Conclude contract with patient iro:

  • Preparation
  • Exercises
  • House inspection
  • Risks
  • Finalise and sign the informative permission form

Conclusion of the planning

If there are any concerns in the last five (5) days before the operation (such as colds, flu, fever or skin lesions), please contact our office as soon as the operation may need to be postponed.

We will schedule the operation (place / day / date / time) but cannot guarantee that it will work out that way.You are encouraged to follow a wellness and weight loss program. We will communicate with your GP. Your family is welcome to contact us.

We will supply you with a operation book that will guide you and your family through the different steps of your journey. You can mark the different steps as you proceed. You will receive your operation book in our office after you have been booked for your operation. Please look at the index of your operation book under the document heading.

Your Operation book should accompany you to all encounters with us as well as to the hospital. The idea is that you and us mark off and make notes in the book as you progress with your treatment. It is not as hard as you might think.

By following our Joint Clinic CARE PATHWAY described in the operation book, you will:

  • be more educated and engaged in your care and recovery.
  • be happier with your care experience.
  • be more likely to refer friends and family members to us.
  • Experience improved functional outcomes.
  • Reduced  lengths of stay.
  • Less complications and readmissions.

You can download your operation book here:



Being patient centered is a core value of our practice. We try to find common ground in understanding our patients. Sometimes we must also be realistic about the expectations and outcomes.

We therefore use outcome questionnaires to determine the medium and long term outcomes and satisfaction of our patients.

Outcomes in clinic practice provide a mechanism in which a healthcare provider, the patient, the public, and the payer are able to assess the end results of care and its effect upon the health of the patient and society. Please print out and fill in your relevant scoring sheet as instructed and bring or mail the completed form to Dr. Botes’ office.

There are many causes of osteoarthritis of the hip joint but in all cases the gliding action of the cartilage upon itself fails, the surface roughens up. This can be caused by age related deterioration, infections, injuries, overuse of joints, poorly fitting head in socket (congenital dysplasia), avascular necrosis, Perthes’ disease, and many other causes. The eventual outcome is poor movement of the hip joint with the cartilage worn away not unlike the tread of a tyre being worn away. The damage to the joint can be graded in severity with the help of proper x-rays. When other non-surgical and in some case surgical treatments of the arthritic hip have failed, total joint replacement is often the only way out. 

Indications for joint replacement:
  • Severe or constant joint pain.
  • Pain that can not be managed by medication or other methods.
  • Joint pain that hinders walking, climbing stairs, getting in/out of a chair.
  • Joint pain that interferes with sleep or does not subside with rest.
  • Joint swelling that limits bending or straightening or does not respond to treatment.
  • Bow legs or X legs deformities.
  • Substantial limitation of quality of life.
  • We will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, we will perform a physical exam to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

Tell us if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

  • Tell us of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell us if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • You will be asked to fast for 6 hours before the procedure, generally from after midnight.
  • You may receive a sedative prior to the procedure to help you relax.
  • You may meet with a physiotherapist prior to your surgery to discuss rehabilitation.
  • Arrange for someone to help around the house for a week or two after you are discharged from the hospital.
  • Based on your medical condition, we may request other specific preparation including referral to another specialist physician.

Inpatient Experience

  • A incision will be made in one of three places on the back of the hip (over the buttock), on the front of the hip (near the groin), or on the side of the hip.
  •  The incision is anterior in the case of a knee replacement.
  • The surgeon will use special instruments to work through the incision.
  • Surgery involves cutting and removing diseased bone, capsules, tendons and other tissues.
  • Diseased tissues will be replaced with an artificial prosthesis.
  • The operation itself takes about 70 – 100 minutes. Time is added to put you to sleep and to wake you up after the operation.
  • When you wake up in recovery and the anesthetist is satisfied with your progress you will be moved back to the ward or to the high care unit if deemed necessary.
  •  There will be a dressing on your thigh and drainage tubes from the wound into suction bellows.
  • There will also be a tube into the veins of your arm to be used to administer bloods, fluids, antibiotics and pain killers. Intravenous and drainage tubes are usually removed the next morning.

You will be in hospital for 2-5 days following your surgery. Each patient is rehabilitated at his/her own pace.  A physiotherapist will begin to see you on the day of surgery. She will help you to mobilize out of the bed on the day of surgery. You will then be taught how to do exercises and to begin strengthening the muscles around the hips and knees. These exercises need to be continued at home after discharge. 

A dedicated person will be appointed as a care navigator for each patient. The navigator will coordinate the treatment of the patient and will also maintain continues communication with the patient and his/her family. High risk patients and patients with special needs will be identified and cared for. Personnel will continuously scan patients for the development of complications. Patients will be educated to distinguish between complications that need medical or surgical treatment and others that is to be expected, but that is only discomfortable and should be endured. 

