Revision hip and knee surgery

Orthopaedics

This information is a GUIDE only and the contents may differ dependent on your health.

Who will you meet and where will you go?

• Consultant: The surgeons who oversees your care. They plan and complete the revision operation.
• Registrar and Fellow: Assists the consultant in clinics and in the operation. They also provide support to the nursing and Resident doctor team.
• Resident Doctors: Ward based doctors on ward 27. They assist with ordering tests, reviewing test results and reviewing patients on a day-to-day basis.
• Surgical care practitioner (SCP): Work in outpatient clinics pre- and post-op, such as review clinic and sign off clinics they also assist the consultant with your surgery.
• Nurse Practitioners: Work on the ward to look after your medical needs. They work at both Friarage and James Cook hospitals, ordering tests and reviewing test results. They also complete daily medical reviews and may see you in the joint replacement clinic.
• Nurses and Health Care Assistants (HCAs): Provide nursing care and assist with personal care on the ward. They will support and encourage your independence and recovery following your surgery.
• Physiotherapists and physiotherapy assistants: Provide help and assistance with your rehabilitation. They will show you your exercises on the ward and get you up and walking. They may also follow you up in the joint replacement clinic.
• Occupational Therapist (OT): The OTs help with rehabilitation and recovery after surgery. The OTs may call prior to your surgery to ask if you need any equipment and how high your furniture is. You will be assessed on the ward after surgery – To assist the OTs with their assessment, it is helpful if you can fill in the Elective Orthopaedic Height Sheet
• Revision Nurse Specialist: Point of contact before, during and after your surgery. They will help the ward doctors and nurse practitioners with your care.

Hospitals

Friarage hospital in Northallerton

• The main outpatients department is where you will attend outpatient appointments, pre-assessment, sign off clinics and joint replacement clinics.
• Gara orthopaedic unit is the elective orthopaedic unit. It is a Nurse led orthopaedic unit. You may be offered this ward if you are generally fit and well or if your medical issues are well controlled.
• If your revision is being performed because of an infection, you will not be offered your operation here.

James Cook University Hospital in Middlesbrough

• Trauma outpatients is where you will attend outpatient appointments.
• The department of peri-operative medicine clinic is where you will go for your pre-assessment before your operation is scheduled.
• You will attend the rehabilitation centre for joint replacement clinic and physiotherapy appointments.
• Ward 27 is the elective orthopaedic ward. This ward has both Nurse practitioner and resident doctors.
• You will need to come to this ward if you have more complex, pre-existing medical needs, or are having revision surgery due to infection.

Before your operation PREPARE

Prehabilitation – getting you into shape for your operation:

Exercise:
Being active before your operation will make your recovery easier and quicker, simple changes such as waking more can have a benefit.

Weight loss:
Being overweight can put you at risk during the operation and make your rehabilitation harder. If you are overweight, you should try and reduce your weight prior to surgery. The NHS has support online at: www.nhs.uk/live-well/eat-well or ask your GP for advice.

Stop smoking:
Smoking can delay your wound healing after the operation. We advise all patients stop smoking prior to revision surgery. If you need help to stop smoking, please mention this at your pre-assessment appointment or see your GP. Nicotine replacement therapy can be provided.

Reduce alcohol: Aim to reduce alcohol intake prior to surgery, if you feel you need help with this please ask at your pre-assessment appointment or see your GP.

The evening before your operation please eat a high carbohydrate meal (Complex carbs such as brown bread/pasta/rice and grains).

Remember to follow fasting instructions which will be discussed with you at your pre-assessment.

Forward planning:

• Prepare your home: Cook and prepare meals for the freezer, ensure laundry is done and things needed are moved to an easy reach area.
• Purchase medications:
  Please purchase paracetamol and ibuprofen for pain relief, Lactulose and senna for constipation (unless you are told not to take these, this can be discussed on the ward for alternatives).
• Purchase any aids needed: Grabber for pick up from the floor, sock aids, shoehorns etc, as smaller items are not issued.
• Ensure you have loose fitting clothing and sensible shoes: Your leg may swell so loose-fitting clothes are advised. Wear comfortable shoes that do not slip off the feet.
• Transport: Ensure you have transport organised to and from the hospital. Please ensure transport home is flexible for when you are ready to be discharged.
  If possible, ask family or friends if there is anyone who could stay with you or can pop in to check you are ok at home, or help with tasks such as shopping, laundry etc.

Checklists

Pre-Admission check list

[…] Arrange support from family or friends for when you are back home (for help with cleaning shopping etc).

[…] Arrange transport for going home. Ask friends or family to be flexible.

[…] Stock up cupboards and freezer with food.

[…] Keep regularly used items within easy reach.

[…] Consider purchasing a grabber tool prior to admission (and any other smaller aids you may find useful – as these will not be supplied).

[…] Stock up on over-the-counter medications (Paracetamol, Ibuprofen, Senna, and Lactulose will not be supplied by the hospital).

[…] Have some Ice packs or some frozen peas in the freezer, ready for you to use when you get home (this will help with pain and swelling).

[…] Have a good supply of your regular medications (consider getting a repeat prescription renewed prior to your surgery).

What to bring check list

When packing you will be in hospital for 3 to 4 days on average. For some cases where the revision is being done for infection you may need to be in for a week or more.

[…] Slippers (NOT Backless).

[…] Comfortable loose-fitting clothes (you will be expected to get dressed each day).

[…] Night clothes.

[…] Shoes (remember your foot may swell so these should be loose fitting, sliders and flip flops are not recommended).

[…] Washbag and toiletries.

[…] Glasses, dentures, and Hearing aids (If needed).

