Hip replacement is performed to replace damaged parts of the hip joint. It is an excellent option to provide pain relief for patients suffering from hip pain due to severe arthritis or avascular necrosis. It is performed when non-operative options such as pain relief medications or injections do not help with pain management.

It is also performed to treat certain types of hip fractures. 

This varies from patient to patient. Generally, if pain interferes with your daily activities, if it disturbs your sleep, or if it affects your work, they are good reasons to consider surgery. 

Daycase hip replacement implies patients are admitted, operated on, and discharged home on the same day of surgery.

The main aims of daycase hip replacement are:

Effective pain relief

Early mobilisation

Early recovery

Enhanced recovery: To understand daycase hip replacement, you will need some understanding of enhanced recovery in joint replacement. Enhanced recovery was introduced many years back in the UK healthcare system to improve patient outcomes. The idea was to involve multidisciplinary teams in the care of patients, to control pain better, to mobilise patients early, and to reduce the length of hospital stay. The overall intention was to make the peri-operative pathways more efficient. If you think about this, early mobilisation has significant advantages such as early recovery, reducing the risk of clots, reducing the risk of hospital-acquired infection, and reducing the length of hospital stay. Over a period of many years, the length of hospital stay has been reduced from about 1 week to 2 - 3 days, due to the introduction of enhanced recovery.

Daycase pathway is along the same spectrum as enhanced recovery but in a super-efficient mode. So, it actually provides significant advantages to everyone.

Nothing special. Keep skin surfaces clean. Any signs of infection anywhere in the body let the operating team know ASAP, as you may not be fit for surgery. Attend pre-op assessment and any pre-op education classes arranged by your hospital. Look up some information about hip replacement surgery online or go through all my questions on this page. On the day of surgery, follow fasting advice as per instructions from the pre-assessment team. Same advice for medications, check with the pre-assessment team if you need to stop any of them before surgery for a short period. 

Let me talk about my practice:

Pre-surgery:

You will be admitted to the ward or daycase unit a few hours before surgery on the day of surgery. There will be some checks done by the nursing and medical staff. You will be reviewed by the Anaesthetic and Orthopaedic teams. 

Surgery:

Usually, spinal anesthesia is used unless any contraindications. From experience, patients are more comfortable post-surgery with this type of anesthesia. You can either be awake or have a sedative if you prefer to sleep during surgery. You can listen to music if you prefer during surgery. 

Post-surgery:

You will go to the ward. You can eat and drink immediately upon return to the ward. One of the big advantages of Spinal anesthesia is that the effect of the anesthesia will last longer than the surgery. So your leg will remain numb and comfortable for a longer period than the surgery itself. Also, you can have a top-up of pain relief before the pain gets worse. The idea is to get pain relief before the pain worsens after surgery.   

Once the effect of the anesthesia has completely worn out, likely you will be mobilised on the same day of surgery. You will be reviewed by the physiotherapist on the same day. This very much depends on what time of the day, the anesthesia effect wears out. 

If you are planning a daycase surgery, you will also have blood tests and x-rays performed on the same day of surgery.  The physiotherapist will also teach some hip exercises to be performed at home. You will have to pass all the checks before being deemed fit for discharge. If we feel, it is not safe for discharge, we will keep you in the hospital overnight. Your safety is our priority. 

Interestingly, what you will notice is that pain is actually less when you start mobilising.    

There are 3 goals with this pathway:

1. Provide good pain relief

2. Mobilise early

3. Promote early recovery          

You will see a physiotherapist before leaving the hospital. The physiotherapist will teach you some simple hip exercises to be done at home, help with mobilisation, provide crutches as required, and assess for stair climbing, bed-to-chair transfers, etc... Feel free to ask them any doubts, especially regarding mobilisation and activities of daily living. Walking is probably the best exercise for your hip.

It varies from patient to patient. Generally in about 6 weeks, most patients are back to their normal activities. Some patients can take 3 months for this. This will also depend on your mobility status before surgery and pre-existing health conditions. 

You can start walking under the supervision of a physiotherapist or trained nurse, once the effect of the anesthesia has completely worn out. 

Traditionally patients have been advised to sleep on their backs for upto 6 weeks after hip replacement surgery, to reduce the risk of dislocation. With the introduction of enhanced recovery and daycase pathways and also with current published literature, there is no good evidence to suggest that sleeping on the back will reduce the risk of dislocation. 

