Rapid recovery program

This program incorporates changes to traditional care based on the best available research evidence, to improve and accelerate recovery, quickly and safely after your operation.  A safe and early discharge with appropriate follow-ups, results in improved patient satisfaction and lessens infection and thromboembolism.

Enhanced recovery programs are multimodal and focus on the following elements:

  1. Utilising surgical and anesthetic techniques which facilitate early mobility
  2. Excellent multi-modal post-operative pain treatment allowing early patient mobilisation and preventing drug side effects
  3. Intensive post-operative physiotherapy

If you wish to have a day case surgery, please discuss this with Charles and his Anesthetist to make sure you are eligible.

Before your surgery

Choosing a date for surgery

For patients in a lot of pain, we can usually find you an early surgery date which means you don’t have to wait in pain for too long. Many patients will need to make arrangements with family or arrange time off work and typically we will find a surgery date, which is 2-3 months away. There is absolutely no pressure to have surgery until you feel ready.

Surgery cost and quotation for services

For self-funded patients, Charles’ secretary will provide you with a written quotation.

If you have a private insurance, fees are totally or partly covered by your private health fund – please contact your private insurer for further information.

Consent forms

Before accepting surgery, you must be aware of its risks. You’ll find in the section “your surgery” of this website a complete description of the risks related to joint replacement. If you accept to be operated once you’ve understood the potential complications, and we have answered your queries, you’ll have to complete and sign a consent form to authorise Charles to perform the surgery.

Charles collects information about each surgery for the purposes of patient management and research. Charles does research which is published and presented at international meetings. This research makes a valuable contribution to the overall body of knowledge on joint replacement and makes a difference to patients around the world – today and in the future. Patient information is anonymised and patient privacy is not compromised. You will be given a database consent form, which is to be completed prior to your surgery.

The two consent forms (authorisation for surgery and data collection) can be downloaded on this website (section “your surgery”) and will have to be completed and returned to the hospital (*) prior to your admission date.

(*) Charles Riviere’s secretary – The Lister Hospital, Chelsea Bridge Rd, London SW1W 8RH, UK

Anaesthetic

Charles works closely with a small number of expert anaesthetists to optimise the pain relief and recovery after the surgery. The anaesthetist for your surgery will depend on which day your surgery is scheduled. The anaesthetist will usually contact you to discuss your anaesthetic beforehand. You should ask them to provide you with a quotation for their services.

Your teeth

Tooth decay and mouth infections can be a cause of infection in joint replacement. It is very important you talk to your dentist to address abscess and tooth decay prior to having surgery, as infections in the mouth can cause infections in other parts of the body. Even years after you have surgery, it is important to ensure you are vigilant about dealing with decay in your mouth, or any small infections on other parts of your body. Please talk to your dentist, a copy of the current advice from the Arthroplasty Society of UK, which outlines recommendations for mouth care after joint replacement surgery.

Pre-operative testing

You will need to have a chest x-ray, ECG and blood tests done prior to surgery. These are standard tests for all patients. These are usually done 2 weeks prior to your pre-admission appointment. These investigations can be done at The Lister Hospital, at The Medical Chambers Kensington (TMCK), or at a pathology location that is convenient for you. The results are required for your pre-admission appointment. Results need to be back in time for your pre-admission appointment.

Pre-admission clinic

The Lister Hospital will contact you a few weeks prior to your surgery to make an appointment for you at the pre-admission clinic. At this appointment, you will be fully assessed and given all the information you need about your hospital stay and procedure. A general practitioner can be present at your pre-admission appointment if it is necessary. Test results from your chest x-ray, ECG and blood pathology will be discussed with you and your anaesthetist may come see you at the pre-admission appointment.

The day before your admission to hospital a nurse from the pre-admission clinic will contact you after 4 pm, the day prior to your surgery. The nurse will inform you what time you need to arrive at the Lister Hospital and will give you instructions on when to begin fasting (nil by mouth).

Managing your medications

Prior to your surgery we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions. Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery. We will let you know if this is something you need to do.

Aspirin: Baby aspirin (81mg) daily is OK to continue. If you take a full-dose (325mg) aspirin, this must be held for 1 WEEK before surgery.

Medications to notify Charles’ team if you are taking: Anticoagulant other than aspirin & Immunosuppressive medications (methotrexate, prednisone etc.)

Anti-inflammatory medications (Voltaren, ibuprofen, aspirin etc) you should stop these 10 days before surgery as they slow your body’s ability to stop bleeding and tissue healing. However, if you are under a haematologist or cardiologist it is important you check with them that it is safe for you to stop them.

Homeopathic remedies such as Arnica may be taken to reduce bruising.

