The Trauma and Orthopaedics department deals with all musculoskeletal conditions and works closely with the rheumatology department. The work of the department is split into trauma (emergency work) and elective orthopaedics (planned work), both take place on the same site and share outpatient and operating theatre facilities.
Patients undergo surgery at both the Royal Cornwall Hospital and St Michaels Hospital in Hayle, and on occasions at the Duchy Hospital in Truro. The Department has a number of surgeons who are recognised nationally and internationally for their pioneering work. This includes young adult hip surgery, hand surgery, arthroscopic surgery, complex foot and ankle surgery and Knee surgery.
Some surgery is a day case, where people do not require a stay in hospital. More complex operations are likely to require a short stay in hospital to aid recovery. Some operations or procedures can be undertaken without being put to sleep (general anesthetic), and use local anesthetics to numb the required area. All of these options will be discussed with you.
Surgery is usually considered as last resort. The best way to prevent the need for surgery is to maintain a healthy weight and lifestyle, as this will reduce strain and pressure on joints, especially the hips and knees. Approximately every pound of extra weight puts an extra three to four pounds of pressure on each knee joint when walking and this increases with some other activities such as climbing stairs.
For more information on the Orthopaedics and what services the team here in Cornwall can offer, visit – https://www.royalcornwall.nhs.uk/services/trauma-orthopaedics/
Many people with arthritis find that having surgery brings about a dramatic reduction in their pain and an improvement in their mobility and quality of life. A wide range of types of surgery can help people with arthritis, from small procedures (such as operations to remove cysts or nodules), to major surgery (which includes total joint replacement).
As drug treatments are continually improving, many people with arthritis will never need to have surgery. Some people can effectively manage their condition through their medication and lifestyle.
Therefore the decision to have surgery is usually only made after other treatment options have been explored. You should find out as much as you can about the different procedures before weighing up the pros and cons with your doctor. As with all operations, there can be risks and complications in having surgery for arthritis, such as infection or the operation being unsuccessful.
As a person with arthritis you may consider having surgery if:
Joint replacements can be very successful at relieving pain. The degree to which movement may improve will depend on how severe your arthritis is and how strong the muscles are surrounding your joints. Some people need surgery to prevent their arthritis getting worse. A joint that is not operated on may become stiffer, deformed and the muscle around the joint may be weakened, which could make an operation in the future more difficult.
Information from Royal Cornwall Hospital on Hip & Knee surgery and the Joint School
In a total hip replacement both the ball (femoral or thigh bone) side of the hip joint and the socket (acetabular or pelvic side) are replaced with an artificial joint. For more information from Royal Cornwall Hospital see: https://royalcornwallhospitals.nhs.uk/services/trauma-and-orthopaedics/
Royal Cornwall Hospital run a Joint School for people who are having a hip replacement. This is an educational session run by the clinical team. It gives you the opportunity to learn more about and prepare for your surgery. It is best if you attend joint school a few weeks before your surgery. For more information see the section about ‘Joint school’ https://royalcornwallhospitals.nhs.uk/services/trauma-and-orthopaedics/
A total or partial knee replacement removes the affected part of the joint and replaces the damaged joint surface.
Making the decision to have surgery
The decision to have surgery will be made by you with advice from your consultant. Find out as much as you can so that you have all the information you need to make a decision. You will need to assess the risks and complications involved in the surgery and weigh them up against the benefits of having the operation (see below).
Joint replacements are very successful operations and should last at least 10-15 years before revision surgery is needed. The success of surgery will depend in part on how well you look after your joint. Revision surgery may not be as successful as the original replacement. Bear in mind that you will have to exercise your new joint to keep the muscles around it strong, but you will be careful to not overstrain your joint.
How long a new joint will last will depend on the type of procedure used, which joint is replaced and your age and lifestyle, so discuss this with your doctor.
You may be interested in the following information about “shared decision making“.
https://www.england.nhs.uk/shared-decision-making/
It remains that the best option is to avoid surgery by maintaining a healthy weight and active lifestyle
The Benefits of Surgery
The benefits of surgery should be a decrease in pain and improved mobility. Surgery can also prevent joints deteriorating further and prevent disability.
There may be total pain relief in the area that has been operated on, once any discomfort from the operation itself has cleared. However, improvement to the movement of the joint after the operation can be difficult to predict and depends on many factors including the extent of the deterioration of the joint before surgery, the strength of muscles surrounding the joint and the success of the operation itself. Re-aligning joints can make them easier to use and can improve appearance which may make you feel better about yourself.
Many people find that, with less pain and improved movement, they are able to do more, giving a boost to their independence. Most people are able to go back to work once they have recovered from their operation. Daily activities, such as dressing or housework, are often easier to do after surgery. You may find it easier to use public transport or get back to driving a car once you have fully recovered from an operation.
