Your Hip or Knee Replacement — What to Expect

Stage 1

Pre-operative Assessment

Before any joint replacement surgery, you will attend a pre-operative assessment clinic — a dedicated appointment with a specialist nurse, usually two to four weeks before your operation. The purpose is to ensure you are as fit as possible for surgery, to identify and address any health issues that could increase operative risk, and to give you a thorough briefing on what to expect.

This appointment is important and should not be missed. It is your opportunity to ask questions, raise any concerns, and ensure that nothing is left uncertain before your admission day. The pre-assessment nurse will typically spend 60–90 minutes with you.

Medical History & Medications

A full medical history is taken, including past operations and any existing conditions such as diabetes, heart disease, respiratory conditions or kidney problems
All current medications are reviewed — including over-the-counter medicines, supplements and herbal remedies
Blood-thinning medications (warfarin, apixaban, rivaroxaban, clopidogrel) will need to be stopped in the days before surgery — specific instructions will be given
Diabetes medication may need adjustment around the time of surgery — your GP and the pre-assessment team will advise
Any known drug allergies are recorded

Investigations & Tests

Blood tests — including full blood count (to check for anaemia), kidney and liver function, clotting screen and blood group
Urine dipstick — to screen for urinary tract infection, which must be treated before surgery to reduce infection risk
Electrocardiogram (ECG) — to assess heart rhythm, particularly in older patients or those with cardiac history
Chest X-ray if clinically indicated
MRSA swabs — nose and groin swabs to screen for carriage of MRSA; decolonisation treatment is given if positive
Anaemia is identified and treated proactively — iron supplementation started early if haemoglobin is low

Optimising Your Health Before Surgery

Weight — if you are significantly overweight, losing even a modest amount before surgery reduces anaesthetic risk, infection risk and blood loss
Smoking — you will be strongly advised to stop smoking before surgery; smoking significantly increases wound healing problems, chest complications and infection risk
Alcohol — excessive alcohol intake increases bleeding risk and anaesthetic complications; reducing intake is advised
Dental hygiene — active dental infections must be treated before joint replacement surgery; see the specific advice section below
Skin conditions — any active skin infections, eczema or psoriasis over the operative site need to be treated before surgery

Practical Preparation

Consent — informed consent for your procedure is usually taken at your pre-operative consultation with Mr. Lodge, and confirmed again on the day of surgery
Fasting instructions — you will be given specific "nil by mouth" instructions; typically no food for six hours and no clear fluids for two hours before your anaesthetic
What to bring — any regular medications, a dressing gown, suitable loose clothing and footwear for mobilising after surgery
Discharge planning — it is important to confirm your discharge arrangements in advance; you will need a responsible adult to collect you and stay with you for the first 24 hours at home
Home preparation — consider practical arrangements at home: raised toilet seat, bath board or shower stool, removal of trip hazards

Please inform the pre-assessment team of any changes to your health between your pre-assessment appointment and your admission date — particularly any new infections, illnesses, or changes to your medications. A new infection in the days before surgery may require the operation to be postponed to protect the new joint replacement from contamination.

Stage 2

Anaesthetic Options

Hip and knee replacement surgery can be performed under either spinal anaesthesia or general anaesthesia. Mr. Lodge works closely with a dedicated team of consultant anaesthetists who will discuss the most appropriate option for you at your pre-operative assessment and again on the morning of your operation.

The choice of anaesthetic is a shared decision between you, the anaesthetist and Mr. Lodge — informed by your medical history, your preferences and the planned procedure. In many cases, a combination of techniques is used to optimise pain control and recovery.

Spinal Anaesthesia

Mr. Lodge's preferred approach where suitable

A fine needle is used to inject local anaesthetic into the fluid surrounding the spinal cord in the lower back, numbing the lower half of the body completely
You remain conscious but feel nothing below the waist; sedation is routinely offered to ensure you are relaxed and comfortable throughout
Takes effect within minutes and typically lasts 2–4 hours, providing excellent pain relief into the early post-operative period
Associated with lower rates of blood loss compared to general anaesthesia, due to the mild reduction in blood pressure it produces
Reduced post-operative nausea and vomiting — patients typically feel well enough to eat and drink sooner after surgery
Evidence supports lower 90-day readmission and revision rates compared to general anaesthesia in large arthroplasty registry studies
Allows earlier mobilisation — most patients can begin standing and walking within a few hours of surgery
Not suitable for all patients — those with certain spinal conditions, blood clotting disorders or who are taking certain medications may not be candidates