[…] Your regular prescribed medications (please bring these in their original boxes).

[…] This booklet.

[…] Something to do such as a book or tablet.

What is a revision surgery?

When a hip or knee replacement no longer functions correctly, revision surgery is often required. During this procedure, a surgeon replaces the old implant with a new one.
Revision surgery is more complicated than the primary surgery and depending on the reason for the revision surgery recovery may take longer. During revision surgery samples are taken to ensure there is no infection within the old joint replacement.

Why is revision surgery needed?

It is considered when the previously implanted artificial hip or knee joint (prosthesis) begins to wear out, becomes unstable or fails to function properly. Common reasons for revision include:

• Prosthesis wear and tear: Over time, your artificial hip or knee joint may wear down leading to pain, reduced mobility, and instability. This is especially common in individuals who are younger and more active.
• Loosening: The components of your artificial hip or knee may become loose, causing pain and instability. This can be associated with bone loss around the prosthesis.
• Infection: Infections can develop in your hip or knee joint, leading to inflammation, pain and potential damage to the prosthesis. In some cases, antibiotic treatment may treat the infection, but surgery is often required to replace the prosthesis.
• Fracture: A fracture around your prosthesis may occur due to trauma, resulting in the need for surgery to repair or replace the damaged parts.
• Instability: Some individuals may experience persistent instability in the hip or knee joint after initial replacement surgery. Revision surgery may be needed to resolve these problems.
• Allergic reactions: In rare cases, individuals may develop allergic reactions or sensitivities to the materials used in the prosthesis and then need them replacing.

Types of revision – Single stage and two stage revision

Most revision surgery is done in one operation. The implants are removed, and a new joint implanted at the same operation (single stage).

Occasionally we may need to do your operation as 2 separate procedures (two stage).

A two-stage revision is usually used when a patient has an infection that is difficult to treat with a single stage operation.

• Single stage surgery: The old implant is removed, the joint is cleaned, and the new implant is placed during the same surgery.
• Two stage surgery: During the first operation (first stage) the implant is removed and cleaned, before a temporary spacer is placed in your hip or knee. You will then be treated with antibiotics until the second surgery (second stage). Once we are confident the infection has been treated you will undergo a second operation (second stage), where the temporary spacer is removed, and your new revision hip or knee replacement is inserted.

After the operation

After surgery you will be taken to the ward where you will start your rehabilitation. On the ward you will be given regular pain relief, please ask if more is needed.

• You will be encouraged to get up and sit out of bed once safe to do so; this has many benefits such as reducing the risk of chest infections and blood clots. It also helps your bowels to work.
• You will be given exercises by the physiotherapy team and will be expected to do these exercises independently. Initially these may be painful, but over time they will help to reduce your overall level of pain.
• You will be encouraged to do your own washing and dressing; this supports your rehabilitation, ensuring you will be able to do this at home.
• You will have bloods taken the next day. An X-Ray will also be performed.
• If your revision is due to infection, you may be required to stay in hospital on antibiotics. This may be until the samples taken are reported and a plan has been made with the infectious diseases team.

Common concerns once home

• Wound: Do not remove the dressing to your wound. Ideally the dressing, put in place by theatre, should remain in place until your two week follow up. Under some circumstances this may be changed earlier by one of the orthopaedic team. If you have any concerns, please contact the revision specialist nurse.
• Pain: Revision hip and knee surgery is painful. Please take the medication as prescribed. Strong pain medication can make you feel tired, dizzy, and sickly. If you experience this, let the nursing team know, and this can be reviewed. On discharge we will supply a week of medication, after this you will need to see your GP for further supply (Try not to leave this till the last minute!). Please also note that medications you can buy in the shop will not be provided.
• Constipation: May people suffer with constipation following surgery, especially when taking pain medication. To avoid this; take the laxatives as prescribed, ensure you are drinking enough water and eat plenty of fruit, vegetables and high fibre foods. Please seek medical help if you experience severe abdomen pain or bleeding from the bottom.
• Swollen legs: Swelling to the operated leg is normal, as is bruising (bruising can be extensive, you may bruise down to your toes this is normal). To improve bruising and swelling elevate the leg when at rest.
• The use of ice therapy will also reduce swelling and bruising. If when elevated your leg swelling does not improve, you have pain in your calf, and/or the leg is hot, please contact the revision specialist nurse as this could be an indication of a blood clot
  (Please take the anticoagulant as prescribed to reduce the chance of getting a blood clot).
• Driving: Driving initially should not be attempted, although there is no legal requirement around driving after an operation. It is up to your insurance company to approve whether you can drive, this is usually around six weeks. Please contact them to check your cover.

Elective Orthopaedic Height Sheet

Leg

To help us determine whether you will need any equipment we require your lower leg measurement. To do this you need to be seated with your feet flat on the floor; and to measure from the crease in your knee bend to the floor (as illustrated right).

It is important that your furniture at home is of a good height to allow you to transfer on and off independently. Please would you or a relative measure the following items to assist us in assessing this?
(Please note not everyone will need to be provided with equipment).

Armchair

Please sit in the arm chair and measure
the distance from the top of the compressed
cushion to the floor:

Please tick which type of leg your usual armchair has:

Bed

Please sit on the bed and measure
the distance from the top of the
compressed mattress to the floor.

Bed type

[…] King size […] Double […] Single

Base type

[…] Divan […] Slatted

Please tick which type of leg the bed has:

Toilet

Please measure the height from the toilet seat down to the floor.

Height of toilet:

• Upstairs: ………………………… inches
• Downstairs: ………………………… inches

Useful numbers

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the patient experience department of any special requirements, for example; braille or large print by emailing: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

ST3676