After your surgery

Going Home

Before going into hospital planning for the recovery period following discharge is essential. You will need help at home for the first few weeks following surgery as your mobility will be reduced and your full energy levels will not have returned. You may find it can take up to two to three months following the operation before you reach your pre-operative energy levels. Help with washing, dressing (particularly shoes and socks), cooking and getting your shopping may also be necessary.

If there is no one available, you might consider home help of some kind or make arrangements to stay for a couple of weeks in a rehabilitation facility. We can advise on these details.

Most patients having joint replacement will need a grabber to assist with reaching and picking things up from the floor, also a useful aid when dressing. Some patients will need crutches to take home (please bring your own crutches into hospital, otherwise the hospital will charge you extra for the use of their equipment.)

You may need the assistance of the occupational therapist if you consider that your home environment poses any difficulties postoperatively.

Rehabilitation centre

Rehabilitation centres are places to ease the recovery. Patients receive physiotherapy, hydrotherapy and occupational therapy sessions tailored to their condition, which enables them to return home with confidence.

If you wish to be discharged to a rehabilitation centre, Charles’ team will recommend you high-quality places to go.

Follow-up appointments

You must have new X-rays done for every appointment. If you are coming to the Lister clinic for your appointment, you can conveniently arrange to have your x-rays done at Lister Imaging immediately before your appointment with Charles.

Your first follow-up appointment will take place 6 weeks after surgery. Charles will look at your x-rays, wound, and range of operated joint mobility. This is an important consultation as most complications happen during the first weeks after a joint replacement.

Other follow-up appointments are also important even if you are not experiencing any problems. This is the opportunity to screen complications before they become symptomatic and concerning.

Self-physiotherapy

After your surgery, you’ll be taught techniques of self-physiotherapy which are the safest and the most efficacious for your joint. Click on the following link to access post-operative physio recommendations:

Regarding sports, swimming is excellent exercise to fasten your recovery. High impact exercise such as running, tennis and squash, should be avoided until 4 to 6 months from the date of the operation. This is to enable the bone to strengthen around your implant.

To improve your comfort after your surgery, Charles performs technique of skin closure where no specific care is needed. Your wound will be consistently closed with sutures under the skin and will dissolve naturally. The medical super-glue on the skin incision will peel off on its own over the next 2 – 4 weeks.  Therefore, you will have no drain, no sutures, nor staples to be removed.

Taking care of your wound

After surgery, you may not have a dressing on your wound as it is rended water-proof by a specific medical glue acting as a dressing. No further nurse care is required for your wound. You are allowed to have a shower the day after the surgery without having to protect the wound, however, avoid submerging it in water (no bath) for 6 weeks.

It is normal to have a small blood collection (hematoma) or oedema around your operated joint. This will progressively move down towards the ankle and the swelling will be reabsorbed over 1 to 2 months.

Preventing infection

Antibiotics are recommended for all patients who have had a joint replacement for the life of the implant when you are undergoing a dental cleaning, extraction, root canal or filling. In other procedures involving skin penetration, or testing involving the gastrointestinal and genitourinary tract, we also recommend preventative antibiotics. It is recommended that you report your joint replacement procedure to any physician you may see.

Work & sports activities

When can I go back to work?

Usually, patients are away from work for anywhere from 4 to 12 weeks.  Decisions to return to work are based on patient progress, unique situation, work type, and patient choice.

When can I resume sports activities?

Individual ability and endurance will differ between patients.  Activities such as swimming, bike riding, golf, hiking, and low impact sports activities can be resumed somewhere between 6 and 12 weeks after hip and knee replacements.  If you enjoy golf, putting and pitching are authorised after 4 weeks, and a full swing at 3 months.

Other sports such as tennis, squash or running should be avoided until 4 months from the date of surgery.

Driving & flying

Driving

If surgery was performed on the right leg, driving is deferred for up to 6 weeks after surgery.  For those patients that are progressing quickly, and are of both pain medications and an assistive device, they can take a “driving test” (brake response test) earlier than 6 weeks.

For left leg surgeries, patients are able to drive when they are on pain medication, no longer require a walker or crutches, and feel safe and comfortable.

For more precise information, please visit the following link: NICE guidelines

Flying

Flying puts you at higher risk of blood clots following major surgery. This is thought not only to be due to prolonged immobility but also due to the drop in atmospheric pressure and oxygen saturation in the blood. Long haul flight (>5h) should be avoided during the first 3 months postoperatively.

If you must fly, prevent blood clot formation by wearing your TED stockings, taking regular walks during the flight, and by taking a junior (75mg) aspirin for 2 days before and on the day of your flight (provided there are no contraindications).

For more precise information, please visit the following link: NICE guidelines

Will my joint set off a metal detector?

It is possible that your hip or knee replacement will set off a metal detector, such as those found in airports.  You will be provided with a card identifying you as a joint replacement patient in the event a metal detector would be activated.  However, airport security may still require more detailed screening.