==Knee replacement surgery and your recovery programme

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1 40 Publication date: Apr 2006 Date last reviewed: May 2011 Date next review due: May 2013 Leaflet code: UCLH/S&C//SUR/ORTHO/TKR/3 University College London Hospitals NHS Foundation Trust Main switchboard: Or: Knee replacement surgery and your recovery programme A guide for patients and carers UCLH Trauma & Orthopaedic Team Bring this booklet with you when you come in to hospital for your surgery

2 If you would like this document in another language or format, or require the services of an interpreter, contact us on Ext We will do our best to meet your needs. Contents page Introduction 3 The knee joint 3 How can a knee joint replacement help? 5 Important things to consider before having a knee replacement 7 What are the risks of surgery? 7 Problems that can happen months or years after your knee operation 10 What happens if you choose not to have the operation? 11 What is the alternative to surgery? 12 Asking for your consent 13 Your joint recovery programme 14 What happens before you come into hospital? 14 Preparing for your operation 16 On the day of your operation 19 What you can expect straight after your operation 19 Your recovery after knee replacement surgery 20 Exercising and other advice 21 On the day of your discharge 29 How can you help your recovery 30 Frequently asked questions 32 Contact details 34 Where you can get more information 34 Your exercises 35 Space for your notes and questions 2 39

3 Introduction Heel raises Stand holding onto the back of a chair for support. Push up on to your toes. This booklet is to help you understand what is involved in knee replacement surgery. It explains how we do the surgery and gives details of the benefits, risks and alternatives. It also includes information about what happens before and after your operation. At UCLH patients are admitted on the day of their surgery and most will stay in hospital for an average of three to four nights. The information in this booklet is based on research studies and may differ between surgeons and hospitals. Members of the orthopaedic team will explain any differences to you and will try to answer any questions you have. Squats Hold on to a chair for support and slowly bend your knees. Return to the upright position. We are asked by the Government to gather information about knee joint replacements, so you will be asked to fill in questionnaires about yourself and your knee pain before and after your surgery. We are also a large teaching hospital and from time to time we carry out important research about joint replacements. You may be asked whether you would like to participate in this research, but you do not have to take part. 38 Hamstring curls Holding onto a chair for support, slowly bend your knee, bringing your foot towards your bottom. Slowly straighten your knee. The knee joint The knee joint is a complex joint between the bottom of your thigh bone (femur) and the top of your shin bone (tibia). The knee cap (patella) rests in front of the knee joint. This type of joint is called a hinge joint. The surfaces of the knee are coated with a smooth cartilage lining. Osteoarthritis occurs when the cartilage wears away, which can expose the underlying bone. This will cause roughening and distortion of the joint, resulting in painful and restricted movements. With osteoarthritis the knee joint space can reduce and we can see the formation of small, bony outgrowths called osteophytes. 3

4 Normal knee joint Knee extension Sit on a chair: pull your toes up, tighten your thigh muscle and straighten your knee. Hold for about five seconds and then slowly relax your leg. Knee flexion Knee joint with osteoarthritis Sit on a chair with your feet on the floor. Bend your knee and slide your foot back as much as possible. Return to the start position and repeat. 4 37

5 How can a knee joint replacement help? Straight Leg Raise Tensing the muscles at the front of your thigh, lift the whole leg straight up off the bed Inner range quads Place a rolled up towel under your knee. Keeping your knee on the towel, lift your foot off the bed. Knee bending Keeping your foot on the bed, slide it towards you to bend your knee. Knee replacement surgery, or knee arthroplasty, is a treatment for severe arthritis of the knee joint. Arthritis can cause pain. A knee replacement is recommended when the joint pain is causing disability and has a serious effect on your day to day activities. By replacing your arthritic knee joint with an artificial one, surgeons try to: Stop your knee joint hurting Help you move more easily Stop your knee from locking Improve your quality of life Knee replacement surgery replaces the bone that is affected by osteoarthritis with an artificial joint that has metal and plastic parts. We often use a special grout for the surgery which is called bone cement to fix the new parts in place. The operation that replaces both sides of your knee joint is called a total knee replacement and the operation that replaces one side of your knee joint is called a uni-compartmental knee replacement. You and your surgeon will decide the best type for you. 36 5