You will be assisted to walk with a walking frame or crutches. The amount of weight you will be allowed to place on your operated leg and the time that you would need to use the crutches will be determined by Dr D Botes after the surgery. On the 2nd or 3rd day an assessment will be done about how well you have reached your mobilisation milestones. You will also be taught how to engage stairs before you are discharged.


You will be using two crutches (elbow) or a walking frame when you get up to walk for the first time. By the time you leave the hospital you should be walking comfortably and climbing one set of steps. Please keep contact with your physio therapist and arrange an outpatient visit to them if you do not reach the agreed mobility mile stones. Crutches must be discarded only after four to six weeks and after your follow-up visit to the surgeon (this is for primary surgery only).

You can sit in the left front seat of a car on your way home. If there is need to transfer a patient to a sub acute facility, the process of authorisation must be started timeously. 

Factors that will be taken into account are:
  • Patient living alone.
  • Patient living far off.
  • Frail, old age, weak patients
  • Patients with complications.
  • Patients with problematic comorbidities.
  • Patients with complex pathology.

After having been discharged you will be required to take anti-coagulation medication Pradaxa for 2 – 4 weeks (unless there is a contra indication, such as peptic ulcers). Patients will be supplied with take home medication for pain, swelling, constipation, sleeplessness and other problems detected in the hospital. Patients should continue with their previous home medication except if instructed otherwise. Please take pain medication regularly in the first few days, but you can change to over the counter medication as soon as the pain and discomfort dissipates.

You will be given precise instructions before you leave the hospital. Please be on the look out and report risks and complications like pressure sores, post operative infections, deep vein thrombosis. Special care need to be taken to avoid falling down and getting injured. If you are worried about the condition of your wound, please take a photograph and send it on to Dr. Botes for advice. Should you experience any pain in your chest or calf after discharge, report this to your doctor without delay. The risk of blood clots remains until about 8 weeks after the operation.

Make sure everything you need is easy to get to and on the same floor where you will spend most of your time. If you will need to use the stairs, you should limit using them to once a day.

  • Have a bed that is low enough so that your feet touch the floor when you sit on the edge of the bed.
  • Set up your bed on the first floor if you can. You may not need a hospital bed, but your mattress should be firm.
  • Have a bathroom or a portable commode on the same floor where you will spend most of your day.
  • Make sure you can reach everything you need without getting on your tiptoes or bending down low.
  • Make sure you can get to your phone. A portable phone can be helpful.
  • Place a chair with a firm back in the kitchen, bedroom, bathroom, and other rooms you will use. This way, you can sit when you do your daily tasks.
  • For the first two weeks you may need help bathing, using the toilet, cooking, running errands, shopping, going to the doctor and exercising.
  • Do not sit for extended periods of time as it may lead to swelling of your legs.

Steps you can do to lessen joint pain include:

  • Try to avoid activities that make the pain worse.
  • Use the medication that was supplied to you on discharge from the hospital.
  • At a later stage you can use over-the-counter pain medication, such as Panado.
  • Sleep on the side of your body that does not have pain. Put a pillow between your legs.
  • Lose weight if you are overweight. Ask your health care provider for help.
  • Try not to stand for long periods of time. If you must stand, do so on a soft, cushioned surface. Stand with an equal amount of weight on each leg.
  • Wear flat shoes that are cushioned and comfortable.

Things you can do to avoid hip pain related to overuse or physical activity include:

  • Always warm up before exercising and cool down afterward. Stretch your quadriceps and hamstrings.
  • Avoid running straight down hills. Walk down instead.
  • Swim instead of run or bicycle.
  • Run on a smooth, soft surface, such as a track. Avoid running on cement.
  • If you have flat feet, try special shoe inserts and arch supports (orthotics).
  • Make sure your running shoes are made well, fit well, and have good cushioning.
  • Cut down the amount of exercise you do.

See your provider before exercising your joint if you think you may have arthritis in other areas or you have injured your replaced joint.

You must see the surgeon at 2 weeks, 6 weeks, 3 months, 6 months and 1 year after the operation. It is only between 6 and 12 months that you can expect to have reached the final, or near final result of your replacement operation. This period could be much longer in the case of revision surgery. For the first few months after the operation you may experience swelling of the operated leg (usually down in the mornings, up in die evenings).

Routine follow up visits should be scheduled for 3, 5 and 10 years after the operation or if abnormal symptoms appear.

Skin clips are removed 14 days after surgery. The wound should be healed by now or may need further attention.

