What happens in hospital?

When will I be admitted?

Patients traditionally came into hospital the night before the operation but there is an increasing trend to come in on the day or surgery.  This of course, does depend to some extent on the age and faculty of the patient and to some extent where they live but if you do come on the day of surgery all the tests will have been done beforehand. 

How long will I be in hospital?

The length of stay following surgery is variable.  It may be in some circumstances as short as three days and quite often five days, may be seven days on occasions.  There are instances of patient being discharged on the same day as but this is still very experimental and is not the accepted routine.  Do not feel rushed and the most important factor is to make sure the whole process is acceptable for you and there is a gradual and safe transition, either back to intermediary care or to your home circumstances.

Nil by mouth

If you come in on the day of surgery you will need to come in possibly starved, ie not having anything to eat or drink from midnight but you will be told of the exact timing.  You may need to come to hospital early. 

Immediately prior to surgery

When you come into hospital you will be checked by the hospital and ward staff and shown to your room. You may take a shower prior to the operation and placed in a surgical gown.  You should be seen by the surgeon operating on you, or a representative of the surgeon, for the consent form to be signed and your leg marked.  The leg is normally marked very close to the hip or knee so that it can be seen when you go to the operation for surgery. 

Getting to theatre

Some hospitals you walk to theatre or are pushed in a chair.  Less frequently now patients go down on a bed or a trolley.  When you leave the ward all your details are cross checked by the nurse handing over to the porter, if a porter is used, and once you go into theatre a second check occurs, checking your name, your armband, any allergies and what operation you are having. 

In the anaesthetic room

When you go into the operating room you will shown into the anaesthetic room where you will be seen by the anaesthetist.  In fact the anaesthetist will probably have seen you earlier on either before or after the surgeon has seen you. You will have had a Venflon tube and/or drip inserted into your arm so fluids can be replaced during the operation. With regard to your position, if a spinal anaesthetic is to used you will be asked to sit on the table bending slightly forward so that the injection can be given. Once the anaesthetic takes effect you will be positioned either on your back or the side depending on the surgical technique and you may be draped up and prepped in the anaesthetic room prior to coming into theatre but practices do vary.

In theatre

Once you are taken into theatre a re-draping is often carried out whereby the leg is isolated from the rest of the body with sterile drapes and quite often a curtain is put up from just above the waist up to exclude the top end of your body and the anaesthetic and other personnel from the wound.  Very commonly we use special theatres with ultra-clean air and very high ventilation and air flows and there is quite often a slight noise or hum from the Air Flow system and the air can be slightly cool. The temperature in theatre is controlled to about 20 degrees so it is reasonably comfortable but if you are cold then various devices can be used to ensure that your body temperature is maintained. Surgery is then carried out which takes normally about 60 to 80 minutes although it does vary depending on exactly what you are having done.

In recovery

You will have an oxygen mask or nasal cannular to ensure adequate oxygenation and then following the operation, you may be in the Recovery area for a short period of time where you will be monitored by one of the anaesthetic staff to make sure all your physiological parameters, ie your pulse and blood pressure are acceptable and pain relief is controlled before going back to your room or your ward.  There will be a dressing on your leg.  You may well have a urinary catheter in place if a spinal anaesthetic has been used because after the spinal bladder function can be abnormal for a period of time.  You may or may not have a drain in place.  Surgeons have different philosophies about using drains which is a tube coming from the wound to drain blood out although there is increasing trend not use a drain.  You may well have a check x-ray in the recovery although more commonly these x-rays are taken later on. 

Back on the ward

To reduce the risk of blood clots you may have a daily injection of low molecular weight Heparin and you may well also have a mechanical device applied to either your foot or your calf to cause a pumping action to pump blood from the leg back to the heart keeping the blood circulation going to reduce the blood clot risk.  You will also be asked to do calf muscle exercises to help pump blood back up the limb. You will also receive intravenous antibiotics after surgery to help prevent infection.

Getting going after surgery

There are some practices of very early mobilisation.  In fact there are stories of some patients even walking back from the Recovery Room, particularly in patients staying in hospital just a day or two.  This seems to be more popular in the US where there is a strong drive to reduce inpatient stay. However, we would stress that this is not the norm, particularly in the UK and most patients don't mobilise until the day following surgery.  You will be monitored overnight and the next day you will be seen and checked over by the nursing staff and by the physios. Normally patients will be standing within 24 hours and then will progress to walking, either with a Zimmer frame or with crutches over the next day or so. Initially this will be with assistance and then eventually by yourself. You will progress through various stages - being able to transfer from bed to chair, going to the toilet and back and going to the shower and gradually becoming independent, walking down the corridor and being able to go up and downstairs with instruction.  This process takes three to five days depending on many factors such as type of surgery, age and pre-operative fitness.  You will have various checks to make sure all is well and there are various protocols to be adhered to.  When it is safe for you to go home you will normally be allowed to go home in a car. 

Do I need any aids or appliances?

We have normally in the past assessed patients for any additional aids by the Occupational Therapist and these sometimes include a raised toilet seat and assistance to get shoes and socks on and possibly even alterations to furniture at home.  The principle is to ensure that the furniture is not so low that the hip is abnormally flexed which could introduce a dislocation risk.  There is some variation in terms of how many appliances are needed but at the moment it is still fairly common to have some appliances provided for about six weeks after the operation and in some cases these appliances can be supplied and indeed fitted if necessary prior to the operation, although most of these appliances are easily fitted and are quite simple and modular.