6 Total knee replacement Your exercises Ankle Movements Slowly move your foot up and down. You can start this straight after surgery. Static quads Uni-compartmental knee replacement Push your knee down into the bed, tightening the muscle at the front of your thigh. Static glutes Slowly squeeze your bottom muscles. Hold for a few seconds and slowly relax. 6 35

7 Contact details UCLH Therapy & Rehabilitation team (physiotherapists and occupational therapists): Telephone: (switchboard) and extension Both telephone messages and are checked daily Monday to Friday. Where can you get more information? Arthritis Research UK Copeman House St Mary s Gate Chesterfield Derbyshire SA1 7TD United Kingdom National Joint Registry NHS Choices The Royal College of Anaesthetists: Patient leaflets 34 Telephone: Fax: Web site: Web site: Kneereplacementexplained.aspx Web site: University College London Hospital NHS Trusts cannot accept responsibility for information provided by external organisations. Important things to consider before having a knee replacement Surgery is harder with people who are overweight and the results may not be good. Your age is less important than how fit you are. A knee operation is a serious operation. You may not be able to have one if you have a serious heart disease or another serious illness. If you have a knee replacement when you are young, you are more likely to need a second one later on in life. When this happens, you can have an operation to replace it. Second knee joint replacements (revisions) are harder to do and the recovery and outcome might not be as good as the first knee replacement. What are the risks of surgery? Knee replacement surgery generally has very good results and complications are rare. But like any operation, it does have risks. Anaesthetics can have side effects. For example, you may feel sick afterwards. If you do feel sick, please tell a nurse, as we may be able to give you medication to help. You may have an allergic reaction to the anaesthetic or get breathing or heart problems. These problems are serious but rare; facilities are available to deal with them if they happen. We will monitor your blood pressure, heartbeat, temperature and breathing. If you have any allergies, you must tell your doctor and anaesthetist before your operation. A blood clot in your legs: (3% risk). You can reduce the risk by wearing the elastic stockings we will give you 7

8 8 after your operation (Thrombo Embolic Deterrent, TED, stockings). The stockings help keep the blood flowing in your legs. Getting out of bed either on the same day or the next day after your operation helps reduce the risk. If you get a blood clot (a deep vein thrombosis or DVT), you will need drugs to thin your blood. In most people, the clot causes no trouble and goes away after treatment. A blood clot in your lungs: (under 1% risk). A blood clot in your leg can travel in your blood stream to your lungs. This is a serious complication. You can reduce the risk by wearing the elastic stockings we will give you after your operation (TED stockings). The stockings help keep the blood flowing in your legs. Getting out of bed either on the same day or the next day after your operation helps reduce the risk. If you get a blood clot you will need drugs to thin your blood. In most people, the clot causes no trouble, and goes away after treatment. A heart attack, stroke or chest infection: (under 1% risk). These things are more likely to happen if you already have heart disease or chest problems. We will ask you questions on your health when you come for your pre-operative medical assessment. This assessment clinic will take place before you come in for surgery and the medical team will identify any health risks before you have your operation. Infection (under 1% risk). There is a risk of infection in the skin and tissue around your operated knee joint. To reduce the risk of infection you will be given antibiotics straight before and after surgery. When you are on the ward clean your hands with soap and water, hand wipes, or alcohol gel before meals and after going to the toilet. When will I see my consultant again? You will be given an appointment to see your consultant team six to seven weeks after your operation. You are more likely to see one of his team members rather than the consultant himself. When can I have a bath? You can have a bath six week weeks after surgery. Your wound should be completely healed, and you should be able to get in and out of a bath safely. The therapist will discuss with you how to get in and out of the bath when you are in hospital. When can I do gardening? You can garden when you feel ready. If you start gardening soon after your operation kneeling might be difficult for the first period after your operation. You might find it easier sitting on a chair. When can I kneel? We do not advise you to try kneeling for the first six weeks after your operation. Most patients will find it uncomfortable to kneel for the first 6 to12 weeks after surgery. Over time most patients with a knee replacement will be able to kneel. When can I fly? Will I be stopped by airport security? If you are planning on a long flight we do not advise this for the first six weeks after your operation. We also advise you when you do fly to wear TED stockings. Most people with hip or knee replacement surgery will alert the airport security. Just inform the security staff that you have had joint replacement surgery. Can I take up an impact sport once I have recovered from my operation? We do not advice patients that have had a total knee replacement to take up impact sport activities like jogging/ running and tennis at any stage after their surgery. Patients that have a uni-compartmental knee replacement will need to discuss with their consultant the sport activities they can do after their surgery. 33