Practice Policies

Consultation Fees
  • First consultation, Follow-up visits, Post operative follow up visit, After hours, unscheduled all push-in Consultations: 0146/0145 codes will be added to consultation code 0191/0192 at medical aid rates.
  • Telephonic or email consultations will be charged as appropriate, code 0130/0132.
  • Disposables used in the office will be charged at Nappi code rates.
  • Medicines used in the office will be charged at Nappi code rates.
  • You will receive a quotation for Dr Botes’ fees.
  • Medical certificates and scripts may be charged at code 0132.
  • Third party form completion e.g. insurance or employer reports will be charged at private rate. This have to be paid before the form is released.
  • Special arrangements must be made beforehand for a consultation to deliver a medico-legal report. 

A hospital plan will not cover out of hospital doctor visits, radiology examinations or pathological tests.

Gap cover insurance may cover the shortfall in doctors fees but their terms differs between the different insurers.

The patient is liable for the full payment of the account. It remains your responsibility for what your medical aid that requires in connection with tariffs, designated service providers, referring letters, pre-authority and other limits. The patient is responsible for the whole amount of the account irrespective of what the medical aid covers. Our contract is with you and not with the medical aid.

Any payment made directly to you by the medical aid must be paid over to the practice bank account with in 72 hours. The outstanding amount is payable in full at your next follow-up visit.

Please make arrangements with our accounts manager for down payment on outstanding amounts.

Proof of payment with your account number as reference must be emailed to botesorto@iafrica.com, otherwise we will not know and your account may not be credited.

We work with almost all medical aids, but we have a fixed rate for our services. This means that except for the medical aids that we have pre-arranged contracts with, there will be a co-payment.

Funds Contracted For All Procedures:

  • Discovery and most funds that are administered by Discovery.
  • Momentum and various funds administered by Momentum.
  • Polmed
  • Fedhealth
  • Bonitas
  • Bankmed

Funds Contracted For Primary Hip And Knee Replacements:

1. Through the Care Expert program:

Patients are eligible for the care expert program provided that their medical schemes have contracted with Mediclinic for this product and that it is elective surgery. The following cases are specifically excluded, namely; bilateral replacements, patients with bleeding disorders, trauma cases, revision replacements and where there are additional theatre procedures performed that are not part of the model. The global fee includes the costs of the hospital, surgeon, surgical assistant and the prosthesis cost. Negotiations is ongoing to include the costs of all other service providers. Until then, they will continue to charge as they do today.

  • LA Health Medical Scheme
  • Libcare Medical Aid
  • Liberty Health Blue
  • Massmart Health Plan
  • MB Med
  • Nedgroup medial aid scheme
  • Old Mutual Staff Medical Aid Fund
  • PAmed medical Aid
  • Platinum Health
  • Polmed
  • Profmed
  • Quantum medical aid
  • Rand Water medical aid
  • Remedi
  • Retail Medical Scheme (Shoprite)
  • Roshmed medical aid
  • Sizwe medical fund
  • Swazimed
  • Thebe Med
  • Tigerbrands medical scheme
  • Topmed medical aid
  • Tsogo Sun Group medical scheme
  • Witbank Coalfields medical aid
  • Umvuzo Health
  • Health Squared
2. Through the ICPS program:
  • Transmed
  • Medihelp
  • Bonitas
  • AECI
  • Selfmed
  • Nedgroup
  • MB med
  • Samwumed
  • Compcare
  • SABC
  • Old Mutual
  • Fedhealth
  • Medshield

We Do Not Serve Workman Commisioner (Injury On Duty) Patients.


The information contained in this website is for information purposes only. Whilst we make every effort to ensure that the information on this website is correct, Joint Clinic Paarl can make no warranty as to its accuracy, freedom from error or reliability.

Joint Clinic Paarl shall have no liability for any loss or damage resulting from the use of this website, the inability to use this website, any information contained within it or any defect in it. The information contained in this website is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment.


This website is owned and operated by Joint Clinic Paarl. All material, including the text, designs, graphics, photographs and other content, used on this website are the copyright of Joint Clinic Paarl, except where otherwise expressly stated. You are permitted to print or download content for your own personal use only. You may not use or reproduce any material on this website for any commercial purpose or on any other website, unless with our prior written permission.

Social Media Policy

Social media such as WhatsApp, Facebook, Twitter and other webpages will not be answered. If an
emergency or urgent question arises please contact the rooms or contact the emergency ER-24 department all at MediClinic Paarl hospital.

Emails will be regarded as non-urgent and may not be answered timeously

Privacy Policy

Joint Clinic Paarl is committed to safeguarding your privacy online. This policy only covers this website. Weblinks from this website to other websites are not covered by this policy.

