About the Hip and Knee Joint Operation
A joint replacement involves inserting an artificial joint. Joint replacement surgery is needed when the joint becomes worn out, usually due to arthritis. The surgeon removes the damaged ends of your joint and replaces it with an artificial implant. The specially designed metal and plastic parts are custom fit to your joint to restore smooth and painless movement.
Hip replacement
A hip joint replacement means replacing one or both sides of the hip joint with an artificial socket and a metal ball and stem.
Knee replacement
A knee joint replacement means replacing one or both sides of the knee joint and often the underside of the knee cap.
If you require any
equipment to assist you when you go back home, please plan to have it delivered to your home prior to your discharge.
Integrated Comprehensive Care for your Joint Replacement Surgery
You will be supported by
one UHN health care team that includes you!
Your health care team will work with you to ensure you have a safe seamless care experience that prepares you for your recovery at home. This includes your rehabilitation at one of UHN's
Altum Health clinics. Altum Health is a part of UHN and has 11 clinics in cities across Ontario.
Monitoring your Progress
To help us understand how you are doing before and after surgery, we will collect information from you using surveys called 'patient reported outcome measures' or PROMs. This information will help us to plan the best possible care for your unique needs.
You can complete your PROMs at home using a secure online link that will be emailed to you with your unique username and password. Alternatively, you may complete your PROMs during your clinic visit using an iPad that will be provided to you.
You will complete your PROMs at:
- Pre-Admission visit before surgery
- 6 weeks after surgery
- 3 months after surgery
- 1 year after surgery
You will receive a reminder by email to complete your PROMs.
Pre-admission Visit
If you are having a knee replacement, do not shave the hair on your legs 5 days before your operation.
Usually
2 to 3 weeks before your operation, you will have a pre-admission appointment at Toronto Western Hospital. This appointment can take
from 2 to 5 hours. You can eat before your appointment (and you may want to bring a snack), unless your doctor has told you not to.
Pre-Admission Clinic
Toronto Western Hospital
Main Pavilion – 1st Floor
TWH Maps & Directions
What should I bring to my Pre-Admission appointment?
- Your health card (OHIP card) or other insurance (if applicable).
- Credit card if you plan to have a private or semi-private room during your hospital stay after surgery.
- Your "co-pilot": spouse/partner, a trusted friend or family member (to offer you support and be a second set of ears).
- All the medications you take in their original containers. This includes prescription medications, over-the-counter medicines, vitamins, supplements and herbal or natural products.
- A list of any questions that you may have about the operation and recovery.
- Name and phone number of any medical specialists that you have seen in the past 3 years. If you have had a cardiac stress test, echocardiogram and/or a pulmonary function test in the past 3 years, it would be helpful to bring a copy of the final report with you to this appointment.
- A copy of your history and physical form filled out by your family doctor, and any relevant test results.
- Name and phone number of your family doctor and pharmacy.Patient Reported Outcome Measures (PROMs), completed online prior to appointment (if able).
What happens during my pre-admission visit?
- You will have blood tests and routine skin swabs.
- The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
- You may also need an
electrocardiogram (ECG) to check your heart and a
chest x-ray to check your lungs.
- You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have.
- A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for cleaning your skin, eating before operation, taking your medications and pain management.
- An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after operation.
- A pharmacist will review your medications.
Depending on your needs, you may also meet:
- A member of the medicine team, if you have other complex health problems.
- A Clinical Nurse Specialist (CNS), or Nursing Coordinator, who specializes in the care of patients having your specific operation. They will review any preparation that is required before your operation, plans for discharge home after operation and specific instructions regarding your recovery.
You will attend a 1 hour education class that will review every step of your surgical journey with UHN. You will meet members of your care team at UHN who will be able to answer any additional questions you may have about your surgery.
When do I start taking a chlorhexidine shower?
- Chlorhexidine is an antiseptic soap that will help clean your skin, and help lower the chance of an infection.
- Start taking a chlorhexidine shower every day, starting 4 days before your operation, and on the morning of your operation. You will take a total of 5 chlorhexidine showers.
- You can buy this soap (also called Stanhexidine or Chlorhexidine Wash 2%) at the Shoppers Drug Mart in Toronto Western Hospital.
How do I take a chlorhexidine shower?
- Use the chlorhexidine soap from your neck to feet, washing the groin and anal areas last. Rinse the soap from your body.
- Use your usual soap/shampoo on your face and hair. Chlorhexidine can irritate your eyes and ears.
- Use a clean towel each time to dry yourself. Dry the groin and anal areas last.
- Do not use any lotion or powder after your shower.
- If your skin becomes irritated by the chlorhexidine soap, go back to your usual soap.
Day Before Your Operation
What should I do the day before my operation?
-
DO NOT eat any solid foods or milk products after midnight on the night before your operation.
- Only drink clear fluids 4 hours prior to your operation. Examples of clear fluids you can drink include: apple juice, beef or chicken broth (no noodles or vegetables), Jell-O or popsicles, water, cranberry juice, pop (ginger ale, 7-Up), lemonade and tea.
TIP: By drinking warm fluids such as tea or broth you may not feel as hungry.
- You must have a shower with soap and water to clean your skin the night before and the morning of your operation to reduce the chance of infection after your operation. Read more about
cleaning your skin.
- Remove all nail polish and body piercings.
- If you smoke, do not do so for 24 hours before your operation.