9 Frequently asked questions Will I have pain after my operation? In the long term the pain caused by the osteoarthritis will be helped by having a knee joint replacement. Knee replacements however can be painful for the first weeks after surgery. We do advise you to take your prescribed medicine on a regular basis. What do I do if my leg swells up? We expect that knee replacements have some swelling following surgery. Keeping mobile will help reduce the swelling. If the leg becomes hot and red please notify your GP immediately. When do my stitches or clips come out? Your wound will be assessed by your district nurse within two weeks after going home. Any stitches or clips you might have will also be removed. We will notify your GP and the practice should arrange this. How long do I have to wear my TED stockings? We advise patients to wear the TED stockings for up to six weeks after their knee surgery. When can I start my knee exercises? You can practice your knee exercises before your operation. You can start with a low level of exercises on the day of your operation and progress these the day after your operation. When can I take my full weight on my operative leg? And when can I stop using elbow crutches? Clear instructions will be given to you after your operation. Most patients can take their full weight on the operative leg straight after their surgery. You can stop using elbow crutches when you are comfortable walking with out them. 32 This will also help reduce the risk of infection. Avoid touching wounds, drips, catheters or other medical devices. If you do get an infection, we will give you more antibiotics. If you notice any swelling, discharge or itching around your wound, at any time after your operation, let your nurse or doctor in hospital know, or your general practitioner (GP) once you are back at home. It is important that we treat any signs of infection, quickly because a joint replacement that becomes infected might need another operation. Urine problems: (under 0.3 % risk). If you cannot urinate (pass urine) after your operation, you may need a plastic tube (catheter) inserted to help you empty your bladder. Dying from surgery (extremely rare) Deaths caused by anaesthesia are very rare. There are probably about five deaths for every million anaesthetics in the UK. Your anaesthetist will discuss the risk of the anaesthetic with you. The risk of death after a hip or knee replacement is minimal (0.1% risk). Damage to the nerves in your leg: (extremely rare). The nerves in your leg might be damaged during surgery. This can make your foot floppy and weak. Most people recover from this complication, but this can take up to six months or more. If it happens to you, you may need further investigations to identify the problem. Many patients experience some numbness around their wounds which may be permanent. Not all the pain disappears. This operation will only take away the pain that is caused by your arthritic knee joint. It will not help to relieve pain that is caused by problems elsewhere. Your surgeon will explain this to 9

