Joint replacements, especially of the hip and the knee, are now being performed in ever increasing numbers all over the world. They have a very high rate of success and tremendously improve the quality of a patient’s life.

Any person who has developed arthritis of their joint due to any cause may need a joint replacement surgery. The various causes of arthritis are:

1. Osteoarthritis: This is a degenerative arthritis which occurs following age related wear and tear of the cartilage. This is the most common type.
2. Inflammatory arthritis: Rheumatoid Arthritis, Ankylosing Spondylitis
3. Post-traumatic arthritis: occurs following a fracture or a significant injury to the joint.

Joint replacement surgery is an elective procedure, the timing for which should be decided by you in consultation with your surgeon. This surgery is indicated mainly for pain. When your joint pain becomes severe and unbearable, when it disturbs your sleep at night, when it is no longer relieved by medication or physiotherapy, and when it interferes with your activities of daily living, you must consider having this operation. Sometimes limitation of joint motion or instability may be the indications for surgery.

You are probably the best judge of when you will finally need the joint replacement surgery.

• 95 – 98 % success rate
• Marked relief of pain
• Correction of deformities
• Improved range of motion
• Increased walking ability
• Improved gait

The maximum benefits become apparent after you regain strength in your leg muscles. This may take 3 to 6 months.

• Unlimited walking
• Sitting on chair / commode
• Cycling
• Swimming
• Doubles tennis

• Running / Jogging
• High impact activities
• Squatting
• Sitting cross legged

• Infection
  • Early infection can occur in the immediate post-op period. Measures such as maintaining strict asepsis in the theatre and use of prophylactic antibiotics keep the rate of infection to below 1%.
  • Late infection can occur more than two years after surgery. Any focus of infection elsewhere in the body such as dental or urinary infection can spread to the replaced joint as it is a foreign body in our body.
• Deep vein thrombosis / pulmonary embolism
• Dislocation

There are several things that you can do before your surgery to make your recovery easier and safer.

• You will have to undergo a series of tests before the operation. These tests include blood tests, urine test, chest x-ray, ECG, 2-D Echocardiography and if necessary a dobutamine stress test. You will then be seen by a Physician or Cardiologist who will assess your fitness for surgery.
• Show all your Medicines to your doctor before operation as some of the medicines may need to be discontinued temporarily before the operation.
• Stop smoking at least four weeks before your surgery. This will help reduce the risk of complications during and after your surgery.
• Make sure all infections, including urine infection; chest infection, tooth abscesses or infected leg ulcers are adequately treated prior to the surgery. This is because infections could spread through your body during the operation and infect your newly replaced joint.
• Commit to the success of your surgery: Working as a team, you, your physician, physiotherapist and your family must adopt a positive attitude toward the success of your surgery. Together, you will gain a clear understanding of the common goals and expectation of the procedure.
• Remain as active as possible by performing gentle exercises such as walking, range of motion exercises and swimming. Studies have shown that the stronger and more flexible you are before your operation the quicker you will recover and more flexible you will be after the operation.

• You will usually be admitted to the hospital a day prior to your surgery.
• You will undergo a pre-operative assessment by your anaesthetist. This will also give you a chance to discuss the type of anaesthesia for your surgery with them.
• On the day of your operation, it is usual that your doctor will ask you not to drink or eat anything. The area around your joint may be shaved to reduce the risk of infection.
• About an hour before the operation you will be given tablets or an injection to relax you. This is known as a 'pre-med'. You will then be taken into the operating theatre where you will be given your anaesthetic and have your operation.
• The operation usually lasts for 1-2 hours.
•  After the operation you will be kept in the recovery room for about 1 hour for observation. Once you are fully conscious and your vital parameters are stable, you will be shifted back to your room.
• You will be given IV fluids for the first 24 hours. You will be given pain medications to take regularly whilst you are recovering.
• You will be given a soft diet on the evening after the surgery. Full diet is usually allowed from the next day.
• 24-48 hours after the operation the physiotherapist will begin your exercise program to help you get back onto your feet. You will require either a walker or crutches to mobilize for the first 6 weeks.
• Once you, your surgeon and physiotherapist are happy with your condition and mobility you will be discharged from hospital. The usual hospital stay for joint replacement is 4 to 7 days.

• Continue the exercise program as advised by your surgeon and physiotherapist.
• Take medications as advised.
• Sutures are generally removed after 14 days once the wound is healed.
• It takes 3 to 6 months of regular exercise before you can appreciate the full benefit of your joint replacement surgery.
• The more care you take of your replaced joint the longer it will last. Avoid high impact activities like jumping or sudden twisting movements.
• While undergoing any urological or dental procedure, you need to take appropriate antibiotics to prevent infection spreading to your replaced joint.

Every effort is made to minimize any risk or complications from occurring. However, like any other surgery they do occur. Listed below are common signs and symptoms that may indicate a complication with your new joint. Please contact your doctor should you feel that you may have problem or are experiencing any of these signs and symptoms:

• Fever of 101 degrees Fahrenheit or 38.3 degrees Celsius.
• Unusual redness, heat or oozing at the wound site.
• Shortness of breath.
• Increase in pain that is not relieved by medication.
• Increase in pain or swelling in the calf.
• Leg appears deformed or short

“Joint replacement is a surgery to improve quality of your life.”