At Home with Dr Christian Jessen - 378

| ORTHOPAEDICS|

WORDS: CATHERINE FRANCIS | PHOTOGRAPHS: GETTY IMAGES

Y

our hips or knees
can be worn down
or damaged by
osteoarthritis,
rheumatoid arthritis,
fractures or repeated
overuse. In such
cases, there may come a time when
treatments such as physiotherapy,
medications (for example, painkillers
and steroids) and physical aids aren't
enough to keep you mobile and
pain-free and, as a result, your
specialist may suggest that the best
option is to have the joint replaced.
Normally, the cartilage between
the bones stops them rubbing
together. But if the cartilage is worn
away, the joint becomes stiff and
painful. A joint replacement can
sound like a drastic move, but for
many people it's a life-changer,
allowing them to throw away their
walking sticks and painkillers.
When a total hip replacement is
required, the affected parts of the
joint are removed and a 'ball and
socket' made from metal, ceramic
or plastic put in their place. The
joints may be 'cemented' to the
healthy bone, or left 'uncemented'
and pressed into place, with the
surfaces roughened and treated
to encourage the bone to grow into
the joint. Hip replacements are
most common in people aged 60-80,
but can be done on younger people.
A 'hip revision' is when an
artificial joint is replaced - usually
after around 15 years. This is a
more complicated operation as the
original replacement hip has to be
removed and your surgeon may have
to reconstruct some of the bone.
With knees, you may only need
a partial replacement, but a total
replacement is more usual. The new
hinge is usually made of metal (on
the femur) and plastic (on the tibia)
and tends to last up to 20 years. It
doesn't usually bend as far as a real
knee joint, but can reduce pain and
improve mobility.
A 'knee revision' is also more
complicated than the original
surgery. Knee joints can be replaced
a number of times, but usually
become less effective with each one.

WH AT SHOULD I
DO TO P R EPAR E?

If you're significantly overweight,
your orthopaedic surgeon will advise
weight loss first, to help avoid any
complications from surgery and

reduce the strain on your joints. A
body mass index (BMI) of over 30
increases the risk of complications.
If you're a smoker, you'll be advised
to stop, as this raises the risk of
infection. It's also a good idea to
work on strengthening muscles in
your upper body (to prepare for
using walking aids) and your lower
body (to aid recovery and help with
post-operation exercises).
You will have a pre-operative
assessment with your surgeon a few
weeks before your operation. You
may be given antibiotics before the
operation, to lower the risk of
infection. If you're having a general
anaesthetic, you'll be told to fast
for around six hours before.
Prepare your home to make it
easier to manage after the operation
- get aids such as a shower seat in
place, arrange furniture to make it
easier to get around, stock up on
food and make sure friends or family
can help you for a couple of weeks.

WHAT HAPPEN S
IN TH E O PERAT ION ?

A hip or knee replacement is done
under general anaesthetic, or using
a spinal or epidural anaesthetic,
where the pain is blocked from
the waist down but you stay awake.
A hip operation normally takes
about two hours, and a knee
replacement one to two hours.
Revisions take up to twice as long.
The surgeon cuts through the skin
and muscles to reach the joint and,
with a knee replacement, the kneecap
is moved aside. The damaged bone
can then be removed with a surgical
saw, and the replacement joint is
inserted. The back of the kneecap
may be replaced with a plastic part
(called patellar resurfacing). Some
operations are now 'minimally
invasive', involving smaller incisions
that cause less damage to muscles
and speed recovery. To help achieve
greater precision, computer-assisted
imaging is increasingly used.
With revision surgery, there may
be less bone available to hold the
new implant, and it can fracture
more easily. You may need a bone
graft from elsewhere in the body
to rebuild the bone. The incisions
are then stitched or clipped, and
covered with a dressing.

AF TER T HE SU RG ERY
It will take a few hours for the
anaesthetic to wear off and, if >

DON'T WORRY,
THE RISK OF
COMPLICATIONS
IS SAID TO BE LESS
THAN ONE IN 100

What are the risks?
All major surgery comes with possible risks, such as
infection or problems as a result of the anaesthetic.
After a joint replacement, there's a small risk of joint
or kneecap dislocation, loosening of the joint, or
small fractures in the bone, all of which may require
further surgery or wearing a brace. Some people
experience a build up of scar tissue, which may
restrict movement, and there's a slim possibility of
damage to blood vessels and nerves, leading to
numbness (usually temporary). There's a small risk
of one leg ending up shorter than the other, which
will require a raised shoe to correct your balance.
Metal-on-metal hips (where both parts of the joint
are made from metal) are used less now, as they're
more likely to become damaged and need revision
than metal-on-plastic. There's also some evidence
showing that traces of metal can get into the blood.
However, joint replacements are one of the most
effective types of surgery in modern history. Around
70,000 hip replacements, and a similar number of
knee replacements, are done in England and Wales
each year. There's less than a 1% chance of serious
complications and most patients enjoy a successful
outcome, with less pain and improved mobiltiy.

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