10 you in more detail when you are deciding about having surgery. Problems that can happen months or years after your knee operation Your knee gives way or buckles. Doctors call this instability. It is painful and can interfere with your daily life. It also increases the wear and tear on your knee replacement. If this happens, you may need a revision knee replacement or other surgery to make it more stable. You still have pain in your knee. Your surgeon will investigate to see if a cause can be found. Sometimes, he or she won t be able to find one. Usually the pain will go but it can take many months. The knee replacement becomes loose. This can happen slowly over time, usually taking longer than 10 to 15 years to become noticeable. If it happens, you may need another operation to replace the loose knee joint. You have problems bending the knee. Occasionally, the knee has to be manipulated to get it moving. It is normally best to work harder at bending the knee yourself. This gets it going much earlier and allows an earlier return to full function. If you are very active and do lots of exercise discuss with your consultant and your physiotherapist what would be the advisable level of exercise for the first few weeks after surgery. If you have never exercised on a regular basis you might find the idea of exercising difficult. It is however very important you start and continue with the exercises you were shown in hospital for at least the first six to twelve weeks after your operation. After your operation you might feel more tired than usual or that your knee joint is painful after you have been active. It is important that you take time to rest in between your active periods. You can discuss any questions you have with your therapist. In the long term Reducing or keeping your weight stable will help you keep mobile. Regular exercise is good for your joint replacement, and for you. Walking, swimming and cycling are activities that you can do in the long term. You should avoid activities that jolt and jar your knee joints such as jogging, running or tennis. You can ask your consultant or your physiotherapist about what exercise you can do. Do not start a new exercise programme with out medical or physiotherapy advice. The knee replacement stops working. This is rare, but sometimes your knee replacement can break down (surgeons call this mechanical failure ). 10 You need a second knee replacement (a revision). Most revisions are done because the original knee 31

11 You will have a follow-up appointment with your consultant team six to seven weeks after your operation to check how things are going. You will have a physiotherapy referral to check your mobility and exercises two to four weeks after your operation. This can be arranged either at University College London Hospital or your local physiotherapy department. How can you help your recovery It takes time to recover from a knee replacement. It may be three to six months before you feel back to your normal self. Many people can feel emotional and tearful after a big operation. If you feel that your mood is very low for a long time after your operation, discuss this with your family doctor (GP). Straight after your operation We expect patients that have knee replacement surgery to experience pain and stiffness after their operation. Knee swelling is also common. It is important that you take your prescribed pain relief medication on a regular basis once you return home. If you feel that you still have discomfort despite taking medication speak to your GP. It is important that you give your self time to recover after your operation. If you work, discuss with your consultant how much time you should take off work after your operation. Depending on your level of physical activity and exercise you do, you might have to decrease or increase your activity after surgery. replacement has become loose from the bone, possibly because of an infection. The knee becomes painful and unstable. Your knee joint needs to be permanently removed. This is the worst that could happen some time after your operation, but it is very rare. If it did happen, it may leave you with a leg that is permanently straight. Your knee replacement gets infected. Very rarely, knee replacements can get infected months or years after surgery. Your knee may get better with antibiotics, but sometimes you may need another operation to clean out the joint. On rare occasions if the infection can t be controlled by antibiotics, the replacement joint may need to be taken out. If your surgeon doesn t think it is possible to put another artificial joint in, then you may need to have an operation to make your knee joint stiff. This means the knee is left permanently straight. What happens if you choose not to have the operation? If your pain does not get any worse, and you can cope with it, you may not want to go through a joint replacement surgery. A painful knee joint will not shorten your life. Some people find that the pain does not get worse over time and manage to live with it. If you have joint symptoms that are stopping you from enjoying life, research suggests that it is better to have surgery before you become too disabled

12 What is the alternative to surgery? If you decide not to have knee joint replacement surgery there are strategies that could help you manage your day to day difficulties. Treatment without drugs 12 Stay active: taking regular exercise may reduce your pain. Gentle exercise like walking, swimming, low impact exercises at home or a gym can be helpful. Lose any excess weight: carrying extra weight puts a strain on your hips and knees. This is likely to make your pain worse. If you are overweight, losing weight may be all you need to do. See a physiotherapist: physiotherapists can teach you exercises to strengthen your leg muscles and keep you mobile. Get help with mobility: there are many devices to help you move around more easily and confidently, including walking sticks, other walking aids and shock absorbing shoes. Treatment with drugs Painkillers may help to control your pain. The most common painkillers are paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs for short). Your doctor will probably suggest you try paracetamol first, because it is the safest treatment for most people. Some NSAIDs come as a cream or gel to rub on your sore joint. If you do not want to take pills, you can try creams or gels, but you may find that pills or tablets work better for you. When travelling, try and give your operated leg as much leg room as possible, as bending it to sit in a car might be difficult for the first few weeks after surgery Sexual activities If you do not have severe pain, it is safe to continue sexual activities. You may find it safer and less stressful to remain on your back. On the day of your discharge On the day that you go home you will be discharged from the ward by 11 am. You may be asked to wait in the discharge lounge whilst you wait for your prescription. This means that the next patient waiting for surgery can use the bed. Car parking is very difficult around UCLH sites. Parking meters are located around the hospital site and you might not find free spaces. There is a drop off and pick up area at the back of the hospital. We do advise you to plan your travel back home before you come in to hospital. You will be discharged with a prescription of medication to help with your pain and medication that helps thin your blood (anticoagulants). The medication prescribed for pain is generally similar to what you have been taking before you come in to hospital. Your general practitioner (GP) will be notified that you have been discharged and a discharge summary is sent to the GP practice. A district nurse will review your wound and remove the stitches or clips with in two weeks of your discharge. 29

