Orthopaedic surgery: hip or knee replacement, poorly healed fracture, what should you know before coming?

Hip or knee replacement

When is it considered?

Osteoarthritis, wear of the cartilage, is the most frequent cause. A joint replacement is discussed when pain, limping, stiffness and limited walking strongly affect daily life despite medication, weight loss when useful, physiotherapy or injections. In people with sickle cell disease, the head of the femur may undergo necrosis, sometimes in young adulthood: this osteonecrosis can also lead to a hip replacement, with specific preparation related to the disease.

Preparation

Before a joint replacement, the team looks for anything that could compromise the result:

• an infection, particularly of the teeth, the urinary tract or the skin, to be treated before the operation;
• anaemia, poorly controlled diabetes or kidney failure;
• medicines that need adjusting, particularly anticoagulants;
• the condition of the skin where the incision will be made.

Hospital stay and recovery

The patient generally gets up very early after the operation, often the following day, with a physiotherapist. Prevention of deep vein thrombosis relies on mobilisation and, depending on the case, anticoagulant treatment for several weeks. Walking is first done with crutches. After a hip replacement, some movements may be discouraged at first to limit the risk of dislocation; instructions depend on the technique used.

Fractures that do not heal or heal poorly

A fracture may fail to heal, known as non-union, or heal in the wrong position, known as malunion. These situations occur particularly when the fracture could not be properly immobilised, when it was very displaced, in the case of infection or in someone with fragile bones. They show as persistent pain, abnormal movement, deformity or shortening of the limb.

The assessment includes X-rays, often a CT scan, and a search for infection. Treatment may consist of fixing the bone with a plate, screw or nail, adding a bone graft, or correcting a deformity. Reports of previous treatments, surgical or not, are valuable.

Bone and joint infections

An infection of the bone, osteomyelitis, or of a joint can follow an open fracture, an operation or a blood infection. It shows as pain, redness, discharge through a sinus and sometimes fever. Treatment often combines surgical cleaning with prolonged antibiotic treatment chosen on the basis of samples. It requires patience and close follow-up.

How long should you stay in Morocco?

The length depends on the operation: a few days in hospital for an uncomplicated joint replacement, longer for complex fracture revision or infection. To this must be added the pre-operative assessment and a period of rehabilitation and monitoring before the return journey. A long flight after orthopaedic surgery increases the risk of deep vein thrombosis: the timing of the return and the preventive measures are set by the surgeon.

After the return: continuing rehabilitation

The exercises learned during the stay must be continued with a physiotherapist in the home country. The patient leaves with the operative report, the type of implant fitted, rehabilitation instructions, the anticoagulant treatment and its duration, and the schedule of follow-up X-rays. Fever, redness or discharge from the wound, increasing pain or significant swelling of the calf require prompt medical attention.

Frequently asked questions