Advice on Frequently Asked Questions (FAQs)

Appointments

1. Do I need a referral to see you in clinic?

For both the NHS and the private sector you will require a referral. 

As an NHS patient your GP can organize this through the system of Choose and Book. 

You can be seen either in the General Hospital or at the Three Shires.

In the Private sector your GP can refer you directly and this is covered under the appointments section.


2. How long will I wait to see you in clinic?

In the NHS your appointment is governed by the 18 week pathway. Your wait will vary according to time of year but will usually be 9 -11 weeks in Northampton General Hospital and around 4-6 weeks in the Three Shires as part of the choose and book system

In the private sector as a private patient we will see you within a few days. 

We will always try to accommodate urgent appointments if you ring on the day of clinic.

3. Can I transfer back to the NHS?

If you wish to transfer back to the NHS it is possible. 

However you will be required to wait as if you were a new patient being referred into the NHS. 

This will mean you will wait 18 weeks at least for any surgery.

4. Can I transfer to the private sector?

You can transfer to the private sector at any time during your treatment. If you are uninsured you will need to discuss the cost of you surgery with the BMI Three Shires Hospital. 

They offer a range of options for payment.

Anaesthetic

1. Who will my anaesthetist be?

In the NHS and the private sector the anaesthetist will vary for each list.

In the private sector I utilise the services of the Northampton Anaesthetic Practice (NAP) which comprises consultants with practicing privileges at the Three Shires hospital.

In either setting you will meet your anesthetist on the day of your surgery.



2. Can any operations be done with local or mild anaesthetic, i.e. not general?

Hip and knee replacements and arthroscopy cannot be done under local anaesthetic in the true sense.  

All these operations require a form of general anaesthetic.  A spinal anaesthetic is a form of general anaesthetic in which you can remain awake, and this may be offered to you.

For this your body is anaesthetized from the waist down after a needle is inserted into the spinal canal and local anaesthetic injected. This paralyzes the nerves to the legs for a short period (a few hours) which is more than enough for your operation.

Some patients do not like the idea of being a wake for the operation. You can be sedated as well as having the spinal and this will allow you to sleep through the operation for a short time.


3. Will I feel pain after the operation?

You will experience discomfort but will not experience severe pain.

You may be provided with a pump containing strong pain killer (typically morphine).  

You can administer this yourself and it is impossible to overdose yourself. The pump administers small preset doses of painkiller and once it has administered one dose you cannot administer another for typically 5 minutes.  

By using the pump as needed you can control your own pain relief.


4. What type of anaesthetic will I have?

The type of anaesthetic you have is discussed between you and the anesthetist. 

You will require a form of general anaesthetic. This will depend on other medical problems you may have.


Surgery

1. How long will I have to wait for my operation?

If you are having surgery within the NHS the time that you wait is now governed by a process called the 18 week pathway. 

This will mean that we would try to complete the time you receive surgery within 18 weeks of referral from you general practitioner. 

Within the General Hospital this unfortunately stretches out to 18 weeks but as an NHS patient in the Three Shires it may be alot less. 

If you are having private treatment you will receive surgery between 2 and four weeks following you referral however we will always try to accomodate your wishes.


2. How long will I stay in hospital for hip/knee replacement/revision?

The time patients spend in hospital will obviously vary from individual to Individual. A typical stay is 2-4 days.

There is no time limit for which a patient has to stay but you will stay until you are confident and safe walking with crutches, can climb stairs (if you have them at home) and can care for yourself.



3. How big will the scars be?

The size of the scar does vary with individuals. 

Typically for a hip replacement or resurfacing it will be 15 centimeters long and for a knee replacement 20 centimeters long. 

These are rough estimates however and your scar will be as long as needed to safely carry out your operation. Click on knee or hip to see a picture of a typical scar three days after surgery.


4. How many of these operations do you perform each year?

I perform between 300 and 400 joint replacements each year as a combination of both hips and knees


5. Can I have both knees or hips replaced at the same time?

Bilateral, synchronous, surgery i.e. both sides at the same time, carries increased risks of complications. 

For this reason it is not carried out routinely. 

However it is possible for knee surgery but generally requires the surgeon to operate in a staggered fashion so the overall surgery time is not excessive. 