General Anaesthesia

Appropriate in selected patients or by preference

You are rendered fully unconscious and unaware of the procedure from induction until the anaesthetic wears off in recovery
Delivered via intravenous drugs and/or inhaled gases, carefully titrated by the anaesthetist throughout the operation
Appropriate where spinal anaesthesia is contraindicated, technically difficult, or where the patient has a strong preference for being fully asleep
Modern general anaesthesia is very safe — the anaesthetist continuously monitors heart rate, blood pressure, oxygen saturation and depth of anaesthesia
Post-operative nausea and vomiting is more common than with spinal anaesthesia, though modern anti-emetics are highly effective
Pain management after surgery relies more heavily on oral and intravenous analgesics rather than the residual effect of spinal anaesthesia
Recovery from general anaesthesia typically takes slightly longer than from spinal, though most patients are mobilising within hours

Local Infiltration Analgesia & Nerve Blocks

Regardless of the primary anaesthetic technique used, Mr. Lodge routinely performs local infiltration analgesia (LIA) at the end of surgery — injecting a combination of local anaesthetic, anti-inflammatory and vasoconstrictor agents into and around the operative site. This provides powerful, targeted pain relief in the immediate post-operative period, reducing the need for strong opioid painkillers and contributing to faster recovery.

For knee replacement surgery in particular, peripheral nerve blocks — such as an adductor canal block or genicular nerve block — may be added by the anaesthetist to further reduce post-operative pain while preserving the motor function of the quadriceps, which is needed for early mobilisation. The combination of spinal anaesthesia, LIA and a peripheral nerve block represents the most effective multimodal analgesia strategy currently available for knee arthroplasty.

What to Expect on the Day of Admission

You will be admitted on the morning of your operation in the majority of cases. After changing into a surgical gown, you will be seen by Mr. Lodge and the anaesthetist, who will confirm the operative plan, answer any last-minute questions and check your consent. Compression stockings will be placed on your legs. You will then be taken to the anaesthetic room adjoining the operating theatre, where your anaesthetic will be administered. The operation typically takes 60–90 minutes.

After surgery, you will be transferred to the recovery room, where you will be monitored by recovery nurses until fully awake and stable. Most patients then return to a standard ward, though some may go to a higher-dependency area overnight if clinically indicated.

Stages 3 & 4

After Your Operation — In Hospital

The immediate post-operative period is managed within a structured Enhanced Recovery After Surgery (ERAS) pathway — a evidence-based programme designed to optimise every aspect of care in the hours and days following surgery to minimise complications and facilitate the fastest possible safe recovery.

Pain Management

Effective pain control is central to rapid recovery — patients who are comfortable mobilise earlier, breathe more deeply and leave hospital sooner. Pain after joint replacement is managed using a multimodal approach, combining several different analgesic techniques rather than relying on any single drug:

Residual spinal anaesthetic — provides excellent pain control for the first 2–4 hours after surgery.
Local infiltration analgesia — injected at the time of surgery, providing targeted relief around the wound.
Regular paracetamol and anti-inflammatory medication — given around the clock as a base layer of analgesia.
Short-acting opioids (e.g. oxycodone or tramadol) — used for breakthrough pain and gradually withdrawn as recovery progresses.
Ice therapy — applied to the operative site regularly to reduce swelling and provide local pain relief.

It is important to take your pain medication regularly and as prescribed, particularly in the first few days. Pain that is well-controlled allows you to engage fully with physiotherapy, which is the key determinant of a good functional outcome.

Blood Clot Prevention (VTE Prophylaxis)

Joint replacement surgery significantly increases the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). A comprehensive prevention strategy is used to reduce this risk to a minimum:

Thromboembolic deterrent (TED) stockings — fitted before surgery and worn on both legs throughout the hospital stay.
Calf compression devices — pneumatic devices that intermittently squeeze the calf muscles during and after surgery to maintain venous blood flow.
Low molecular weight heparin (LMWH) — a daily injection given from the evening after surgery. For hip replacement, this is continued for 28 days; for knee replacement, for 14 days, in line with NICE guidelines.
Early mobilisation — the most effective DVT prevention measure of all. Walking activates the calf muscle pump, driving venous blood flow back towards the heart and preventing stagnation in the deep veins.
Good hydration — adequate fluid intake keeps blood viscosity low and reduces clotting risk.

Physiotherapy & Early Mobilisation

Physiotherapy begins on the day of surgery itself — or at the very latest on the morning after. A physiotherapist will visit you on the ward, help you to stand, and begin gentle walking exercises with the aid of a frame or crutches. This early mobilisation is not merely encouraging — it is essential to the success of the procedure.

Before you are discharged, the physiotherapy team will ensure you can safely manage stairs, get in and out of bed independently, and are confident walking with your walking aid. For knee replacement patients in particular, achieving a satisfactory range of flexion before discharge is an important goal of the inpatient physiotherapy programme.

