Orthopaedics 360

Pain after joint replacement is one of the things patients worry about most before surgery. The reality tends to be much better than expected.

Modern pain management uses a multimodal approach - combining several methods to control pain rather than relying on a single strong opioid.

During surgery, I inject a long-acting local anaesthetic mixture around the joint before closing in a knee replacement. We find we don't need this for a hip replacement. This provides several hours of relief while the spinal block wears off.

After surgery, the plan typically includes paracetamol taken regularly around the clock, possibly an anti-inflammatory (celecoxib), and sometimes a nerve pain modifier (pregabalin). Opioids are available but are used as a supplement, not a foundation. We use Palexia and Endone when we need to use Opioids.

Most patients are genuinely surprised by how manageable it is. The most common feedback I hear is "I expected it to be much worse."

A few things patients can do: take medications on schedule rather than waiting until pain is severe, do your physio exercises even when the joint is uncomfortable, and keep the leg elevated when resting.

Pain that is well-controlled in the first two weeks makes rehabilitation significantly more effective.

drchienwenliew.com.au

For most of my career, the prevailing view was that doctors don't do social media. I think that's changing, and here's why I changed my mind.

During a consultation, research suggests patients absorb as little as 20 to 30% of what they're told. It's not a reflection on the patient. It's just how the human brain works under stress and information load. That's why we've always tried to deliver information in multiple ways: printed material, videos, follow-up calls.

I actually love instagram - Social media is how I personally consume information. I use Instagram to research new workouts, nutrition advice, ideas for crafts to do with my kids and to be inspired. It's where I go when I want to learn something quickly and visually. It's the medium of this generation, and it's not going away.

So we launched our Instagram page a couple of weeks ago. Its what our patients seem to respond to - What I think we will find is that short, focused posts - a clip about what to expect in week one of recovery, or what goes into a hip implant - will land in a way that a five-page information booklet often doesn't. People will watch them before their appointment. They will share them with family members. It will help us focus attention during the consultation on what specifically matters to each patient.

The feedback has been more positive than I expected. We've been producing educational videos for several years on youtube, and the engagement on the new formats on instagram has reinforced that patients genuinely want this kind of access.

If clear communication matters to you - and I'd argue it should matter to all of us - this is worth considering.

Dr Chien-Wen Liew

Want to see how we approach it? Follow Dr Liew on Instagram.
https://www.instagram.com/drliewhipknee

Dr Chien-Wen Liew Hip Knee Replacement (@drliewhipknee) • Instagram photos and videos 196 Followers, 51 Following, 32 Posts - See Instagram photos and videos from Dr Chien-Wen Liew Hip Knee Replacement ()

Something I wish more patients knew before they came to see me: what you do in the weeks before surgery affects your result just as much as what happens in the theatre.

This is what I focus on with every patient before we operate.

NUTRITION

Your body needs protein to rebuild muscle and soft tissue, vitamin C for wound healing, iron to avoid anaemia, and vitamin D for bone health. Many patients arrive nutritionally depleted and do not realise it. A high-protein diet in the 4 to 6 weeks before surgery makes a measurable difference.

WEIGHT

Even a modest reduction in BMI before surgery reduces operative risk, reduces implant stress, and improves functional outcomes. It is not about a number on the scale. It is about giving your body the best possible conditions to heal.

FITNESS AND STRENGTH

Patients who are stronger before surgery recover faster. Simple home exercises, walking, and hydrotherapy in the weeks leading up to the procedure build the muscle reserve that carries you through early rehabilitation.

STOPPING SMOKING

Smoking significantly increases the risk of wound complications, infection, and delayed healing. I ask all patients to stop at least 6 weeks before surgery.

MANAGING MEDICAL CONDITIONS

Blood pressure, blood sugar, and anticoagulation all need to be optimised before we operate. Your GP and I work together on this.

Surgery is a partnership. The outcome belongs to both of us.

drchienwenliew.com.au/learn-hip
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