Your Role, Your Family’s Role, Your Team’s Role

Part of The Joint Replacement Guide — Phase 2: Considering Surgery · Article 9 of 44 · Hip & Knee

Key Points

Joint replacement involves cooperation between the patient and a multidisciplinary clinical team. Family, friends or carers may also help if the patient wants them involved.
Preparing for surgery, understanding the recovery plan and participating in appropriate rehabilitation can support recovery, but no patient can control every outcome.
The amount of practical help needed after surgery varies. Planning before admission can identify whether support, equipment or changes at home may be useful.
A lack of available family or friends should be discussed with the clinical team; it should not be assumed that everyone has an informal carer.
Rehabilitation should follow the individual plan provided by the team. Severe or worsening pain and other concerning symptoms should not simply be “pushed through.”
The team may include surgeons, anaesthetists, nurses, physiotherapists, occupational therapists, pharmacists and other professionals. The exact arrangements differ between hospitals.

A Partnership, Not a Test of Willpower

Joint replacement is not simply something done to a passive patient. Patients should receive clear information, have opportunities to ask questions and take part in decisions about their care.

There are practical steps a person may be able to take before and after surgery. These can include:

giving the team complete and accurate information about health and medicines
asking questions or explaining concerns
following individual instructions about medicines and fasting
participating in suitable preparation and rehabilitation
planning for discharge and recovery at home
knowing whom to contact if problems develop

However, recovery is influenced by many factors outside the patient’s control, including the underlying condition, general health, the surgical procedure, individual biology, complications and access to support.

A slower recovery or less favourable result does not necessarily mean that the patient failed to prepare or work hard enough.

Your Role Before Surgery

Before surgery, you may be asked to attend a preoperative assessment. This helps the team understand your health, medicines, allergies, previous operations and individual risks.

Tell the team about:

all prescribed and non-prescribed medicines
anticoagulants or antiplatelet medicines
allergies and previous reactions
diabetes, heart or lung conditions, sleep apnoea and other diagnoses
recent infections, wounds or dental problems
smoking, alcohol or recreational drug use
previous difficulties with anaesthesia
mobility, communication or accessibility needs
circumstances that could make recovery at home difficult

This information is used to plan safer care, not to judge the patient. Do not stop prescribed medication unless the responsible clinician gives specific instructions.

NICE advises giving people having hip or knee replacement information about exercises, lifestyle and ways to maximise independence and quality of life before and after surgery.[1] The advice should be tailored to the individual rather than treated as a guarantee of a particular result.

Goals and Expectations

It can help to discuss what you hope surgery will allow you to do. Goals might include:

sleeping more comfortably
walking a particular route
managing stairs
returning to work
completing personal care independently
taking part in a valued activity

Goals should be realistic, individual and agreed with the clinical team. Recovery is not always linear, and the time needed varies.

A goal is a way to guide rehabilitation—not a promise that a particular activity will be achieved by a fixed date.

Your Role After Surgery

NICE recommends that rehabilitation should usually begin on the day of surgery where possible, or within 24 hours, provided the person is medically well enough.[1]

Before leaving hospital, a physiotherapy or occupational-therapy professional should provide advice about mobility, everyday activities and rehabilitation. Patients undertaking self-directed rehabilitation should understand their goals and have a contact for advice and support.[1]

Your plan may include:

getting out of bed and beginning to walk with assistance
using crutches, a frame or another walking aid
exercises to restore movement and strength
gradually increasing everyday activity
measures to reduce the risk of blood clots
pain-management advice
wound-care instructions

Follow the programme provided for you. More exercise is not automatically better, and another patient’s programme may not be appropriate for you.

Some discomfort, stiffness and swelling are common during early recovery. However, do not assume that severe, rapidly worsening or unusual pain is simply part of rehabilitation. Contact the team if symptoms prevent you from following the plan or if you are unsure whether a reaction is expected.

Supervised outpatient rehabilitation should be available when a person has difficulty with everyday activities, ongoing functional impairment or rehabilitation needs that are not being met through a self-directed programme.[1]

Family, Friends and Carers

Some people benefit from practical or emotional support after leaving hospital. Others recover with relatively little informal help. The amount and duration of support vary according to:

the operation
mobility before and after surgery
other health conditions
the home environment
caring responsibilities
whether the person lives alone
local clinical pathways

Possible help may include:

transport home and to appointments
shopping or collecting prescriptions
preparing meals
heavier household tasks
looking after children, dependants or pets
emotional support
help with personal care, when needed and agreed

Family members and friends should only undertake tasks they are willing and able to perform. They should not be expected to provide clinical care without appropriate instruction.

Information about the patient’s care should only be shared with relatives or friends with the patient’s consent, unless another lawful basis applies. A patient may choose who is involved and may change that decision.

If You Live Alone or Have Limited Support

Not everyone has family or friends available. This should be discussed during preoperative assessment and discharge planning.

Tell the team if you:

live alone
are a carer for someone else
have stairs or access difficulties
may struggle with meals, medicines or personal care
have concerns about coping safely
lack transport
have communication, cognitive or accessibility needs

The team can assess what is required for a safe discharge. Depending on individual need and local provision, options may include equipment, occupational-therapy assessment, community services or formal care.