13 Driving and getting in and out of a car You should not drive until your consultant gives you clearance to do so. You can discuss this at your post operative follow up appointment. Most people can drive after six weeks. You can travel with a black cab or a local minicab company. Getting in and out of a black cab might be difficult for the first few weeks after your operation as you may need to bend your operated knee to get in and out. However, if you use a wheelchair, black taxis may be suitable as many of them now have chair lifts. Your OT will talk to you about this and give you individual advice. You should be able to travel as a passenger in the front seat of an ordinary car quite easily. If you do travel by car, follow these instructions: Park the car a few feet away from the kerb, so you can stand at the same level as the car. Ask someone to put the front passenger seat back as far as possible to give you plenty of legroom. Recline the seat half way. Facing the kerb, carefully lower yourself down, sliding your operated leg forwards. Do not hold onto the door. If you need support, hold onto the car frame or the seat behind you. Sit down carefully. There are risks with taking any medication. The main risks of taking paracetamol are taking too many tablets (overdose), which can be very serious. If you are taking paracetamol regularly, be careful that you do not take any other medicines with paracetamol in (such as cold and flu remedies). If you think that you may have taken too much paracetamol, seek medical attention immediately. The main risks of taking NSAIDs are stomach and bowel problems, such as ulcers developing or internal bleeding. These complications can be very serious. If you intend to use NSAIDs creams or gels and also take NSAIDs tablets, you need to discuss this with your GP first, as there is a risk of taking above the recommended dose. As with any medication, you may have an allergic reaction to painkillers. If you have any problems with your medication, tell your doctor straight away. Asking for your consent If you decide to go ahead with the surgery, by law we must ask you to sign a consent form. This confirms that you agree to the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before you sign the consent form. This booklet also gives you information on the risks of joint replacement surgery. If you are unsure about any aspect of your proposed treatment, please speak to a senior member of staff again. Lean back. Then, keeping both knees together, lift both your legs into the car. Turn your hips at the same time as you bring your legs into the car. You can make swivelling easier by sitting on a plastic bag

14 Your Joint Recovery Programme If you have decided to go ahead with a knee replacement it is important that you understand and you are involved in every stage of the surgical process. This will help toward the best possible recovery following your operation. What happens before you come in to hospital? Following your decision to have a knee replacement you will be offered a date for your medical pre-assessment, the joint recovery programme introduction session and the admission date for your operation. The medical pre-assessment clinic and introduction session are outpatient visits and will take place before you come in to hospital for your operation. Information about these sessions will be posted to you along with your appointments dates. The Pre-Assessment Clinic (PAC) is an outpatient clinic which you must attend before you are admitted to hospital for your operation. This clinic normally takes place two to six weeks before you come in to hospital. It can take up to three hours so allow time. You will meet a nurse who will ask you questions about your general health and you might have medical checks, such as X-rays and blood tests. Depending on your medical history you might meet an anaesthetist who will assess you regarding your anaesthetic. The joint recovery programme introduction session is a group session led by a nurse, physiotherapist and occupational therapist. This session is in addition to the PAC clinic and lasts approximately two hours. This session will help you prepare for your operation. The session will cover information about your joint replacement and how to plan the stages before, during and after your admission to hospital. Please feel free to bring a 14 It is best to get dressed sitting on a bed or a chair. Getting dressed when you are standing up can increase the risk of you falling. The therapist will practice with you how to dress. Depending on your needs they will advise you on dressing aids you require and their use. If you are unable to manage these tasks when you are ready to go home, you may need a carer to help you. We will work with your family and social services to arrange this care before you go home. Toileting Follow the same instructions as detailed in sitting and standing. You might need some toilet equipment to raise your toilet seat to the appropriate height. Make sure that the toilet paper is within easy reach. Kitchen tasks It may be useful to have a stool or high chair in your kitchen, so you can avoid standing for too long. You might be using two elbow crutches when you first go home. This will make carrying cups and dishes difficult. Consider eating your meals in the kitchen if carrying items to another room is difficult. Consider using a kitchen trolley to move things from one room to another. If you need to reach something at a low height, move your operated leg behind you keeping the knee straight. Then hold onto something firm for support and then bend the leg that was not operated on. The therapist will practise with you how to do this and check that you can do it safely. 27

