Joint Replacement & Reconstruction

What is advanced joint arthritis?

Advanced arthritis means the protective cartilage of a joint (most often the knee or hip) has worn so far that bone rubs on bone, and pain and stiffness disrupt daily life. When this stage is no longer controlled by other treatments, joint replacement is the most definitive route back to a pain-free life.

Why does it reach this stage? (in plain terms)

Cartilage caps the ends of the bones like a slippery cushion; over the years, with extra weight, past injuries or joint disease, this thin layer becomes worn and rough until it can no longer repair itself, causing inflammation and chronic pain.

Symptoms and signs

• Joint pain that continues even at rest or at night
• Severe stiffness and reduced range of motion
• Difficulty walking, using stairs or sitting and standing
• Sometimes a deformity (bowing) of the joint

Treatment options — step by step

Joint replacement is always the last step; we try simpler options first.

Step 1 — Lifestyle and physiotherapy

• What it is: Weight loss, activity modification and strengthening exercises.
• How it helps: Reduces joint load and strengthens the supporting muscles.
• Who it suits: Mild to moderate stages.
• What to expect: Gradual pain improvement with consistency.

Step 2 — Oral medication

• What it is: Pain relievers and anti-inflammatories.
• How it helps: Controls pain and inflammation.
• Who it suits: When lifestyle alone is not enough.
• What to expect: Relief while taking it, under a doctor's supervision.

Step 3 — Injections

• What it is: Corticosteroid, gel (hyaluronic acid) or PRP.
• How it helps: Reduces inflammation and improves joint lubrication.
• Who it suits: Moderate pain not responding enough to medication.
• What to expect: Relief for a few weeks to months.

Step 4 — Joint replacement (surgery)

• What it is: Replacing the worn surfaces with a precise artificial joint — described in detail further down this page.
• How it helps: Markedly relieves pain and restores movement.
• Who it suits: Advanced arthritis that has not responded to earlier treatment.
• What to expect: Substantial improvement after a course of rehabilitation.

The surgery, step by step with Dr. Jalil Emad

1. Careful pre-operative assessment: I review your limb alignment, bone quality and your own expectations, and plan the implant type and size to fit your body.
2. Minimally invasive access: I reach the joint through the gentlest possible route, sparing healthy muscle, so that post-operative pain and recovery time are reduced.
3. Precise resurfacing of the joint: the damaged surfaces are removed and the metal components and smooth polyethylene bearing are positioned with high accuracy and in correct alignment to restore fluid, stable movement.
4. Final check and stabilisation: I test the joint's stability, range of motion and balance before closing, so that from day one you have a solid foundation for rehabilitation.

Your rehabilitation and recovery roadmap

Phase 1: First two weeks (protect and start moving)

Care and key precautions

Controlling pain and swelling is the key to everything here: use ice (15–20 minutes at a time), keep the leg elevated, and take the prescribed medication. Sleep on your back with a pillow under the ankle (not under the knee) so the knee stays straight. Keep the wound clean and dry. Walking with a frame or crutches begins on day one, bearing weight as tolerated.

Exercises for this phase

Ankle pumps

• Goal: Improve circulation and prevent blood clots and swelling.
• Step-by-step technique: Lie on your back with the leg straight; move only the ankle gently up (toward you) and then down. The knee does not move.
• Reps & timing: 10–15 times, every one to two hours through the day.
• Safety note: If you feel sudden calf pain, warmth or swelling, call immediately (possible clot).

Quadriceps set (isometric)

• Goal: Keep the thigh muscle active without moving the newly operated joint.
• Step-by-step technique: With the leg flat on the bed, tighten the front-thigh muscle so the back of the knee presses down toward the bed and the heel lifts slightly. Hold 5 seconds, then release.
• Reps & timing: 10 times, 3 sessions a day.
• Safety note: Do not hold your breath; ease off if you feel sharp pain.

Phase 2: Weeks three and four (increase range of motion)

Care and key precautions

Walking becomes smoother and you usually move from a frame to a single cane. Once the wound has fully healed, a normal shower and light household tasks are allowed. The aim of these weeks is to regain bending and straightening of the joint.

Exercises for this phase

Straight leg raise

• Goal: Strengthen the thigh for better control of the joint while walking.
• Step-by-step technique: Lie on your back; bend the good leg and keep the operated leg completely straight. Tighten the thigh, lift the whole straight leg about 20 cm, hold 3 seconds and lower slowly.
• Reps & timing: 10 times, 2–3 sessions a day.
• Safety note: If the knee bends as you lift, work on the quad set first, then attempt this.

Heel slide

• Goal: Restore knee flexion range.
• Step-by-step technique: Lie on your back; slowly slide the heel of the operated leg along the bed toward your buttock until the knee bends to a comfortable point, hold a few seconds, then return to straight.
• Reps & timing: 10 times, 2–3 sessions a day.
• Safety note: The movement should be slow and without sharp pain; do not force the knee.

Phase 3: Second month (back to daily life and early strengthening)

Care and key precautions

Most patients now walk without a limp and gradually put the cane aside. Driving is usually possible once you are off narcotic medication and have regained enough control of the leg (with my approval). Resume out-of-home activities gradually.

Exercises for this phase

Stationary cycling

• Goal: Increase range of motion and muscle endurance without impact on the joint.
• Step-by-step technique: Set the saddle fairly high so the knee does not over-bend; pedal slowly with no resistance at first. As it eases, increase the time.
• Reps & timing: 5–10 minutes, once or twice a day.
• Safety note: If a full pedal stroke is painful, start with half-turns forward and back only.

Mini-squat

• Goal: Strengthen the thigh and hip for stable walking and stairs.
• Step-by-step technique: Stand facing a fixed surface and hold it; feet shoulder-width; bend the knees only to about 30 degrees (as if starting to sit) and straighten again. Keep your back straight.
• Reps & timing: 10 times, 2 sessions a day.
• Safety note: The knee should not go past the toes; reduce the range if it hurts.

Phase 4: Third month (advanced strengthening and balance)

Care and key precautions

You are now ready to return to moderate physical work and more dynamic activity. This phase focuses on balance and deep strength so that the new joint feels completely confident in everyday movement.

Exercises for this phase

Single-leg balance (proprioception)

• Goal: Retrain the joint's sense of position and prevent falls.
• Step-by-step technique: Stand beside a table or wall; shift your weight onto the operated leg and lift the other foot slightly off the ground; hold your balance. First holding on with a hand, then without.
• Reps & timing: 10–20 seconds, 3–5 times a day.
• Safety note: Always practise near a support so you can catch yourself if you lose balance.

Step-ups

• Goal: Build functional strength for stairs and slopes.
• Step-by-step technique: Stand in front of a low step; place the operated leg on the step first and lift your body up, then step down in a controlled way. Use the handrail.
• Reps & timing: 10 times, 2 sessions a day.
• Safety note: Control the step-down; do not let the knee suddenly 'give way'.

Return to competitive sport (from month four onward)

A return to low-impact activities such as walking, swimming and cycling is encouraged from around the fourth month and is very good for an artificial joint. High-impact, high-contact sports — long-distance running, jumping or football — are generally not advised after joint replacement, as they shorten the implant's life. I will set your exact return-to-activity plan personally, based on your surgery and your recovery.

The services I offer

From precise diagnosis and non-surgical options (medication, physiotherapy and specialist injections) to joint-replacement surgery and rehabilitation — you can take this whole path under my care. Book a consultation to choose the best next step.