- Do not drink alcohol for 24 hours before your operation.
Day of Your Operation
Arrive
3 hours before your scheduled operation time:
Pre-Operative Care Unit (POCU)
Toronto Western Hospital
Fell Pavilion – 2nd Floor, Room 116
TWH Maps & Directions
All hospital entrances are open by 6 am, however the Leonard entrance (between Nassau and Wales) is easiest to access.
What do I need to bring with me to the hospital?
- Wallet
- Toiletry items
- Loose fitting clothes
- Loose, non-slip closed footwear to accommodate for swelling (other than slippers)
- Current prescription medication
- 2-wheeled walker
What will happen before my operation?
- We will take your temperature, pulse, check your breathing, blood pressure, and do any other tests at this time.
- You will change into a hospital gown. Any belongings you do not need should be sent home with your family members.
- Your surgical team will interview you when you arrive in the surgical patient waiting area.
- The surgeon will mark the location for the joint replacement surgery on your body.
- Once in the operating room, we will help you onto the operating room table and you will be kept warm with a blanket.
- We will put a blood pressure cuff on your arm and an oxygen monitor on your finger.
- We will register your heartbeat on a heart monitor. A plastic mask will be placed over your face to give you oxygen.
- We will give you medicine through an intravenous line. You will need the intravenous line for a couple of days.
Will I be given anesthesia?
- The anesthesiologist will talk to you about the anesthesia that will be used for surgery.
- Regional anesthesia is typically used for this operation. This involves injecting anesthetic (freezing) medication directly into the part of your body being operated on.
- Regional anesthesia lowers the chances of side effects, such as nausea, sleepiness, sore throat and constipation, which may accompany other anesthetic options.
After Your Operation
On this page, you can read all about what to expect during your hospital stay. Or, just click on one of the links below, to get the answer you want right now.
What will happen right after my operation?
- You will be taken to the Post Anesthetic Care Unit (PACU) and stay there for 1 – 2 hours.
- We will check your vital signs, level of consciousness and dressing.
- We will check the colour, sensation, and movement of your toes.
- You will receive pain medication and start patient controlled anesthesia (PCA).
- Ice packs will be put on your joint.
- Once you are fully recovered from your anesthetic and your vital signs are stable, you will be moved to the 9A Inpatient Unit in the Fell Pavilion.
- You will be attached to some or all of these tubes:
IV – We usually take the IV out as soon as you can drink fluids.
Oxygen – Oxygen helps you breathe. We use either nasal prongs or a clear plastic mask. - Once you are eating and drinking, we will prescribe pain pills that can be taken as needed.
How long will I stay in the hospital?
You will be ready to go home on the same day, or the day following your surgery.
What discharge information do I need to know?
Your doctor will have already given you information about where you will go when you leave the hospital. You will be discharged home or to a respite facility. You will have to arrange and pay for the respite facility yourself prior to your surgery.
Transportation
- Discharge is 11:00 am.
- Please make transportation arrangements before your discharge.
- Ask a friend or family member to bring a wheelchair (available at Nassau and Bathurst entrances) up to the unit. They are available at the Nassau St. and Bathurst St. entrances.
- Wheelchairs cost $1 to rent.
What you take home
- Discharge summary.
- 6-week follow-up appointment with your surgeon.
- Staple removal kit to take to your family doctor.
- Prescriptions for blood thinners, pain medication and stool softeners.
- Information on safe storage and disposal of opioid medications.
- Home exercises.
- UHN Altum Health clinic post-op rehabilitation appointment.
Staple removal
- Make an appointment with your family doctor to have the staples removed, 14 days after surgery.
Back at home
Call 911 if you have chest pain, tightness, or shortness of breath, OR, if you have a painful headache you can't treat with medication.
How can I take care of myself when I go home?
- Do continue strengthening exercises.
- Do follow instructions for getting in and out of bed safely.
- Do take extra care on stairs and remove loose rugs and tripping hazards.
- Do get help to put on socks, pantyhose, pants and shoes (especially hip replacement patients).
- Do not sit on low chairs, sofas, or toilet seats (especially hip replacement patients).
- Do not cross your legs (especially hip replacement patients).
- Do not twist your torso (upper body). This is especially important for hip replacement patients.
When to seek help
Follow-up appointments
Before you leave the hospital we will talk about your
3 follow-up appointments:
Your first appointment
When
14 days after your operation. You are responsible for scheduling this appointment.
Where
Your family doctor's office.
What to Expect
Your doctor will remove your staples.
What to Bring
The staple remover that we provided before you were discharged from the hospital.
Your second appointment
When
About 6 weeks after the operation.
Where
Hip and Knee Service
Toronto Western Hospital
East Wing - 1st Floor, Room 1F-835
TWH Maps & Directions
What to Expect
You and your surgeon will follow up, to discuss your operation and recovery.
Your third appointment
When
7 – 14 days after your operation. You should have your appointment date time and confirmed UHN Altum Health location prior to leaving the hospital.
Where
Your community UHN Altum Health clinic.
What to Expect
An initial assessment and subsequent rehabilitation treatment sessions conducted by UHN Altum Health interprofessional team (including physiotherapists, chiropractors, kinesiologists, physiotherapy and occupational therapy assistants).
What to Bring
Your hospital discharge summary, comfortable loose fitting clothes, water bottle, and a positive attitude and motivation to actively participate in your recovery!