A lack of informal support should not be presented as personal failure. It should prompt practical planning.

Preparing the Home

The occupational-therapy or physiotherapy team may recommend changes based on the individual assessment. Possible preparations include:

removing or securing loose rugs and other trip hazards
improving lighting
keeping frequently used items within easy reach
arranging food and essential supplies
planning a safe place to sit and sleep
checking routes to the toilet and washing facilities
arranging any recommended walking aids or equipment

Not everyone needs a raised chair, toilet seat or other adaptation. Buying equipment before assessment can be unnecessary or, occasionally, unsuitable. Ask the team what is recommended and whether it will be supplied.

Driving and Transport

You will need transport home after surgery and may need help attending early appointments.

Do not drive until:

the clinical team considers it appropriate
you can get into and control the vehicle safely
you can perform an emergency stop without hesitation
you are no longer affected by sedating medicines
you meet the requirements of your motor insurer

Times vary according to the joint, procedure, side operated on, type of vehicle and individual recovery. NHS guidance commonly advises waiting at least six weeks after total knee replacement and at least six weeks after hip replacement, but individual advice and local protocols take precedence.[3,4]

Do not rely on a general timescale as automatic clearance to drive.

Your Multidisciplinary Clinical Team

The professionals involved vary between services, but may include:

Orthopaedic surgeon: assesses surgical suitability, discusses the procedure and alternatives, performs the operation and oversees surgical care.
Anaesthetist: assesses anaesthetic considerations and manages anaesthesia, physiological safety and aspects of pain relief.
Pre-assessment staff: review health, medicines, test results and preparation for admission.
Ward and theatre nurses: provide care before, during and after surgery.
Physiotherapist: supports mobility, exercises, walking-aid use and functional recovery.
Occupational therapist: helps with everyday activities, equipment and planning for the home environment.
Pharmacist: reviews medicines and supports safe medication use.
Pain team: may help when pain is difficult to control or requires specialist input.
Discharge or care-coordination staff: may help arrange services or follow-up.
GP and community clinicians: may continue managing existing conditions and provide care after discharge when appropriate.

Not every patient will meet every professional listed, and job titles or responsibilities differ between hospitals. The service should explain who to contact with questions or concerns before and after surgery.[1]

Enhanced Recovery Programmes

Enhanced Recovery After Surgery, or ERAS, describes a coordinated pathway covering preparation, anaesthesia, pain relief, mobilisation, nutrition, discharge and follow-up.

It is not simply a demand that patients recover faster. It is a multidisciplinary approach intended to support safe recovery and reduce avoidable delays.

ERAS guidance supports:

clear information before surgery
individual risk assessment and preparation
effective, opioid-sparing pain relief where appropriate
eating and drinking at an appropriate time
mobilisation as soon as the person is medically able
clear, functional discharge criteria
coordinated multidisciplinary care.[2]

Preoperative education is recommended, but evidence does not show that education or patient effort alone determines the result. The pathway as a whole—and the person’s individual circumstances—matter.[2]

Discharge Planning

Discharge should be based on clinical and functional criteria, not pressure to leave hospital by a predetermined time.

Before discharge, the team may check whether you can:

move safely between the bed, chair and toilet
walk using the recommended aid
manage any necessary steps or stairs
understand your medicines
follow the wound-care and rehabilitation plan
recognise symptoms that require medical advice
obtain appropriate help or equipment
contact the relevant service if problems arise

Raise concerns before leaving hospital. If circumstances change after discharge, contact the service using the details provided.

Important Information

This article provides general educational information and does not replace instructions from the clinical team responsible for your care.

Preparation and rehabilitation can support recovery, but no action by a patient, relative or carer can guarantee an uncomplicated operation or a particular outcome. Advice about exercise, equipment, support, discharge and driving must be tailored to the individual.

Seek urgent medical advice after surgery for symptoms such as sudden breathlessness or chest pain, a hot or increasingly swollen joint, wound discharge, fever, uncontrolled pain or a sudden deterioration in mobility, following the contact instructions supplied by your hospital.

References

National Institute for Health and Care Excellence. Joint replacement (primary): hip, knee and shoulder. NICE guideline NG157. Published 4 June 2020; last reviewed 19 December 2024. Available from: https://www.nice.org.uk/guidance/ng157 [Accessed 14 August 2026].
Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Acta Orthop. 2020;91(1):3–19. doi: https://doi.org/10.1080/17453674.2019.1683790
NHS. Preparing for a hip replacement. Available from: https://www.nhs.uk/tests-and-treatments/hip-replacement/preparing-for-a-hip-replacement/ [Accessed 14 August 2026].
NHS. Recovering from a knee replacement. Available from: https://www.nhs.uk/tests-and-treatments/knee-replacement/recovery/ [Accessed 14 August 2026].
Centre for Perioperative Care. Your perioperative journey. Available from: https://www.cpoc.org.uk/patients/your-perioperative-journey [Accessed 14 August 2026].

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