15 member of your family or a friend with you to the introduction session. Having someone with you in the introduction session can help you plan your time at home before and after your admission. In this session you will be shown how to use elbow crutches and if you wish you can take them home with you to practice. You will be shown your post-operative leg exercises. You will be shown how to get in and out of bed. You will be shown how to use simple aids to help you dress. During this session you will also be assessed individually so we can identify if you need special equipment for your home. Washing and dressing If your knee is uncomfortable and stiff after your operation you will find it hard to wash and dress the lower part of your body because of the amount of bending you can do is restricted. You will not be able to have a bath for the first six weeks. We expect patients to dress and wash on the ward the day after your operation (day 1). This is another way we can identify any specific needs to individual patients. Some suggestions: If you have a shower over the bath, a shower board may be useful. We will assess if this is suitable for you and teach you how to use it safely. You can have a wash while sitting on a high stool at a sink using a long handled sponge / loofah. It is best to wash your hair in this position too. With assistance of a friend or family you could sit on a stool with your back to the sink and lean backwards to wash your hair. 26 Equipment loan. If you do need equipment, in most cases, we can arrange for the equipment to be loaned to you (for up to six weeks) from your local community equipment store. If you live in Camden, Islington and Westminster boroughs our therapy team can arrange the loan of the equipment you need. If your local store does not have the equipment you need, you may need to purchase the equipment. Whether you are charged or not and how much you pay depends on the rules in your local area. You can buy your own equipment locally, over the Internet or by mail order. You can discuss with the occupational therapist your local suppliers and what is available from your local borough when you attend the joint recovery introduction session. Please complete your assessment / home situation form (in the pack that you will receive) and bring this with you to the introduction session. You must attend both the Joint Recovery Introduction session and PAC outpatient clinic before your operation. You can 15

16 choose whether you would like to attend both sessions on the same day or on a separate day. Preparing for your operation Third, lift and swing both legs on to the bed. Use your arms and non operated leg to help move up to the top of the bed. Work. If you work, discuss with your consultant how much time you should take off work after your operation. The time you have off will depend on the physical demands of your work. Getting home from the hospital after your operation. You will need to arrange who will pick you up when you are discharged from the hospital. You will be able to travel as a passenger in a normal car and we will discuss with you how to get in and out of a car. Hospital transport is only provided to patients who for medical reasons are unable to use any other forms of transport. Joint replacement surgery alone does not make you eligible for hospital transport. Practice your exercises and practice using your walking aids. You will be given elbow crutches when you attend the joint recovery introduction session and shown how to use them. Practice walking and going up and down stairs with the elbow crutches (if you have stairs), before you come in to hospital. If you have new unfamiliar home aids also practice using them. Becoming familiar with the post-operative knee exercises before you come in to hospital will make it much easier to start them once you have had your operation. Please remember to bring the elbow crutches with you when you come to the hospital for your operation. Consider which side of the bed your will use to get in and out of bed when you go home. You may need to re-organise the furniture and your room so you can get into bed on your operated side. Sitting and standing Make sure your chair is at the appropriate height for you. To sit down, put your walking aids aside, using your hands feel for the arms of the chair, and slide the operated leg forwards as you sit down slowly. Your arms and non-operated leg will take your weight as you sit down. To stand use the same process reversed. Take your weight on the leg that was not operated on, and push up hard with your hands on the arms of the chair