This website is not encrypted and can be accessed and browsed without disclosing any personal data.
Joint Clinic Paarl collects the following information regarding visitors to our website: IP addresses, information regarding what pages are accessed and when. We use your IP address to help us to track usage behaviour and compile data that will allow content and navigation improvement of our website.

Our website uses email forms for visitors to request information on services. Contact information (i.e. email and postal address) from the email form is collected and used to send information to our visitors as specifically requested by them. Personal details will not be passed to any third parties not involved with Joint Clinic Paarl.

Joint Clinic Paarl places great importance on the security of all personal information. We have security measures in place to protect against the loss, misuse and alteration of personal data under our control.


By continuing to use this website it is implied that you accept our Terms and Conditions and Privacy Policy.

FAQ's on knee & hip replacements

Is there any harm in waiting?

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.

Why you may not be a candidate for a joint replacement?

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.

What happens if the operation is a failure? Can it be redone?

  • 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.

General rules of self care after a hip replacement

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.

How can I avoid to fall.

Patient falling

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.

What is the cost of a joint replacement?

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.

What will happen if I choose not to have the operation?

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.

What is the prominent risk in my case?

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.

How quick will I recover?

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.

How long will I be in hospital?

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.

Will I need physiotherapy after the operation?

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.

Will a blood transfusion be necessary?

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

Is the operation painful?

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.

What type of anaesthetic will be used?

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.

How long will a joint replacement last?

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.

There is the danger that an implant can fail at any time if, for example, there is an unexpected loosening caused by an infection, injury or by collapse of the bone, in which case it cannot support the prosthesis. This is why sporting activities, for example, should be limited and discussed in detail with the surgeon. In general if the patient is too active, it can lead to early failure of the hip replacement.

Follow up studies of large series of these procedures show that at least 90% of the hip replacements performed still function after 10 years (i.e. 1% failure rate per year). Recently, the National Institute for Health and Care Excellence (NICE) suggested a ten-year revision rate of 10% as an acceptable benchmark performance of a primary total hip implant, which was loosely based on an earlier report by Murray et al.

Among patients over age 65 the failure rate is lower and in younger and more active groups it can be as much as five times higher. On average the aim is to have at least 90% 15 year survival of the hip   implants. Many 25 and 30 year total hip survivals are commonly seen in   arthroplasty practice worldwide. And with crosslinking methods developed in South Africa 35-38 year follow of survivors is in progress, with wear a low as 0.018mm/year.

What should I do in the waiting period?

  • 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.

What are the benefits of the operation?

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.

When should I have a joint replacement operation?

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.

What are the consequences of injury?

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

What is arthritis?

Arthritis is an inflammatory disorder of the joints that may produce pain and swelling that lasts a lifetime. It affects and limits everyday activities and is a leading cause of disability.

Osteoarthritis is the most common form of arthritis. It is most often related to wear and tear that has been placed on the joints over the years. Its onset is usually after the age of 50. Factors that predispose this condition include family history, obesity, previous surgery to the joint where a large piece of cartilage (cushion between the bones) was removed, or previous fractures in the area of the joint.

Rheumatoid Arthritis is one of the more common kinds of inflammatory arthritis. It is a chronic inflammatory disorder affecting the joints of the body which are lined with a membrane called synovium. These joints include the hip, knee, shoulder, elbow, wrist, hands and feet. Rheumatoid arthritis is likely of autoimmune origin, which means the body produces cells that irritate the synovium in the joint leading to destruction of the cartilage. This form of arthritis occurs in all age groups. It is characterised by stiffness, joint swelling, and laxity of the ligaments, pain, and decreased range of motion.

What is a joint?

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

We want you to be well educated so that you can make informed  decisions about your health conditions.

Your Operation Book

English Version
Afrikaanse weergawe

Patient Documents

Types of outcome measurements

  • Patient reported outcomes
  • Patient reported experiences
  • Doctor orientated measurements
  • Cost of therapists
  • Readmissions
  • Complications
  • Incidence of postoperative infections
  • Revision procedures
  • Research costs
  • Hospital measurements
    • Length of stay
    • Type of care
    • Surgical time
    • Prosthesis costs
    • Medication costs
    • Disposable product use
    • Laboratory tests
    • Radiological tests
    •  Orthotic and prosthetic costs

Scoring sheets

Please fill in your relevant scoring sheet, print it out, and bring or mail it to Dr. Botes’ office.

Measurement of outcomes

The gathering of outcomes data is the only accurate method to determine the effectivity of treatment. The outcome of a surgical procedure can be affected by the following factors, namely:

  • The expectations of the patient
  • The clinical diagnosis
  • Comorbidities
  • Age and sex
  • Psychological factors
  • Risks for thrombosis and infections
  • The type of surgical techniques used
  • The type of prosthesis used

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