The procedures
- Joint replacement: replacing a worn hip, knee or shoulder joint with an artificial one.
- Fracture and trauma surgery: fixing broken bones with plates, screws, nails or frames. This includes hip fractures, which are common in older people and are usually repaired urgently.
- Arthroscopy: keyhole surgery using a small camera to examine and repair a joint, such as the knee or shoulder, often as a day procedure.
- Other procedures on the hand, foot and ankle, ligaments and tendons.
The role of your specialist anaesthetist
My role is to choose, with you, the anaesthetic that best suits your operation and your health, to keep you safe and comfortable during surgery, and to plan pain relief that lets you start moving soon afterwards. Early movement is one of the most important parts of recovery after orthopaedic surgery.
Common anaesthetic approaches
- Spinal anaesthesia: a small injection in the lower back numbs the legs and lower body for a few hours. It is commonly used for hip and knee replacement and hip fracture surgery, often with sedation so that you are relaxed or asleep.
- Nerve blocks: local anaesthetic placed near the nerves to an arm or leg, guided by ultrasound. A block can be the main anaesthetic, for example for some hand, wrist or foot surgery, or can provide pain relief after surgery for many hours.
- General anaesthesia: used for many operations, often combined with a nerve block for pain relief.
Each approach has its own benefits and risks. A spinal anaesthetic may not be suitable if you take certain blood thinners or have some spine or heart conditions. We will talk through the options and decide together. See Types of Anaesthesia.
Preoperative assessment and preparation
I will review your general health, heart and lung function, medications, allergies and previous anaesthetics. For planned joint replacement, you may attend a pre-admission clinic. Blood thinners need careful individual planning, particularly if a spinal anaesthetic or nerve block is being considered. Please do not stop or change any medication unless your anaesthetist, surgeon or prescribing doctor has advised you. See Medications Before Anaesthesia.
Staying as active as you can before surgery, eating well and stopping smoking all help recovery. For older patients, it helps to bring glasses and hearing aids into hospital, and for a family member to know the plan.
What happens during the procedure
Standard monitoring of your heart, blood pressure, oxygen and breathing is used throughout. Under a spinal anaesthetic you will not feel pain, though you may notice pressure or movement. Many people prefer to be lightly sedated and some choose to sleep. Many limb operations use a tourniquet, a cuff around the upper arm or thigh that is inflated to reduce bleeding during surgery. It is released before the end of the operation. Medication to reduce blood loss is commonly given, and you are kept warm.
Recovery and early mobilisation
After joint replacement, most people are encouraged to stand and walk with help on the day of surgery or the day after. Good pain relief makes this possible. It usually combines a nerve block or local anaesthetic placed by the surgeon, regular paracetamol and anti-inflammatory medicines where suitable, and stronger medication when needed. A nerve block can make the limb weak as well as numb, so please ask for help before getting up while it is working.
For arthroscopy and other day procedures, you will need a responsible adult to take you home and stay with you. See Recovery & Aftercare.
Relevant anaesthetic risks and precautions
- Blood clots in the legs or lungs are a known risk after hip and knee surgery and after leg fractures. Prevention includes early movement, compression devices or stockings, and often blood-thinning medication for a period after surgery.
- Delirium, a state of temporary confusion, is more common in older people after surgery, especially after hip fracture. It is usually temporary. Good pain relief, avoiding unnecessary sedating medications, glasses and hearing aids, familiar faces and a normal sleep pattern all help.
- Spinal anaesthesia can cause a drop in blood pressure, temporary difficulty passing urine, and occasionally a headache. Serious nerve injury is rare.
- Nerve blocks occasionally cause numbness or tingling that lasts longer than expected; this usually settles, and permanent nerve injury is rare.
Nausea, sore throat and tiredness after a general anaesthetic are common and usually short-lived. For how often complications occur, see Anaesthetic Safety & Risks.
Links to additional patient resources
- Preparing for Your Procedure
- Understanding Your Anaesthetic & Informed Consent
- Medications Before Anaesthesia
- Recovery & Aftercare
- Anaesthesia for joint surgery, Australian and New Zealand College of Anaesthetists (ANZCA)