Medial Rotation Knee A Patient Guide to Knee Replacement

Medial Rotation Knee A Patient Guide to Knee Replacement

Contents An Overview Of The Knee 3 Surgical Procedure 4 In the Hospital 5 Discharge From Hospital 6 At Home 7 Diet 7 Medication 8 Resuming Normal Activities 9 Driving 10 Stairs 11 Returning To Work 12 Other Activities 12 Do s And Don ts 13 Physiotherapy Excerises 14 2 Medial Rotation Knee A Patient Guide to Knee Replacement

An Overview Of The Knee Your knee is the largest joint in your body and one of the most easily injured. In a normal, healthy knee, the bone surfaces that come together at the joint are smooth and hard. A cushioning layer of tissue (called articular cartilage) prevents contact among these bones. This tough layer of tissue allows the three bones to move without creating friction or wear on the bone surfaces. When this surface is damaged or worn away, your bones rub together causing friction, pain and eventually deterioration of the bone surfaces. In some people, all of the bone surfaces may be damaged. In others, the damage may be limited to only one side of the joint the inner or outer aspect of the joint. The most common cause of damage to your cartilage is arthritis. One in particular (known as wear and tear arthritis) osteoarthritis can set in over time and cause pain and stiffness. Discomfort may be felt when bending or putting pressure on the knee such as when walking, or going up or down stairs. Eventually the pain may become nearly constant. Medication and walking aids may help temporarily but much of the time the only long term solution is knee replacement. There is no medication or treatment that will make damaged cartilage grow back. Medial Rotation Knee A Patient Guide to Knee Replacement 3

Surgical Procedure During a total knee replacement operation the surgeon will remove the damaged surfaces. The replacement surfaces will then be fixed into place. The surface of the upper bone is replaced with a rounded metal component that comes very close to matching the curve of your natural bone. The surface of the lower bone is replaced with a flat metal component and a thin flat shaped polyethylene plastic to serve as the cartilage. The underside of the kneecap (patella) may be replaced with a polyethylene plastic component. The surgery starts with an incision over the knee which exposes the joint. Special guides and instruments are used to remove the damaged surfaces and create the fit for the implants. The implant is then secured to the bone(s). It may be necessary to realign the surrounding knee ligaments to achieve the best knee function. When the surgeon is satisfied with the fit and function of the implants, the incision will be closed. 4 Medial Rotation Knee A Patient Guide to Knee Replacement

In the Hospital One of the aims of knee replacement is to restore mobility and enable you to resume hobbies/activities you may have had to give up. The next few sections will give advice on how best to adapt to your new knee and safely resume your daily activities. A knee replacement is a major operation. Whilst rest is important, it is also important to get out of bed and mobilise (initially under supervision) to reduce digestive/circulatory problems and encourage healing. Both your doctor and your physiotherapist will be on hand to give specific advice on pain control, wound care, diet, exercise and how much weight you can put on your operated leg (weight bearing). Your doctor may order a machine to help begin to move your knee up and down. Usually a physiotherapist will visit you on the day after your surgery and teach you how to use your new knee. It is important that you get up and about as soon as possible after surgery. Even when lying in bed you can pedal your feet on a regular basis in order to promote blood flow in your legs. It is during your stay in hospital that your physiotherapist will help you to achieve the activities such as: Moving about (using a frame or crutches), getting in and out of bed, walking and going up and down stairs. Performing every day activities such as bathing and using the toilet. Using a programme of exercises to increase your range of motion and strengthen your knee. Medial Rotation Knee A Patient Guide to Knee Replacement 5

Discharge from Hospital Depending on how well you heal after the surgery, your stay in hospital can vary from between 3 to 10 days and you will need help at home for several weeks. The following tips can be useful in making your return home more comfortable. Place items that are used regularly at hand height. Avoid very high or very low shelves as these may require the use of steps or kneeling. Position furniture so you can manoeuvre with a frame or crutches and prevent falls or tripping (check with your doctor how much weight to place on the operated leg). Remove rugs and place non-slip mats in your bath. It may even be worth changing rooms around by placing a bed downstairs to reduce the use of stairs. Ideally make sure you have a good chair with arms, that is both firmer and higher than a normal low seated chair as these are safer and more comfortable. However it should not be so high that your legs dangle or lead to pressure on the back of the thigh. Installing a gripping bar and a non-slip mat in the shower is sensible; and a raised lavatory seat may be added if required. Use assistive items such as a long handled shoe horn, long handled bath sponge or a grabbing tool to avoid bending over too far. Get someone to assist you putting on your socks and tying your shoelaces. Use long handled feather dusters for low and high items. Do not sweep, mop or vacuum until your doctor tells you it is safe to do so. You may ride in a car but only if you follow the doctor s instructions for entering and exiting the vehicle (provided you are no longer taking any medication for pain or using walking aids). Raise the seat with pillows to protect your hips and knees. Your doctor will inform you when you can drive (typically within four to six weeks after surgery). Ensure you can brake, without discomfort, before attempting to drive in traffic. 6 Medial Rotation Knee A Patient Guide to Knee Replacement