17 change the way you get in and out of bed. You might need assistance to begin with, but gradually you will be able to move around on your own. The therapist will practice with you how to get out and in of bed when you get up for the first time after your operation. To get out of bed: Get out on the side of your operated leg. First, move your operated leg towards the edge of the bed. Second, bring both legs over to the edge of the bed and sit up. Use your arms to push up. Outdoor environment. 1. Do you have steps to access your home? You can practice going up down these with your elbow crutches before you come in to hospital. 2. Do you have uneven surfaces outside your home? You can practice walking with your elbow crutches along your street before you come in to hospital. 3. Do you use public transport? Following your operation your leg might be uncomfortable and you might be using elbow crutches for a short period of a time. Unfamiliar surroundings with a lot of people, such as on public transport, might not be easy straight after your operation. Steps on to buses and trains can be higher than the average house step. We would advise that you think carefully before using public transport for the first few weeks after your operation, particularly busy times of travelling. House work & small kitchen tasks. After your knee replacement you will go home with elbow crutches and your operated leg will be sore. This will affect your balance and your walking will change for the first few weeks after your operation. Before you come into hospital, you may find it helpful to: To get in to bed: 24 First, sit down on the bed and sit back enough so the back of your legs are supported by the bed. Second, position yourself at an angle so you are facing towards the foot of the bed. Use your arms to balance yourself and position yourself on the bed. 1. Stock up on supplies before you come in to hospital. Plan how you will get your supplies for the first six weeks after your operation. 2. Re-arrange cupboards, drawers and the fridge so items you need are at waist height and easy reach. 3. Make or buy frozen meals and vegetables to use when you first get home. 4. Plan where will you have your meals. It will not be easy to carry items when you are using elbow crutches. Do you have a kitchen trolley? 17

18 18 5. Plan your housework. Do things like washing, cleaning and sorting out cupboards before you come in to hospital. Home environment. Plan your home environment to reduce the risk of falling. 1. Think about what shoes you can wear when you are home. Choose shoes that don t have shoe-laces and with good grip. 2. Remove cables, wires, rugs or small carpets that you might trip on. 3. Do your rooms like bathroom, bedroom, and kitchen have easy access? Could you move furniture around to give your self more space whilst you are using elbow crutches? 4. If you have pets need looking after, dogs that need walking or get excited and jump up towards you, can a friend or a family member help look after them for the first few weeks after your operation? 5. Ensure your home is well lit. If you have friends or family who can assist you with some of these home tasks, ask them before you come into hospital and try to have arrangements in place for when you get home. Your seating surfaces (such as chairs, bed and toilet) must be set at a comfortable height for you to sit and stand with ease. A Furniture Measurement Form will be posted to you - please complete this before attending the joint recovery introduction session. A therapist will discuss your measurements and discuss your equipment needs in this session. Stairs Once you are confident on two crutches or sticks, we will teach you how to manage stairs. This usually happens the second or third day of your stay (day 2 or day 3). The procedure is: Going upstairs: 1. non-operated leg ( sometimes referred to as good leg ) 2. operated leg (sometimes referred to as bad leg ) 3. crutches / sticks Going downstairs: 1. crutches / sticks 2. operated leg ( bad leg ) 3. non-operated leg ( good leg ) Hold both walking aids in one hand and the banister in your free hand. Footwear After the operation, wear footwear that is non-slip and fits well. Trainers and flat shoes are two suggestions. You will find walking easier wearing these types of shoes. Avoid mules, flip flops and high heels. If your knee is stiff you might find shoes with laces difficult to do up for the first weeks after your operation. Choosing shoes without shoe laces, that are easy to put on and off, and are well fitted, will be best. Shoes with velcro fasting are one suggestion. Getting in and out of bed Most patients will be able to get out of bed the day after their operation (day 1). Your operated leg is likely to feel heavy for the first few days after your operation and you will need to 23