Wound Care & Discharge

The wound is closed in layers using absorbable buried sutures with wound glue over the wound to achieve a watertight closure. Very rarely, allergic reactions can occur to the glue — this typically presents as a rash. Whilst it is important to get this reviewed, it is typically very easily and quickly managed with a low-dose topical steroid cream. Please make your surgeon aware if you have had reactions to topical skin glues with previous surgeries, or equally to nail glues used for cosmetic nail extensions. A waterproof dressing is then applied and left intact until your first post-operative review at approximately two weeks. You must keep the wound clean and dry — no baths, swimming or soaking the wound until it has fully healed and the dressing has been formally reviewed.

Most patients are discharged home within one to three days of surgery, once they are independently mobile with a walking aid, pain is well-controlled on oral medication, there are no signs of early complications, and safe discharge arrangements are in place. Some patients — particularly those who live alone or have limited support at home — may stay slightly longer.

Signs that require prompt medical attention after discharge: increasing redness, warmth, swelling or discharge from the wound; calf pain, swelling or redness not present at discharge; a temperature above 38°C; new shortness of breath or chest pain; any concern about wound healing. If in doubt, contact the ward, Mr. Lodge's secretary or attend your nearest emergency department. Do not wait and hope it resolves on its own.

Stage 5

Recovery at Home

The recovery journey continues long after discharge. The weeks and months at home are where the real work of rehabilitation takes place — and where your commitment to physiotherapy, activity and self-management will most directly influence your final outcome.

Days 1–14

Immediate Home Recovery

Rest is important but movement is essential. Walk little and often throughout the day — a short walk every hour or two is far better than staying in a chair for long periods. Keep the wound dry and covered. Take your pain medication regularly as prescribed. Continue your LMWH injections as directed. Sleep in a position that is comfortable; most patients find sleeping on their back or the non-operated side easiest initially.

Week 2

First Post-operative Review

Your wound will be reviewed at approximately two weeks — either in the clinic or by a district nurse at home. The dressing is changed or removed, the wound is assessed, and any stitches or staples are removed if used. You will receive an update on how your recovery is progressing and any specific guidance for the coming weeks.

Weeks 2–6

Building Strength & Independence

Outpatient physiotherapy begins, focusing on strengthening the muscles around the new joint and improving range of movement. You will be walking with one crutch or a stick, and gradually increasing your walking distances. Most patients can begin driving again at six weeks, once they can perform an emergency stop safely and are no longer taking strong opioid pain medication — always check with Mr. Lodge before returning to driving.

Weeks 6–12

Return to Normal Activity

By six to twelve weeks, most patients are walking freely without a stick and managing stairs, dressing and daily activities independently. Hip replacement patients often find recovery feels more complete at this stage than knee replacement patients, where swelling and ongoing stiffness may persist. Continue your physiotherapy exercises diligently — the work done in this period has a lasting influence on the final outcome.

3–12 Months

Full Settlement

Hip replacement patients typically feel fully recovered between three and six months. Knee replacement patients may take six to twelve months for the joint to feel fully settled — this is normal and does not indicate a problem. Residual swelling, occasional aches and sensitivity around the scar are all common in the first year and gradually resolve. A formal follow-up X-ray review is arranged at six weeks and six to twelve months after surgery.

Activity after joint replacement: Low-impact activities — walking, swimming, cycling, golf and gentle doubles tennis — are encouraged. High-impact activities such as running, contact sports and heavy lifting are generally discouraged as they accelerate bearing wear. If you are unsure whether a particular activity is safe for your new joint, please ask Mr. Lodge at your follow-up appointment.

Advice Specific to Joint Replacement

Important Guidance for Arthroplasty Patients

There are a number of specific situations that arise commonly after joint replacement that are important to understand. The following guidance covers flying before and after surgery, and the important topic of dental treatment and joint replacement.

Flying Before Surgery

If you are planning a flight in the weeks or months before your joint replacement, this is generally not a concern — provided you are not within the high-risk window immediately before surgery. However, flights within four to six weeks of your planned operation should be discussed with Mr. Lodge, as the elevated DVT risk associated with long-haul flying in a patient who is already likely to have reduced mobility due to arthritis may warrant additional precautions.

If you have a long-haul flight planned close to your surgery date, your operation date may need to be adjusted. Always inform Mr. Lodge's secretary of any planned travel so it can be taken into account in your surgical planning.

Flying After Surgery

Flying after joint replacement surgery is associated with an elevated risk of DVT due to the combination of prolonged immobility, a hypercoagulable post-operative state, and the cabin environment. There is no single universally agreed waiting period, and recommendations vary between surgeons and airlines.

