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Pre-assessment Clinic

When you are referred to the Golden Jubilee National Hospital's Orthopaedic Department, your first point of contact will be at the Pre-assessment Clinic that is run by experienced nurses and healthcare assistants.

A Consultant Orthopaedic Surgeon will take details of your medical problem and examine you. A nurse will take blood samples and you will have an electrocardiogram. This helps to determine whether you are medically fit for surgery.

You will also be screened for infection (MRSA, urine infection) and, if the result is positive, a treatment prescribed and you will be re-tested before being admitted to the hospital.

You will then visit the Radiology Department where detailed radiographs will be taken to assist in making the correct diagnosis and forming a detailed treatment plan.

Once a treatment plan has been agreed with you, the process of informed consent starts. This is when you are given a detailed explanation of the planned surgical procedure and the associated risks and possible complications. You will also be told about alternative treatments to surgery. The whole process usually takes two to three hours.

The booking office will send out a letter confirming an admission date. Most patients for major joint replacement surgery are admitted the day before the operation. Patients listed for a knee arthroscopy, hand or foot surgery will be admitted on the day of the operation.

Consideration will be given to urgent operations or special personal circumstances. This must be discussed with the nurse or doctor at the Pre-assessment Clinic.

Admission

After admission, a nurse will visit you to check that all the information gathered at the Pre-assessment Clinic is correct. A physiotherapist will then discuss all exercises that will be used after the operation. An occupational therapist will go through the range of specialist aids - such as crutches - that are available.

On the day of the operation

To reduce the risk of a wound infection after the operation, you will be asked to wash your skin with a special provided antiseptic solution. The nurse will give you a pre-medication that will help relaxing and sleeping before the operation. You will be taken to the pre-operative area about 30 minutes before the operation commences. The nurse will check your identity and review the nursing notes before taking you into the anaesthetic room.

After the operation

The physiotherapist will ensure that you are comfortable and without pain before beginning your daily exercises. You will be encouraged to do these exercises on your own once it is safe to do so. Various walking aids will be provided on the ward.

While some patients may need a night's rest before starting postoperative physiotherapy, early mobilization on the day of surgery has proven to reduce the incidence of problems such as deep vein thrombosis (DVT), bedsores and chest infections. The pain team visits all patients after the operation to ensure adequate pain relief is provided. Most patients will have a small catheter in their hip or knee joint through which the nursing staff injects local anaesthetic to relief the pain arising from the surgery (CALEDonian Technique). This technique has been pioneered in Australia and Denmark and has been used in our hospital since the summer of 2007 with great success.

Nursing staff will check vital signs such as blood pressure and pulse frequently in the first 24 to 48 hours. Medical staff on the ward will also visit at least once daily, while a pharmacist will check the prescribed drugs on a daily basis.

Leaving hospital

When you have met all the necessary criteria - such as good pain control with oral medication, independent transfer in and out of bed, and the ability to climb a few stairs - you will be discharged home. Most patients after hip or knee surgery leave the hospital three to four days after the operation. Patients after hand and foot surgery as well as knee arthroscopy go home in the evening after surgery. If you underwent a reconstruction of the anterior cruciate ligament, you usually stay overnight but some patients go home on the day of surgery.

All necessary medication will be given to you and a member of our arthroplasty outcome team (AOT) will visit and give specific advice about the days and weeks following the operation. A nurse will also show you how to care for the wound and dressings at home.

At home it is important that you continue with all exercises given by the physiotherapist. A member of the AOT will contact you approximately two weeks after the operation and can be contacted directly if you are experiencing any problems.

A district nurse will visit approximately 10 days after the operation to remove the sutures.

Follow-up

A member of the AOT will see total knee replacement patients six weeks after surgery, and total hip replacement patients will be seen 12 weeks after surgery to check their progress.

Radiographs are also taken at this stage and discussed with the patient.

Contact
Arthroplasty Outcome Team (AOT) 0141 951 5521, Monday to Friday 9am -5pm. Urgent out of hours, contact 2 West 0141 9515200 or call 0141 951 5000 and ask for the Senior Nurse on Ward 2 West.

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