Post-Operation Recovery

1. How long before I can walk after hip/knee replacement/revision?

You will get out of bed the first day after your operation and walk with the aid of the physiotherapists.

Although there will be discomfort from the surgery, the difference from the pre-operative state will be amazing.


2. How long before I can drive after hip/knee replacement/revision?

Driving a car after a hip or knee replacement depends on your ability to control the vehicle and some basic care of your new joint particularly with a hip replacement. 

With a hip replacement the pitch of the driver’s seat means that your new hip replacement would need to be protected from dislocation for 6 weeks.  

With a larger diameter hip replacement your return to driving can be earlier within 3 to 4 weeks. This is due to the increased stability you gain from such types of replacement. You should discuss this after your surgery.

With a knee replacement there is no risk of dislocation however you still need to be able to control the vehicle. As a general rule it is best to ask for confirmation.


3. How long before I can have sex after hip/knee replacement/revision?

At least six weeks for both men and women is a safe period to refrain from sexual activity after a hip replacement. The largest concern would be the risk of dislocation of you new hip.

With a knee replacement certain sexual positions would be difficult to accomplish as kneeling after a knee replacement is both painful and difficult.


4. How long until stitches come out?

The surgical wound for both hip and knee replacement is closed with surgical clips. These are removed at 10 days.  

If you have gone home they will be removed by the NORTH team (for NHS patients) or at Three Shires Outpatients (for private patients) or with the nurse at your GP surgery if they are happy to do so.


5. How long until I can exercise / play sports / visit gym (weights training) after operations?

For an ordinary hip replacement a period of at least 6 weeks away from sports will be required. 

If you have had a larger diameter hip replacement then an earlier return to the gym or to swimming for light exercise at 4 weeks is possible.

For knee replacement as soon as you are comfortable you can return to the gym. It may actually be beneficial to increasing your range of movement.


6. Will I need physiotherapy? Typically how many sessions?

As an inpatient you will be shown exercises and provided with exercises to do from the physiotherapists. You should follow these exercises.

At the Three Shires as an NHS patient you will be offered further physiotherapy on an outpatient basis for four weeks

At the General Hospital The need for physiotherapy will differ from patient to patient and if necessary you will be provided with additional outpatient physiotherapy. 

The time you spend in this will depend upon how you progress and the number of sessions will be decided by the physiotherapist.



Complications

1. What happens if I have a complication?

If you have a complication that requires further surgery we will admit you and deal with it as soon as possible. 

If you are insured this will be covered by you insurance company. 

If you have paid a package price it is covered under the terms of the package. 

If you are within the NHS we will admit you to the NHS as soon as possible.


2. What is your rate of dislocation for hip replacement?

I have performed over 2500 hip replacements in all my career and have had 20 dislocations. 

In other words my rate for dislocation is very much less than 0.5%
(March 2013).



3. What is your deep infection rate for joint replacement?

I have had 12 deep infections that I am aware of all have required two stage revisions that I am aware of for all hips and knees that I have performed.


4. What about MRSA?

Prior to your operation you will be swabbed to screen you for MRSA. 

If you are found to be a carrier for MRSA you will need to be treated to try to eradicate it prior to your surgery.  

If it cannot be eradicated we will need to discuss the risks and administer specific antibiotics during surgery to reduce the risk of an MRSA infection to you.


General

1. How long does the replacement joint typically last?

Typically a hip or knee replacement will last 15 -20 years.  

The life expectancy of a joint replacement does vary with the age of the patient into which it is being inserted. This is why we choose different hip replacements for very young patients


2. How soon after my surgery can I fly in a plane?

There are no strict guidelines in relation to this.  

All major lower limb surgery exposes patients to the risk of deep vein thrombosis (DVT). 

Flying on long haul flights has also been associated with a risk of DVT. 

General advice would be to delay flights for six weeks and this would fit well with your recovery from a hip or knee replacement and your ability to mobilize after your operation.


3. Will my new joint replacement set off the metal detectors in the airport?

A recent survey has shown that a single joint replacement is unlikely to set off the airport metal detectors.  

The advice from the British Airport Authority is that they would still stop and search an individual if they set of a detector regardless if the individual stated they had had a joint replacement. 

They also state individuals who have had joint replacements do not require a card to state they have had a joint replacement. 

If the detector is set off they will search you regardless.