Wound care
Most hip or knee replacement wounds are closed with absorbable sutures that lie below the skin and do not need to be removed, with an overlying layer of skin glue to ensure the wound is watertight. Occasionally, skin “clips” (these look like staples) are used to close the wound. A waterproof dressing is then used.
The dressing should not be removed until the wound has healed (usually 2 weeks after the operation). The dressing will be removed by a nurse.
Most dressings are waterproof. This means you should be able to shower with it but do not soak it in a bath. The wound needs to be kept dry. Please check with your hospital team that your dressing is waterproof before you shower.
Every patient will have a scar after their operation. The length of the scar will depend on your body type and the ease of your surgery. Scars fade with time. Altered sensation and discomfort can occur around the scar but it usually settles down with time.
Pain and swelling management
Managing your pain
After your operation you will be provided with pain relief to help control your pain. Despite the pain relief, you should still expect your new joint to be painful. It is important for you to regularly take the pain relief that is provided to prevent your pain becoming too severe.
Please be aware that the use of regular strong painkillers can make you constipated.
Common pain-relieving medications you may be offered will include:
- Paracetamol
- Codeine phosphate
- Co-codamol
- Tramadol
- Anti-inflammatories
- Morphine
- Local anaesthetics
Managing your swelling
The amount of swelling and bruising can be different in each person. The swelling may last for many months. Sit with your leg elevated on a stool for a time during the day.
Please also consider these points to help with the swelling:
- Do not stand in one position for too long. Gravity increases the swelling, make sure you spend time with your leg elevated to help reduce the swelling.
- Continue to practice all your exercises regularly, ideally 3 times every day.
- Move around frequently, take regular short walks. The distance you walk varies from person to person. It is best to gradually increase your speed of walking and distance. Moving around and exercising is important to encourage a muscle pumping action to promote your circulation efficiently around your leg.
Constipation and bowels
Whilst painkillers are effective and vital in allowing you to perform your exercises, they can often cause constipation as a side-effect. It is also a side-effect of pain, anaesthetic drugs, reduced mobility, and the surgery itself.
Everybody has a different bowel habit. Your aim should be to get as close to normal for you. Simple measures such as drinking more water, eating more fresh fruit and vegetables may be enough.
You may also be discharged with medicines to help keep your bowel habit normal for you. These are safe and effective medications.
If you become worried about your bowels, you should see your GP in the first instance.
Weight
There are risks associated with every operation, but some risks are greater for patients who are overweight. They are also at a greater risks of implant complications or failure due to more force being placed on the implant.
Hip and knee replacements will help relieve your pain and enable you to live a more active life. However, overweight patients may never achieve the same outcome (mobility and range of motion).
The key elements to losing weight are diet and exercise. Losing weight and then maintaining a healthier weight can be a long and difficult process. The key is to find what works for you.
Resources
There are a number of resources that can help you to lose weight including:
NHS – Live Well, Healthy weight British Heart Foundation – Eat better bookletSmoking and smoking cessation
As well as general health risks associated with smoking, research has shown that smokers are at a much higher risk of complications during and after surgery than non-smokers.
Smoking cessation means to quit smoking. Some of the main advantages to quit smoking in relation to your surgery include:
- It reduces the risk of post-operative complications
- Wounds and bones heal quicker
- It reduces the need for further surgery
- It shortens the amount of time needed in hospital
Resources
People are more likely to successfully quit smoking with support from training stop smoking advisors. There are a number of resources that can help you quit smoking including:
NHS – Live Well, Quit smokingHydration
After the operation, your body will need time to heal and recover. To do this, you need to eat a healthy balanced diet and keep well hydrated.
Drink water or other clear fluids until you are passing plenty of pale urine in the first couple of weeks after your operation. We understand getting up and going to the toilet will be painful with your new joint replacement, but staying hydrated is essential to a good recovery.
Caffeinated drinks, like tea and coffee, do not hydrate you, nor does alcohol.
Blood clots
After a hip or knee replacement, you may be at a higher risk of developing blood clots in the veins in your legs leading to swelling, with or without pain. This is called a deep vein thrombosis (DVT). If it travels to your lungs it can block blood flow causing breathlessness, with or without chest pain. This is called a pulmonary embolism (PE). It can be life threatening and requires immediate medical attention.
On the day following surgery, you will be started on a blood thinning medication (anticoagulant) to reduce the chances of you developing a DVT or PE.
Try to take your medication at the same time each day.
The most common side effects are:
- Feeling sick
- Bruising
- Bleeding that takes longer to stop
- Bleeding from the gums when you brush your teeth
- Spots of blood on the tissue when you blow your nose
Seek medical advice if you experience:
- Prolonged nosebleeds
- Red, pink or brown urine
- Red or black stools
- Coughing up blood clots
- Blood in vomit, or vomit that looks like coffee grounds
- Bleeding that is severe or you cannot control
- Large bruises (bigger than your hand)
- Unexpected pain, swelling, joint pain or unusual headaches