19 time you go home. Always exercise within comfort and pain limits. Walking At first, you might use a frame to walk, then crutches, and then you might go on to use sticks. On flat ground, walk in the following order: First: place your walking aid in front of you. Second: bring your operated leg forward and level with your walking aid. Third: bring your non-operated leg forward and past your operated leg. On the day of your operation You will be admitted on the day of your operation (day 0 of your stay). Instructions will be given to you at pre-assessment clinic (PAC) about when to stop eating and drinking. On the morning of your operation you will meet a nurse, your consultant s surgical team and the anaesthetist. Once you have been assessed you will be escorted to theatre. A knee replacement takes between one to two hours, and you will also spend time in recovery before you go to your ward. You will either have a general anaesthetic (a drug that sends you to sleep ) or an epidural (an injection into the spine) or both. If you only have an epidural, the lower part of your body will be numb and you will not feel anything. The theatre staff will put a screen up so you will not be able to see the surgery, but you may be able to hear what is going on. What you can expect straight after your operation When you wake up, you will be lying on your back with a needle in your arm connected to a bag of fluids and / or medication (called a drip ). You may also notice a plastic tube (a drain ) coming out of your knee joint, which stops fluid collecting under your scar. Normally we will take the drip and drain out after one or two days. We will give you elastic stockings (TED stockings) to help the circulation in your legs. Your scar will be over the front of your knee, closed with stitches or clips and it will be covered with a dressing. You will be advised by your therapist when you can try to walk with one crutch / stick. You may even achieve this before you leave hospital. You will feel pain and stiffness in your operated knee joint. There are several options to help control the pain: You may have medication given to you with a drip and you will be able to control your own pain relief by pressing a button. This is called PCA (patient control 22 19

20 analgesia). A limit is set to stop you taking too much; you can press the button as often as you need to. Taking more painkillers than you need may make it harder for you to get out of bed. If you have an epidural anaesthetic, your legs may be numb and you should feel no pain for a period after the operation. There is a wide range of painkillers (analgesics), which are available from the hospital pharmacy. Morphine-based analgesics, referred to as opioids can be used. These drugs may cause side effects like vomiting or constipation. If you feel sick or constipated, please tell a nurse. Tablets or an injection can be given to stop you feeling sick, and laxatives can be given to prevent constipation. Tell the nurses if you are in pain, as too much pain can delay your recovery. The nurses will provide you with the right painkillers and can contact the doctors if there are any problems. During your stay, you will have an X-ray to check your knee joint replacement. Your recovery after knee replacement surgery Most patients can get out of bed and walk taking their full weight on their operated leg the first day (day 1 of your stay) after their knee replacement surgery. Once you are up walking and can do simple day to day tasks by yourself you can go home. Most patients recover quickly and stay in hospital for three to four nights. Whilst in hospital to help your recovery, you will work with the therapy team. Occupational therapists (OT), physiotherapists (PT) and therapy assistants (TA) will guide you through your post operative rehabilitation programme. You will practice your leg exercises and you will practice walking and going up and down stairs. You will also practice and talk through how you will manage your day-to-day activities when you get home. These activities include getting in and out of a bed, getting washed and dressed, doing the shopping and laundry, preparing meals and enjoying social activities. Remember to take care when doing these activities and follow the advice we give you. Exercising and other advice The therapist will go over the exercises you were shown in the joint recovery introduction session. These are: Leg exercises to assist circulation. Exercises to strengthen muscles of your operated leg. Exercises to regain the movement of your knee joint. Exercise is very important: you need strong muscles to support your operated knee joint and help the healing process. You should continue these exercises after you go home. You will find the exercises at the end of this leaflet. Try to follow your exercises 3 times a day. Start with 5 repetitions of each exercise, increasing to 10 repetitions by the 20 21

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