Mr. Lodge's guidance is as follows:

Short-haul flights (<4 hours): Avoid for a minimum of 6 weeks after surgery in uncomplicated patients without additional VTE risk factors. Patients with additional risk factors (previous DVT/PE, obesity, clotting disorders, malignancy) should wait at least 12 weeks.

Long-haul flights (>4 hours): Avoid for a minimum of 12 weeks after surgery in uncomplicated patients. Patients with additional VTE risk factors should ideally wait 6 months. A study examining consensus among UK arthroplasty surgeons found a median advised waiting time of 90 days for both short- and long-haul flights in patients with one or more VTE risk factors.

When flying does resume, take the following precautions: stay well hydrated, walk the aisle regularly, perform calf exercises in your seat, wear compression stockings, and consider aspirin on the day of travel (discuss with Mr. Lodge first if you are on other blood-thinning medications).

Dental Treatment & Your Joint Replacement

This is one of the most frequently asked questions after joint replacement surgery, and it is important to understand both the risk and the current guidance clearly.

The concern is that bacteria entering the bloodstream during dental procedures — particularly invasive dental work such as extractions, deep cleaning (scaling and root planing), implant placement or other procedures that cause bleeding — could travel in the bloodstream and settle on the surface of the joint replacement, causing a periprosthetic joint infection (PJI). This is known as haematogenous seeding.

PJI arising from a haematogenous source is a well-recognised but uncommon phenomenon. The lifetime risk of late haematogenous PJI after joint replacement is estimated at less than 1%, and the proportion attributable specifically to dental procedures is very small. Nevertheless, the consequences of PJI are serious — potentially requiring major revision surgery — and the question of how to manage dental care in joint replacement patients is one that has attracted considerable attention.

Current Guidance — Before & After Your Joint Replacement

Before surgery: Any active dental infections, decayed teeth or active gum disease should be treated and resolved before joint replacement surgery. The mouth is one of the commonest sources of bacteraemia (bacteria entering the bloodstream), and operating on a joint in the presence of active dental sepsis is inadvisable. If you have not seen a dentist recently, you are strongly encouraged to have a dental review before your operation date. You should not have any dental instrumentation within 4 weeks of your planned procedure.

Immediately after surgery: Elective dental treatment should be avoided for a minimum of 3 months after joint replacement surgery for a routine check-up, and ideally 6 months for any more significant intervention such as fillings and root canal treatment. During this period the new implant surface is at its most vulnerable to haematogenous infection as it is not yet fully integrated into the surrounding bone and tissue.

Longer term: The British Dental Association (BDA) and British Orthopaedic Association (BOA) joint guidance no longer routinely recommends antibiotic prophylaxis before dental procedures for all joint replacement patients. The current consensus is that routine antibiotic cover is not necessary for most standard dental procedures in healthy, immunocompetent patients with a well-functioning joint replacement. However, for patients who are immunocompromised — including those taking long-term steroids, disease-modifying drugs for rheumatoid arthritis, chemotherapy, or those with diabetes — the threshold for antibiotic prophylaxis before invasive dental work is lower, and individual assessment is recommended.

What you should always do: Inform your dentist that you have a joint replacement before any dental procedure. Good oral hygiene throughout the lifetime of your joint replacement is the single most effective preventive measure — healthy gums and teeth reduce the frequency of bacteraemia significantly. If you develop any dental abscess or active dental infection at any time, seek prompt dental treatment and inform Mr. Lodge's secretary, as antibiotic cover during treatment may be warranted in your individual case.

Tell your dentist about your joint replacement: Always inform your dentist before any dental procedure that you have had, or are planning, a hip or knee replacement. This applies whether the procedure is routine or more involved, and allows your dentist to take the most appropriate steps to minimise the risk of bacteraemia at a time when your joint may be vulnerable.

Long-term Care

Follow-up & Long-term Review

Joint replacement is not a single event — it requires long-term monitoring to ensure the implant remains functioning well and to detect any early signs of problems before they become significant.

Mr. Lodge's standard follow-up schedule after primary joint replacement is a wound review at two weeks, a clinical and X-ray review at six weeks. Routine follow-up beyond this point may not be required depending on your progress, and a patient-led approach to follow-up is typically adopted thereafter — meaning you are encouraged to get in touch if you have any concerns, rather than attending scheduled appointments routinely.

If at any point between appointments you have concerns about your joint — pain that is worsening, a change in the character of symptoms, swelling or instability — please contact Mr. Lodge's secretary rather than waiting for your next routine appointment. Early assessment is always preferable to delayed investigation.

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