Hence currently, I do not put any restrictions on my patients. They are allowed to do everything they can from the day of surgery, provided it does not aggravate the pain. It is about being sensible. I strongly believe in a patient-driven pathway.

In my practice, my patients are allowed to do everything they can from the day of surgery itself, provided that particular activity does not aggravate the pain. Essentially there are no restrictions. Rather it is about being sensible. Anything that hurts is not good for you. I tell all my patients, that pain is their friend. Pain will guide you on which activities can be done and which cannot be done. I strongly believe in a patient-driven recovery and rehabilitation process.

Usually we advise patients not to drive for 6 weeks after hip replacement surgery.

If you really want to enjoy your holidays, I would suggest waiting for 3 months if possible. Though most patients would recover before 3 months, it is difficult to accurately predict post-op recovery before surgery. I have had patients going on holiday within a few weeks after surgery. 

Same with flying, especially long flights. I would suggest waiting for 3 months if possible. due to a higher risk of clots in the first 3 months. 

The overall risk of complications is small, about 2%.

Infection – Can be superficial (skin) or deep (joint). Superficial skin infections usually settle with a course of antibiotics. 

Deep infections usually require surgery. There are different types of surgery ranging from washout of the joint to redoing the joint. This depends on several factors.

Your Surgeon is probably the best person to decide whether the infection is superficial or deep.

Dislocation – The hip is a ball and socket joint. The ball bit can occasionally come out of the socket. If this happens, it will usually require reduction under an anesthetic in a hospital.

Blood clots – Clots can happen in the leg or the lungs. Usually, they are treated with a 6 month course of blood thinning medication. Some patients will require longer duration or even lifelong treatment depending on other risk factors.

Leg length inequality – Every effort is taken during surgery to achieve equal leg lengths. However, rarely the operated leg can be made long or short during surgery. This might be required to maximise the hip joint stability and biomechanics of the joint.  

Nerve  injury – Rarely can happen. If the nerve at the back of the hip called as sciatic nerve is injured, you can develop a foot drop wherein you will not be able to lift your foot up with the heel resting on the ground. There is also a risk of femoral nerve injury, which is the nerve at the front of the hip, wherein you will struggle to actively make your knee straight.

It is difficult to predict whether the nerve will recover fully or not and how long it will take to recover. Nerve tends to recover very slowly sometimes taking upto 18 months for recovery.

Loosening and wear of implants – This can happen over time. Generally, hip replacements last many years. On average about 15 years. There are patients for whom the hip lasts less than 15 years and there are also patients for whom the hip can last 20 - 30 years. This depends on several factors.

Fracture – Small risk of fractures on the socket side and also on the stem side. Treatment depends on the type of fracture.

For light duties, 6 weeks off work usually.

For heavy duties and manual jobs, 3 months off work usually.

Knee replacement is performed to replace damaged parts of the knee joint. It is an excellent option to provide pain relief for patients suffering from knee pain due to severe arthritis or avascular necrosis. It is performed when non-operative options such as pain relief medications or injections do not help with pain management.

This varies from patient to patient. Generally, if pain interferes with your daily activities, if it disturbs your sleep, or if it affects your work, they are good reasons to consider surgery. 

Daycase knee replacement implies patients are admitted, operated on, and discharged home on the same day of surgery.

The main aims of daycase knee replacement are:

Effective pain relief

Early mobilisation

Early recovery

Enhanced recovery: To understand daycase knee replacement, you will need some understanding of enhanced recovery in joint replacement. Enhanced recovery was introduced many years back in the UK healthcare system to improve patient outcomes. The idea was to involve multidisciplinary teams in the care of patients, to control pain better, to mobilise patients early, and to reduce the length of hospital stay. The overall intention was to make the peri-operative pathways more efficient. If you think about this, early mobilisation has significant advantages such as early recovery, reducing the risk of clots, reducing the risk of hospital-acquired infection, and reducing the length of hospital stay. Over a period of many years, the length of hospital stay has been reduced from about 1 week to 2 - 3 days, due to the introduction of enhanced recovery.

Daycase pathway is along the same spectrum as enhanced recovery but in a super-efficient mode. So, it actually provides significant advantages to everyone.

Nothing special. Keep skin surfaces clean. Any signs of infection anywhere in the body let the operating team know ASAP, as you may not be fit for surgery. Attend pre-op assessment and any pre-op education classes arranged by your hospital. Look up some information about knee replacement surgery online or go through all my questions on this page. On the day of surgery, follow fasting advice as per instructions from the pre-assessment team. Same advice for medications, check with the pre-assessment team if you need to stop any of them before surgery for a short period. 

