Support for people waiting on hip or knee replacement surgery

If you're on a waiting list for a hip or knee replacement, there are resources and advice to help you stay as fit and healthy as possible.

Working to improve your physical and mental wellbeing before surgery can:

• help you to stay strong and mobile
• prevent additional physical and mental health problems
• help you to cope with surgery and the recovery afterwards

There are many ways to help manage pain.

Understanding pain

Having a better understanding of pain can be very helpful if you're living with it.

A public health campaign called 'Flippin' Pain' has further information on persistent pain.

This campaign was developed by a team of health professionals who work alongside people with chronic pain.

'Flippin' Pain' is also available on social media through Twitter and Facebook.

Exercise

Exercise is a very powerful way of managing arthritis pain and improving mobility. It also won't cause any further damage or harm to you or your joints.

Being physically fit and strong before hip or knee replacement surgery is also really important in supporting the recovery process. The stronger and fitter you are before the operation, the quicker your recovery will be.

Further information about exercise and arthritis can be found with Versus Arthritis. This includes a 12 week exercise programme called 'Lets Move with Leon'. This programme is made up of 30-minute movement sessions and is presented by fitness expert Leon Wormley.

Types of exercise

For good overall fitness, strength and cardiovascular activities are important. Strength exercises include swimming and yoga. Cardiovascular activities include cycling and walking.

However, these are just examples of some activities and the best option for you may be different. It's important to choose an activity you enjoy, and can stick to, to get the most benefit.

The Chartered Society of Physiotherapy has further information on maintaining and improving strength.

You can also focus on moving a specific area with exercises for:

• hip problems
• knee problems

Using medication to control pain

There are lots of different types of pain relief to help joint pain, including paracetamol and NSAIDs.

Night time pain that affects your sleep is common in end-stage arthritis. Taking pain relief before bed may help to improve these symptoms.

However, for some, pain relief may become less effective over time. This is usually the case if you've reached the stage where you and your orthopaedic team are considering joint replacement. This means many people may need a different way to manage pain.

The charity Versus Arthritis has further information on different kinds of pain relief.

Opioid medication

Opioid medication can sometimes be prescribed by a doctor for severe joint pain.

Opioid medication includes:

• co-codamol
• tramadol
• morphine

However, these medications can often have side effects, including:

• constipation
• drowsiness
• long-term dependence

These side effects often get worse if you take opioids for a while or take them a lot.

Taking opioids before your operation can also be problematic. This is because it can impact on your recovery and increase the risk that you'll have to continue to take opioids afterwards.

This means it's really important to think about whether the pain relief you're on is still helping. If it's at all possible, try to slowly reduce the amount you take before the date of your surgery.

Injection therapies

Injections into the affected joint can sometimes be used to help relieve the pain from arthritis. This may provide short-term help but it's not a cure.

If injection therapies are used too near to an operation, they lead to a higher risk of infection. However, if it's going to be a long time until your operation, they may be an option to consider.

Mental wellbeing

Pain and mental wellbeing are closely connected. For example, your mental wellbeing can affect how you feel pain. Persistent pain can also contribute to some mental health conditions.

You should speak to a healthcare professional if pain is affecting your mental wellbeing. They'll be able to advise on the possible treatments and support that's available in your area, including:

• antidepressants - low doses may help with chronic pain and sleep, as well as mental health conditions
• cognitive behavioural therapy (CBT) - a type of talking therapy

Some people also find that complementary therapies like acupuncture may help. However, these are not currently recommended treatments.

The Versus Arthritis website has further information on different types of complementary therapies.

Socialising

It's important to continue doing activities that take you out of the house. Being with others in a different space can benefit your mental health and wellbeing.

You can find ways to socialise through support groups and local arthritis charities. This will also give you the chance to meet people in a similar situation.

Weight management

Weight loss is an important part of managing arthritis pain before surgery.

Even a 5% reduction in bodyweight can greatly reduce arthritis pain and improve function.

However, the results appear to be better the more weight that is lost.

Weight loss works by reducing the amount of stress that is placed on the joints whilst moving and standing.

You can lose weight safely through:

• healthy eating
• exercise

Diet

An anti-inflammatory diet may also help with arthritis pain while you're waiting on a hip or knee replacement. This includes eating foods like:

• fish
• nuts and seeds
• fruit and vegetables
• beans
• wholegrains

Further information on specific types of food that can help.

Where to get further support

To get further advice and support on your condition, speak to a healthcare professional.

If you have any questions before your surgery, contact your surgeon for advice.

The charity Versus Arthritis also has further information on support available across Scotland.

Support at work

A long-term condition may mean that you need extra support at work.

Speak to your employer to arrange an occupational health assessment. This will give you information on potential changes in the workplace that'll improve your safety and comfort.

You can also speak to your GP about getting workplace adaptations.

Travel support

If you struggle to get around by car, it could be helpful to apply for a Blue Badge. This will allow you to park closer to where you're going.

Financial support

If your condition means that you're unable to work due to severe pain or mobility problems, financial support is available.

The charity Versus Arthritis has further information on the types of financial support available.

What to do if your condition gets worse

Conditions like arthritis will cause a fluctuation in symptoms. This means the symptoms will sometimes be worse or better than normal.

If you find that your symptoms are getting significantly worse then speak to your surgeon for advice.

After your operation

Following healthy lifestyle advice before and after your surgery will help to improve the chance of a successful operation.