At Home Calf pain, chest pain or shortness of breath can be a sign of a possible blood clot. Notify your doctor immediately if you notice any of these symptoms. If sutures need to be removed, they are generally removed between 7 and 14 days, you can shower with a water-proof dressing. Avoid bathing for 6 weeks. A dressing will be applied in the hospital and should be changed as necessary. Ask your doctor how to change the dressing if you are not sure. If the wound appears red or begins to leak, notify your doctor. It is normal to have swelling for the first 3 to 6 months after surgery. Wear loose clothing to avoid pressure on the incision. Ask your doctor or healthcare specialist about appropriate wound care. Diet By the time you go home from the hospital, you should be eating a normal diet, which should include fresh fruits and vegetables (avoid excessive intake of vitamin K, such as Broccoli, Lettuce, Cabbage and Spinach if you are taking blood thinning medication). Your physician may recommend you take iron and vitamin C supplements. Continue to watch your weight to avoid putting more stress on the joint. Medial Rotation Knee A Patient Guide to Knee Replacement 7

Medication Take all medication as directed. You may be given Anti-Embolism Socks and be prescribed blood thinning medication to prevent formation of blood clots. Anti-Embolism precautions, including regular exercise should continue for 6 weeks. Due to the fact that you have an artificial joint, it is especially important to prevent any infection from getting in your wound. You should be given a medical alert card and take antibiotics whenever there is the possibility of infection for instance when having dental work done. Be sure to notify your dentist you have had a recent knee replacement and let your surgeon know if your dentist schedules an extraction, periodontal work, dental implant or root canal work. 8 Medial Rotation Knee A Patient Guide to Knee Replacement

Resuming Normal Activities Once you get home you should continue to stay active. The key is to not overdo it. You should expect good days and bad days but notice a gradual improvement over time. In general the following guidelines should apply, though check with your surgeon for more clarity. Weight bearing: Be sure to discuss weight-bearing restrictions with your physiotherapist. Their recommendations will depend on the type of implant and other factors specific to your situation. Sexual relations: Can be resumed 4 to 6 weeks after surgery or when your consultant advises you it s safe to do so. Walking: The procedure is: First move the aid forward, then step with your operated leg and then move your un-operated leg. As your walking improves the physiotherapist will progress you to walking with crutches. You will probably need to use crutches for 3 weeks after your operation, then you may progress to a stick for a while Sitting: For at least the first 3 months, sit only in chairs that have arms. Do not sit on low chairs, low stools, or reclining chairs. Do not cross your legs. The physiotherapist will show you how to get in and out of a chair keeping your operated leg out in front of you. Medial Rotation Knee A Patient Guide to Knee Replacement 9

Driving As a guideline, you should not begin to drive for 3 5 weeks (provided you are no longer taking any medication for pain or using walking aids). Your consultant will advise you on when you are capable of driving which will depend upon your individual circumstances. Some insurance companies insist on you being given verbal permission from your consultant before you are insured to drive again. How to get in and out of car: Move the seat back as far as possible and make sure you get into the car from the road and not the pavement. Get into the car bottom first. You may use your left hand on the seat back and the right on the seat or side of the door. Gently lower yourself, keeping the operated leg a little further out. Slide back onto the seat as far as possible before swinging your legs in. To get out: Repeat the process in reverse. You may find a sheet of polythene to sit on assists with sliding and turning in the seat 10 Medial Rotation Knee A Patient Guide to Knee Replacement

Stairs Your GP and physiotherapist will give you advice on when you should start climbing stairs. The method for doing so is as follows: Put your un-operated leg on the step above and then lift your operated leg followed by the crutches. Downstairs - Exactly the reverse - crutches first, then your operated leg followed by the un-operated leg Medial Rotation Knee A Patient Guide to Knee Replacement 11

Return To Work The length of time it takes for you to return to work depends on the type of activities you perform but typically varying from anywhere between 6 weeks to 3 months. Other Activities Walk as much as you like once your physiotherapist gives you the go ahead, but do remember walking is no substitute for your prescribed exercises. As soon as the stitches have been removed and the wound is absolutely dry you can begin swimming provided appropriate aids are present, (pools with step ladders to get in and out are not recommended and avoid twisting movements to begin with). Other acceptable activities include: ballroom dancing; golf (with spike-less shoes and using a golf buggy) and cycling on level surfaces. Avoid activities that place stress on the joint such as lawn bowls, tennis, badminton, horse riding, any contact sports or jogging until discussed with your consultant at your follow up appointment. Do not do any heavy lifting. Your Physiotherapist will provide you with a list of do s and don ts to remember for your new knee. These precautions are necessary to prevent the new knee from dislocating and to enhance proper healing. Here are some of the most common precautions. 12 Medial Rotation Knee A Patient Guide to Knee Replacement