Exercise and Health
As a result of improved movement and reduced pain, you may find that you can take up exercise that you could not do before surgery. Exercise is an essential part of managing arthritis as it can help to build muscle to support joints, maintain a healthy weight and relax – all of which can have a positive effect on arthritis as well as your general health. Lifestyle improvements and reduced pain can benefit your mental and emotional well-being, and give a boost to your self-confidence. For ideas and groups around Cornwall, visit https://www.healthycornwall.org.uk/
Social Life and Relationships
People often find that they can lead a more active social life after having surgery. You may feel less dependent on your family, and less tense and irritable. When you are in pain you may not want to be touched, which can create distance in relationships. Reduced pain can lead to great improvements in close personal relationships.
The Risks of Surgery
Like any operation, surgery for arthritis has risks. You should ask your surgeon about the risks of a particular procedure. They should give you enough information so you can make an informed choice about having surgery.
You also need to bear in mind that replacement joints may have limitations and do not last forever. It is likely that there will be a waiting list for surgery for arthritis. You need to prepare yourself for time in hospital and time out of work. Moreover recovery can be painful and require effort – it may be a while before you are happy with the outcome of surgery.
There is a small risk of infection during the operation. If this is a minor infection then it can usually be cleared up with antibiotics. If the infection is deep, you may require revision surgery, or your replacement may have to be taken out. It is estimated that a deep infection will occur in less than one per cent of people who have a knee or hip joint replacement.
Having surgery to your lower limbs can bring with it the risk of a blood clot in the leg (venous thrombosis), causing pain and swelling in the leg. This condition is usually temporary, but can be more serious if a bit of the clot breaks off and travels to the lungs
Another relatively uncommon risk is damage to the ligaments, arteries or nerves around a joint. This may settle spontaneously or can be addressed during the surgery or in further surgery.
Reasons why you may not be able to have surgery
Having a joint replacement is major surgery so if you have any other medical conditions, such as heart disease, lung problems, infection or very active arthritis, surgery may put too much strain on your body. You should discuss this with your doctor.
Any infections, such as an ulcer or foot infection, must have cleared up before surgery as these can spread to the site of the operation and cause complications.
If you are overweight, surgery may not be recommended because the extra weight puts more pressure on the body and can make recovery slower. This also means more strain on your heart, lungs and kidneys, which will be under pressure during an operation. It may also not be advisable to have a general anaesthetic if you are overweight.
What to expect after your surgery
Ask your consultant what degree of movement and function they realistically expect you to have after your operation. But bear in mind there is still a risk that your operation may not be as successful as you had hoped. In very rare cases, operations may fail altogether.
Some people still have problems moving after a joint replacement or revision surgery. If you have a full knee replacement there may be some clicking or clunking in the replacement. The device can also loosen. The scar on the knee after a knee replacement may be uncomfortable to lean on or when stretched.
Hip replacements can become dislocated soon after surgery. This can be painful but is uncommon. Before you leave hospital you should be given exercises by your team of health professionals and taught what kind of movements you should avoid to prevent dislocation. If it does dislocate, the hip may need to be put back into place under anaesthetic. More common is loosening of the artificial hip after 10-15 years, and revision surgery may be needed to correct this.
Making an informed decision
You need to get a clear picture from your consultant about how much they expect you will be able to do once you have recovered from surgery. For example, you could get them to demonstrate how much you will be able to bend your knee, what activities you should be able to do free from pain, and what pain levels you might experience.
You may want to ask your surgeon about their levels of experience and success rates for the operation. If you are having a more specific procedure, like an operation on your hand or ankle, make sure it as performed by a surgeon who specialises in that area.
You will also need to think about how you will manage after the operation. It is likely that you will need some support from family, friends or a carer, which you should organise beforehand.
Questions to ask your surgeon
- How often do you do this operation?
- What are your results?
- What is the infection rate? (This should be around one per cent or less)
- How long will my new joint last? (You should not need a revision in the first 10-15 years)
- What is the risk of dislocation? (For a hip joint this should be less than two per cent)
- What can I expect after the operation?
- How will I know if it has been a success?
- What should I do if it isn’t?
- What can I do to help my recovery?
- How soon before I can drive/go back to work?
- What follow-up treatment will I receive?
- What will happen if I don’t have surgery?
- What is the long-term outcome of this operation/type of implant?
- Will you deal with complications or will I get referred to someone else?
- Will I need any physiotherapy or occupational therapy after surgery?
- Do you have any written information about the operation that I could have?
Further useful information on surgery
Versus Arthritis has comprehensive information on its site about surgery including information on the different types of surgery you can have. It includes information on hip replacement, knee replacement, shoulder and elbow replacement surgery. It also has information on hand and wrist surgery and foot and ankle surgery. Click here
NHS Choices has useful information of hip and knee replacement including a video about why it is needed and how it is done: Click here for hip replacement Click here for knee replacement
NRAS has a series of articles on rheumatoid arthritis and surgery: click here