Why does joint replacement surgery sometimes fail?
There is always the possibility that the body’s self-defence mechanism will reject the ‘foreign body’. As with any transplant or major joint replacement surgery, this must be considered. When this happens, the body rejects the ‘wear particles’ that are produced by the components used in the production of implants. This causes the implants to become loose and an operation to replace them is needed. Very occasionally the joint will become infected and surgery is usually required to replace the implants. On very rare occasions, the components break and require further surgical intervention.
Over-activity may cause wear of the implants. Most patients will be able to go back to normal activities such as walking, sitting or lying down within a year of surgery. Any sports or activities which place more strain on the knee replacement such as long-distance running, skiing or hiking should be approached with caution. It is advisable to discuss such activities with your doctor.
Infections: contracting an infectin is very rare. Steps are taken during surgery to prevent this happening, such as special air-flow in theatre. If it does happen, the infection is treated with antibiotics. In chronic cases, further surgery may be required.
Blood clots/DVTs: This occurs in a small number of patients. Precautions for this include the spinal anaesthetic, injections when in hospital and tablets to thin the blood on discharge, anti-embolic stockings, and early mobilisation.
Post-operative bleeding: due to the type and length of the operation, some bleeding is inevitable. Excess blood is removed via a drain, which remains in the wound overnight. A collection of blood called a haematoma may build up in the wound, which, if large enough, may need surgical removal, although this is extremely rare.
When the procedure has been completed you will be moved into the Post Operative Care Unit (Recovery Ward), where the nurses will monitor your blood pressure and heart rate, and control any pain you have by medication prescribed by the anaesthetist. Once your observations and pain are stable, you will be taken back to the ward, where the nurses will continue to monitor you. If you have any pain, be sure to inform the staff of your discomfort.
You will be given intravenous fluids, which may include antibiotics, prescribed as a measure to prevent infection. You will also have three plastic suction tubes inserted into the wound to drain excess blood from the area. There will be a bulky dressing over the wound, which will be reduced when you begin mobilisation.
You will keep the TED stockings on and you will also receive a daily injection or tablet to prevent DVT.
Your rehabilitation starts in hospital. A physiotherapist will get you up and show you various stretching and strengthening exercises which are essential for your recovery. You will also be given advice on practical ways to adjust your lifestyle for the first few months after your surgery.
You will be discharged from hospital 2-3 days after surgery. By this time you should be fairly mobile and able to climb stairs with the aid of your crutches. Before going home, you will be given an appointment to see your orthopaedic surgeon in two weeks time. Your GP will be sent a letter giving information of the procedure that was performed and your condition on discharge. It is vitally important that you continue with physiotherapy on an out-patient basis, and you will be contacted with regards to an appointment for this. You will be discharged on medication to prevent a DVT. At your two week appointment your progress will be checked.
Generally, you may drive again six weeks after surgery. Please contact your insurance company to confirm specific details.
It usually takes about three months for the knee to start to feel normal again, though you should find that even on discharge from hospital you can function better than before the operation.
For the first four weeks after the operation you will need to walk with the aid of crutches. After this you will be able to gradually wean yourself off them, going from two crutches to one, and then to a stick, used on the non-operated side.
By six months, you will have completed about 90% of your improvement; but remember, your knee replacement can still improve, albeit slowly for up to 12-18 months. The long term outcome for your surgery is extremely good. Due to modern replacement implants, more than 90% of implants are still functioning at 10 years.
After joint replacement surgery, aggressive antibiotic treatment is recommended. The main reason for this is that an infection can be transmitted from elsewhere in the body directly to the prosthetic implant.
Antibiotic treatment is advisable and highly recommended if you undertake any of the following;
- Dental procedures
- Gastro-intestinal/genitor-urinary endoscopic examinations, catheterisation or surgical procedures.
- Any infectious condition resulting in a bacterial infection
- Septic lacerations
Where possible, intramuscular injections or vascular catheterisation in the area of the prosthesis should be avoided.
You will be seen by a physiotherapist, who will assess your physical condition and prepare a programme to assist in your post-operative recovery. You will also be measured for crutches.
Tips for daily activities
During your stay in hospital, a physiotherapist will give you practical tips on how to adjust your lifestyle for the first three months after the operation.
You have undertaken major surgery and need to take things easy for the first six weeks. This means:
- No bathing until the wound is completely healed, usually about two weeks after surgery. Try a strip wash or shower instead.
- Don't drive until you have been told you can by your doctor
- Use an armchair with arms that will support your weight.
- stand on your good leg first - avoid putting your full weight on your operated leg when you stand up
- Don't forget to do your exercises- this is very important for your recovery. If exercising causes alot of pain, ask for more pain medication, as the exercises need to be done regularly.