Let me talk about my practice:

Pre-surgery:

You will be admitted to the ward or daycase unit a few hours before surgery on the day of surgery. There will be some checks done by the nursing and medical staff. You will be reviewed by the Anaesthetic and Orthopaedic teams. 

Surgery:

Usually, spinal anesthesia is used unless any contraindications. From experience, patients are more comfortable post-surgery with this type of anesthesia. You can either be awake or have a sedative if you prefer to sleep during surgery. You can listen to music if you prefer during surgery. 

Post-surgery:

You will go to the ward. You can eat and drink immediately upon return to the ward. One of the big advantages of Spinal anesthesia is that the effect of the anesthesia will last longer than the surgery. So your leg will remain numb and comfortable for a longer period than the surgery itself. Also, you can have a top-up of pain relief before the pain gets worse. The idea is to get pain relief before the pain worsens after surgery.   

Once the effect of the anesthesia has completely worn out, likely you will be mobilised on the same day of surgery. You will be reviewed by the physiotherapist on the same day. This very much depends on what time of the day, the anesthesia effect wears out. 

If you are planning a daycase surgery, you will also have blood tests and x-rays performed on the same day of surgery.  The physiotherapist will also teach some knee exercises to be performed at home. You will have to pass all the checks before being deemed fit for discharge. If we feel, it is not safe for discharge, we will keep you in the hospital overnight. Your safety is our priority. 

Interestingly, what you will notice is that pain is actually less when you start mobilising.    

There are 3 goals with this pathway:

1. Provide good pain relief

2. Mobilise early

3. Promote early recovery        

You will see a physiotherapist before leaving the hospital. The physiotherapist will teach you some knee exercises to be done at home, help with mobilisation, provide crutches as required, and assess for stair climbing, etc... Feel free to ask them any doubts, especially regarding mobilisation and activities of daily living. The physiotherapist will also arrange for follow-up appointments as necessary.

To regain your pre-op range of movements, you will need to exercise your knee everyday for the first 3 months. The physiotherapist can only guide you through the exercises, ultimately it is up to yourself to exercise the knee regularly.  

It varies from patient to patient. Generally in about 6 weeks, most patients are back to their normal activities. Some patients can take 3 months for this. This will also depend on your mobility status before surgery, the amount of knee exercises performed, and pre-existing health conditions. 

Knee swelling can sometimes last upto 12 months after surgery. The swelling can sometimes migrate to your foot and you might notice foot swelling for about 12 months.  

You can start walking under the supervision of a physiotherapist or trained nurse, once the effect of the anesthesia has completely worn out. 

The aim of knee replacement surgery is to provide pain relief. You will usually regain your pre-op range of movements. Anything more is a bonus. 

Usually, we advise patients not to drive for 6 weeks after knee replacement surgery.

If you really want to enjoy your holidays, I would suggest waiting for 3 months if possible. Though most patients would recover before 3 months, it is difficult to accurately predict post-op recovery before surgery. I have had patients going on holiday within a few weeks after surgery. 

Same with flying, especially long flights. I would suggest waiting for 3 months if possible. due to a higher risk of clots in the first 3 months. 

The overall risk of complications is small, about 2%.

Infection – Can be superficial (skin) or deep (joint). Superficial skin infections usually settle with a course of antibiotics. 

Deep infections usually require surgery. There are different types of surgery ranging from washout of the joint to redoing the joint. This depends on several factors.

Your Surgeon is probably the best person to decide whether the infection is superficial or deep.

Stiffness - Knees can become stiff sometimes after surgery. Hence it is important, that you exercise the knee everyday, atleast for the first 3 months. If the knee becomes very stiff, sometimes you will require manipulation. Your Surgeon is the best person to decide this.

Blood clots – Clots can happen in the leg or the lungs. Usually, they are treated with a 6 month course of blood thinning medication. Some patients will require longer duration or even lifelong treatment depending on other risk factors.

Nerve and blood vessel injury – Very rarely can happen. The back of the knee contains all the major nerves and blood vessels to the lower leg. Treatment depends on the type of injury.

Loosening and wear of implants – This can happen over time. Generally, knee replacements last many years. On average about 15 years. There are patients for whom the knee lasts less than 15 years and there are also patients for whom the knee can last 20 - 30 years. This depends on several factors.

For light duties, 6 weeks off work usually. 

For heavy duties and manual jobs, 3 months off work usually.