Hip and knee replacement surgery is not the same beast as it once was, with reports of improved and faster rehabilitation.

“It’s not how it was 25 years ago when John next door had his hip replaced, and he was in bed for two weeks, and he couldn’t move, and he couldn’t get back on the farm for two months,” says Paulo Melo, advanced nurse practitioner in the Mater Private. “It’s not like that anymore. Things have evolved.”

Paulo has worked in orthopaedics for the past 18 years, and during that time, joint replacement surgery has undergone major changes.

“We have programmes in place, we have people in place, and definitely the techniques. The fact that we do minimally invasive surgery now means that people recover much faster and with less pain.

“In relation to farmers, they need to understand that they should get it done early, rather than leaving it for another 10 years when it’s too late, nearly.”

Historically, the perception that joint replacement surgery carries a lengthy recovery period “would have been a problem”, he explains, “because it’s word of mouth, right? A farmer hears the person next door went for a hip replacement, and they couldn’t do anything for six weeks and that puts them off completely.

“They’re like, ‘I can’t take six weeks off the farm’, but that is not the case with anymore. We’re making sure that people are back to activity a lot earlier.”

Paulo adds that the support from an orthopaedic nurse specialist once patients return home is also key to a faster recovery.

“It is possibly one of the most important things, because patients are always flooded with questions the moment they arrive home.

“The orthopaedic nurse specialist contacts the patient the day after they go home to check on them, and she will answer all the questions. This is huge for the patients from a mental and a psychological safety point of view.

“It also enables the patient to go home earlier, because a lot of them historically would stay in hospital that extra day or two because they were afraid of going home and being on their own, but when they know that they’re going to be called at home by the nurse, they’re actually very willing to go home, and they prefer it.”

Now, Paulo explains, patients are brought back for a check-up two weeks post-operation rather than leaving it for six weeks.

“We’re removing all of those restrictions and accompanying the patient a little bit closer and more often.”

typically, we admit people on day of surgery, and for some patients they can go home on the same day

Suitability for surgery

But how do you know if joint replacement surgery is for you in the first instance?

“The main reason or indication for doing a joint replacement is pain, and this is pain that is not responsive to other measures,” says James Cashman, a consultant orthopaedic surgeon at Mater Private, Mater Misericordiae University Hospital and Cappagh National Orthopaedic Hospital.

“Prior to considering surgery, we would typically recommend that patients exhaust all non-surgical options. What I mean by that is the two things that patients have control over is weight and exercise. The more weight is controlled, the better your symptoms. And exercise, even though it can cause pain, it is actually beneficial in the longer run.”

In terms of exercise, James cites engaging in a gym or exercise programme as examples. “The main reason to do it [surgery] is for pain. That’s going to be the primary benefit, and the secondary benefits are things like mobility and return to normal function.”

A standard hip replacement surgery now takes 45 minutes. James says that: “typically, we admit people on day of surgery, and for some patients they can go home on the same day. Our latest stay is generally pretty short: 24 hours, 48 hours, that kind of thing.”

In terms of pre-operative preparation, all patients attend the pre-assessment clinics, James continues, where they’re reviewed by nursing and anaesthetic staff, and they’re “optimised” prior to their surgery.

“Say someone has a pre-existing medical condition, such as cardiac disease or respiratory disease or diabetes, that would all be assessed prior to surgery to ensure that they’re optimised beforehand,” James explains.

Paulo stresses that prehabilitation “is a big thing nowadays”, and he advises patients to “exercise well before” their operation.

“It’s really basic stuff – like holding on to the table and just lifting your leg out 10 times, and repeating this three times

“But if people start doing these exercises a few weeks in advance, they precondition the muscles that are going to be involved in the surgery in a way that afterwards, when they wake up from the surgery, it’s not such a shock for the muscles, for the body. It already knows what to do, the muscles already know those exercises, everything is preconditioned already, and so the recovery then becomes much easier and much faster again.”

Brian Flynn, chartered physiotherapist in the Mater Private, says that: “physio before the surgery directly impacts your recovery afterwards. It sets the domino effect in motion. The fitter and stronger you are leading into a surgery, the quicker and easier your rehab is going to be afterwards.

“Looking at your diet, things like smoking and alcohol, anything that can negatively impact healing time frames, you should be looking to address them in the weeks leading into your surgery.”

Patients should be doing physio for six to eight weeks pre and post-surgery, he adds. “Any kind of changes to muscle length and strength tends to take about six weeks to eight weeks of engagement to really notice significant changes. The earlier the better.

“If there was a consultation with your orthopaedic consultant, and there was a talk of hip replacement or knee replacement potentially down the line, that is your green light to get engaged with physiotherapy and with exercise.”

When asked about the preconception that joint replacement surgery is typically for an older patient, James highlights that his practice is “quite broad”.

“We do hip replacements in people across the spectrum, assuming it is for the right reason. If somebody has significant problems with their hip or their knee, and they have tried everything else and they have arthritis, then it can be reasonable to do it.

“However, if you have surgery at a younger age, there is a chance it will wear out, and you might need a further operation at a later stage. Revision surgeries are more complicated and have a bit more involved in them, but first time round, it’s generally a very successful operation.

“The Irish National Orthopaedic Register is a register of all the joint replacements that are done in the country. Over 95% of the reasons for hip and knee replacement is wear and tear osteoarthritis. The other 5% are for other conditions, such as rheumatoid arthritis or trauma.”

For farmers considering joint replacement surgery, James advises finding a time in the farming year when things aren’t so busy. He recommends, “touching base earlier so that you can get the date that you want” and choosing an optimum time where you can make arrangements for help on the farm, if needed.

Brian adds that farmers and people engaged in agricultural activity should “not leave it too late to get in contact with someone” if they are “worried about pain creeping in”.

“It’s very hard to do these very intense manual labour jobs, looking after livestock and keeping the business going, if you end up getting to a point where you are sidelined with pain or discomfort. The earlier you can admit these things [the better]. It doesn’t mean going for hip replacement or knee replacement necessarily, but starting the problem solving is important.”