Patient Consent for Joint Replacement Surgery

Patient consent for any procedure is for obvious reasons necessary.  As a patient you need to understand fully what you are letting yourself in for.  Obviously it is impossible to become an instant specialist in a procedure that you are going to undergo, however, you do need to in simple terms understand that there is risk associated with any operation, minor or severe.  In respect of hip and/or knee replacement surgery the risk percentages are approximately 1% to 2% complication rates, minor or severe, however the flip side of this is that 98% of patients generally do very well with no complications.

As surgeons, we always take great care to minimise the risk associated with any operation.  The degrees of possible complications obviously vary from minor stitch abscesses and or minor reactions to medication to major complications. These can then be a progression in order of magnitude in respect of other complications such as deep infection, mechanical complications of instability as well as complications related to fractures of bone, injury to nerve and blood vessel as well as other forms of complications such as blood clots within the deep veins and these embolising to the lung circulation which can in less than 1% result in death.  Other severe complications such as strokes due to the fact that you may need to be off your blood thinners for a few days prior to surgery also exist.  The stress of an operation can result in a heart attack.  Older patients may become somewhat confused in and around surgery.  Generally they recover well however but this can be disconcerting for family members involved.  Further complications include excessive bleeding which can be managed with appropriate transfusions if necessary and other bone marrow stimulation modalities.

With regards to joint replacement surgery, deep-seated infection is of major concern as it will often result in the need for further operations which can become quite disabling.  There are a number of things we do to prevent this and it will be detailed in a separate heading.  The list of complications can then become quite lengthy as there are many rare complications associated with surgery and cannot be touched on every time consent is taken.  Of importance with respect to joint replacement surgery is that it is essentially an elective procedure, not an emergency and therefore time can be taken to optimise all aspects of health prior to the operation in order to minimise the incidence of complications.

In addition, my consent contains a few, possibly unique clauses and these include a separate consent for the use of medical data for academic and teaching purposes in respect of furthering the practice of medical science.  All my patients are registered with the Human Ethics Research Committee at the University of Cape Town.  This is entirely a voluntary consent.  As a patient you are just a number, therefore confidentiality is maintained and if you should not wish your data to be used in this manner, this will not influence your treatment in any way.

It has been shown in numerous studies that the outcomes of an operation are directly linked to adherence or compliance with respect to post-operative physiotherapy and the use of medication as well as other aspects of activities of daily living.  Hence, if you are not compliant with regards these various instructions then complications can occur which may negatively affect the outcome of the operation.  This is all stipulated in the consent form.

Sometimes we need x-ray guidance which is a small amount of radiation and this is consented for as well.  Consent also includes the use of blood transfusions if required.  Obviously this does not apply to a Jehovah’s Witness patient where we will need to have a detailed discussion regarding risks in this regard.  Fortunately modern joint replacement surgery does not often require postoperative transfusion because of in general minimal blood loss less than 500 mL.

Consent also includes permission for attendance of representatives of the companies that provide the implants and instrumentation we use in theatre. They are all bound by confidentiality and form a vital part of the team. Other personnel in theatre may include visiting physiotherapists, medical students, orthopaedic trainees and or visiting surgeons who come to observe and learn. All surgery is performed by me only with the help of my routine surgical assistant!

This then outlines the discussion regarding consent and a copy of my consent form can be found on the website.