Do s And Don ts Do keep the leg facing forward at all times Do keep the operating leg in front of you as you sit or stand Do use ice to reduce pain and swelling, but remember that ice will reduce feeling (Don t apply the ice directly to the skin use an ice pack or damp towel) Do cut back on exercises if your muscles begin to ache, but don t stop doing them! Don t cross your legs for at least 8 weeks Don t turn your feet excessively inward or outward Don t stand pigeon toed (toes inwards) Don t stand for long periods of time Don t use pain as a guide for what you can or cannot do Medial Rotation Knee A Patient Guide to Knee Replacement 13

Physiotherapy Physiotherapy is an important part of recovery and can have a substantial impact upon both the speed of your recuperation and the control you have over your new knee. Your physiotherapist will give you your own set of exercises to do, however, the exercises listed 1-11 are good general movements to do both before and after the operation. 2 3 times daily; with 10 repetitions each time. To begin with you will find them hard so aim to increase movement with gentle repetition. As you progress try to hold each exercise for around 5 seconds. (Exercises pictured in the lying position can be done lying or sitting on the floor/bed with your legs stretched out) By doing the exercises before your operation you will build up the muscles around your knee and make the exercises afterwards easier. Each exercise should be done 1. Lie on your back or sit with your legs straight, pull your feet up towards you and push your knees down firmly against the floor/bed. Hold for 5 seconds then relax. *This exercise can be combined with a knee bent as below. 2. Put a rolled blanket (or similar) under your knee. Pull your feet towards you and tighten your thigh muscles to straighten the knee (keeping the back of the knee on the roll). Hold for 5 seconds. 3. Pull your toes up; straighten the knee and lift the leg 20 cm off the floor/bed. Hold for approximately 5 second then slowly relax. 14 Medial Rotation Knee A Patient Guide to Knee Replacement

Physiotherapy continued 4. Lay or sit with a sliding board under your leg. Bend and straighten your knee by sliding your foot up and down the board. 5. Lie on your back with your knees bent, squeeze your buttocks together and lift your bottom off the floor. Return to the starting position. 6. Sit on a high chair or table. Bend your knee underneath as much as possible Hold for 5 seconds. Medial Rotation Knee A Patient Guide to Knee Replacement 15

Physiotherapy continued 7. Sit on a chair with a cushion under your thighs. Pull your toes up, tighten the front of your thigh muscle and straighten your knee slowly. Hold for approximately 5 seconds. 8. Stand, holding onto a support. Bend your knee and lift your foot off the floor to approximately 45 degrees. Hold for approximately 5 seconds. 16 Medial Rotation Knee A Patient Guide to Knee Replacement

Physiotherapy continued 9. Stand in front of a table or chair holding on for support. Slowly bend your knees and squat as far as comfortable. Stay down for approximately 5 seconds and feel the stretching in your buttocks and the front of the thighs. 10. Holding onto a support, push up 11. Holding onto a support, place your affected foot onto a step; slowly shift your weight forward over that foot, allowing your knee to bend as much as possible. Medial Rotation Knee A Patient Guide to Knee Replacement 17

Physiotherapy continued The following exercises should only be done if advised by your physiotherapist 12. Stand in front of a small step. Step up with your affected leg on the step. 13. Stand sideways on a step, with one foot hanging over the edge of the step. Slowly bend your operated knee allowing your other foot to brush the floor. 14. Stand up and then sit down slowly on a chair (This can be made easier and more difficult by changing the height of the chair). 18 Medial Rotation Knee A Patient Guide to Knee Replacement

Physiotherapy continued 15. Holding onto a support, stand on one leg Push up on your toes. 16. Standing with support available. Squeeze a foam wedge/towel between your knees, continue to squeeze while gently bending your knees to 45 degrees. Return to standing and relax. 17. Stand, leaning with your back, against a wall and your feet about 20 cm from the wall Slowly slide down the wall, until your hips and knees are at right angles. Try to hold for 15 seconds. Return to starting position. 18. Stand on the operated leg. Try to balance, without holding on for 60 seconds. Medial Rotation Knee A Patient Guide to Knee Replacement 19

The Medial Rotation Knee is endorsed by leading surgeons around the world including; Mr. Christopher Evans, Consultant Orthopaedic Surgeon Robert Jones & Agnes Hunt Orthopaedic Hospital Mr. Yegappan Kalairajah, Consultant Orthopaedic Surgeon Luton & Dunstable Hospital Please note: This document is written for guidance purposes only. Your medical team will tailor your treatment to your individual needs. MatOrtho Limited 13 Mole Business Park Randalls Road Leatherhead Surrey KT22 7BA United Kingdom. T: +44 (0)1372 224200 info@matortho.com For more information visit: www.matortho.com Part No. ML-300-009-L issue 1