At Home with Chris Jessen 2018 - 152

▲ J O I N T H E A LT H

SHOULDER, WRIST
AND ELBOW
REPLACEMENTS

joints. Such a BMI increases the
risk of complications.
If you're a smoker, you'll be advised
to stop, as this increases the risk of
infection. It's also a good idea to work
on strengthening the muscles in your
upper body (to prepare for using
walking aids) and your lower body
(to aid recovery and help with postoperation exercises).
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
about six hours before the op.
Prepare your home to make it
easier to manage after the operation -
the NHS or charities can provide aids
such as a raised toilet seat or shower
seat. Move furniture to make it easier
to get around, stock up on food and
ask friends or family if they can help
out for a couple of weeks.

involve 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 the 'new' bone may be
prone to fracture more easily. You may
need a bone graft from elsewhere in
the body to rebuild the bone. Incisions
will then be stitched or clipped and
covered with a dressing.
RECOVERY PERIOD

Immediately after the operation,
it will take a few hours for the
anaesthetic to wear oﬀ and, if you
were given a spinal or epidural
anaesthetic, you may not be able
to feel your legs for a few hours.

THE OPERATION

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 usually takes about two
hours, and a knee replacement one
to two hours. Revisions can take
up to twice as long.
The surgeon will cut through
the skin and muscles to reach the
joint and, with a knee replacement,
the kneecap is moved aside. The
damaged hip or knee joint can then
be removed with a surgical saw and
the replacement joint inserted.
Some operations are now known
as 'minimally invasive' as they
152 | FEBRUARY 2018

The int
hip jo

You'll be given painkillers to control
the pain so that you are comfortable.
With replacement of a hip, a special
pillow may be used to keep your
hips immobile. With a new knee, a
continuous passive motion machine
may be used to bend and straighten
the knee in bed, keeping it mobile
and reducing swelling.
Many people are up on their feet
within a day or two, although you are
likely to stay in hospital until you're
able to walk, which usually takes
about three to ﬁve days.
A physiotherapist will give you
exercises to strengthen your joint and
speed recovery. You may also have to
wear compression stockings to lower
the risk of blood clots forming, and
you may have to take medicine such
as heparin for several weeks to help
prevent deep vein thrombosis (DVT).
You'll also be prescribed antibiotics to
prevent infection.
You'll need crutches or walking aids
to start with, but you can expect to
be reasonably mobile within four to
six weeks, but you shouldn't attempt
to drive for about six weeks.
You'll continue to improve for
a couple of years, as your muscles
strengthen and scar tissue heals.
It's really important to stay active
during your recovery to strengthen
the muscles around the new joint.
But you should avoid high-impact
activities that put pressure on your
joints, and sideways actions (such as
swimming breaststroke) that can risk
dislocation of the joint.
You'll have regular check-ups,
possibly an X-ray every ﬁve years to
check everything is still stable.

*SOURCE: NATIONAL JOINT REGISTRY. WORDS: SAM WORTHING, IMAGES: GETTY IMAGES, SHUTTERSTOCK

Upper body joint replacements are
less common than hip and knee
ones, but generally tend to be
successful. The shoulder is a ball
and socket joint (like the hip), and a
full or partial replacement typically
lasts about 10 years. The elbow is
a hinge (more like the knee) made
up of three bones, and damaged
parts can be replaced by a metal
and plastic hinge. The wrist is a
complex joint involving eight bones,
but where there is severe damage, a
replacement can recover movement
and reduce pain. If you've got any
problems, ask your orthopaedic
surgeon what's right for you.
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