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TOTAL PARTIAL KNEE REPLACEMENT GUIDELINES FOR PATIENTS THIS IS MODERN MEDICINE
Guidelines for Patients Having Total or Partial Knee Replacements INDIVIDUAL PATIENT NOTES Consultant Name Date of Surgery Weight Bearing Status Walking Device Date for Removal of Sutures Stitches or Staples Clips Other Recommendations
Contents Individual Patient Notes 2 Introduction 4 What is a Total Knee Replacement 5 What is a Partial Knee Replacement 6 What can I Expect from an Artificial Knee 6 Early Planning for Discharge 7 Pre Assessment Clinic 8 Preparing for Admission 9 Pre Admission Checklist 11 Morning of Your Surgery 12 Evening of Your Surgery 14 Physiotherapy 15 Exercise Programme 16 Daily Excercises 17 Walking 21 Stairs Technique 22 Rehabilitation Goals 24 Knee Replacement Goals of Care 25 General Recommendations 26 Call Bells Sleeping Nausea Pain Management General Safety Advice for Home Discharge Instructions 28 Wound Care Signs of Infection Antibiotics Pain Medication Swelling and Bruising Stockings Use of Ice Bowel Care Activities Once Discharged 32 Car Transfers When Getting in and Out of the Car Driving Travel Sexual Activity Potential Complications 36 Conclusion 41 Exercise Diary 42 3
Guidelines for Patients Having Total or Partial Knee Replacements Introduction This information booklet has been written to give you and your family a better understanding of what is involved when you require a Total Knee Replacement A painful knee can severely a ect your ability to lead a full active life The aim of a Total Knee Replacement is to improve your quality of life and reduce pain In this booklet we provide information including things you should know before and after your operation as well as information regarding your discharge from hospital It is important for you to understand the benefits but also the possible problems that may occur after this form of surgery Throughout your stay in Beacon Hospital you will receive continuous advice and support from all members of the orthopaedic team 4
Guidelines for Patients Having Total or Partial Knee Replacements What is a Total Knee Replacement A Total Knee Replacement is designed to replace a knee joint that has been damaged by arthritis Replacing the painful and arthritic joint with an artificial one gives the joint a new surface that moves smoothly and painlessly This is a surgical procedure in which the injured or damaged parts are replaced with artificial parts The procedure is performed by separating the muscles and ligaments around the knee to expose the knee capsule the tough gristle like tissue surrounding the knee joint The ends of the thigh bone femur and the shin bone tibia are removed and sometimes the underside of the kneecap patella is removed The new knee consists of a metal shell on the end of the femur and a metal and plastic cover on the tibia The parts are sometimes held in place with special cement The operation typically lasts about 90 minutes 5
Guidelines for Patients Having Total or Partial Knee Replacements What is a Partial Knee Replacement A Partial Knee Replacement is designed to replace part of a knee joint that has been damaged by arthritis The knee can be divided into three main compartments medial inside lateral outside and patello femoral the joint between the knee cap and the thigh bone Replacing the painful and arthritic part of the joint with an artificial one gives the joint a new surface that moves smoothly and painlessly This is a surgical procedure in which the injured or damaged parts are replaced with artificial parts similar to those used in a Total Knee Replacement What Can I Expect from an Artificial Knee The main goal of this surgery is to alleviate pain There will be some pain after the surgery to start with but you can expect to notice a benefit soon after the operation After recovery you should have greater mobility and an improved quality of life However an artificial knee is not a normal knee nor is it as good as a normal knee About 90 percent of patients with sti knees before surgery will have better movement after a Total Knee Replacement Activities that overload the artificial knee must be avoided Please refer to the Physiotherapy section for more information on these activities TOTAL KNEE REPLACEMENT PARTIAL KNEE REPLACEMENT 6
Guidelines for Patients Having Total or Partial Knee Replacements Early Planning for Discharge Your discharge from Beacon Hospital will usually occur anytime from Day Two post surgery depending on your Consultant and the Multidisciplinary Team Before your surgery your Consultant will discuss your estimated length of stay Be aware that you may go home sooner than expected Ensure that your travel arrangements are flexible On the day of your discharge you may be transferred to the discharge lounge Here you will receive all of your discharge paperwork and the Nurse will explain your discharge instructions If there is any possibility that you may require private convalescence or additional help at home now ahead of surgery is the time to arrange it It can be extremely di cult to get a bed in a private convalescence centre at short notice If you require further information regarding this we have an information pack to help you plan your convalescence Our Discharge Coordinator can provide further information and assistance regarding this 7
Guidelines for Patients Having Total or Partial Knee Replacements Pre Assessment Clinic All patients who are scheduled for joint replacement surgery must attend the pre assessment clinic You will be contacted by the hospital with an appointment prior to your surgery A pre assessment clinic serves several key purposes to ensure a safe and successful surgery Optimises health for surgery The clinic helps to identify any underlying health conditions that could increase risk during surgery or recovery By detecting these conditions beforehand the medical team can address them and improve your overall fitness in advance of the procedure Reduces surgery cancellations By proactively identifying and managing potential health concerns pre assessment clinics aim to minimize the chances of surgery being cancelled last minute due to unforeseen medical issues Preparation for surgery and recovery The clinic sta will explain what to expect before during and after surgery including details about fasting medications and post operative care The pre assessment clinic plays a crucial role in promoting patient safety and a smooth surgical experience The pre assessment clinic is a Nurse led clinic Multiple tests will be performed during your visit and all test results will be reviewed by a Consultant Anaesthetist You will be advised if further tests or follow up appointments are required prior to your surgery It is not necessary to fast for your pre assessment clinic appointment Please allow approximately one hour for your appointment however this may be longer in some cases You may need to attend various hospital departments during your visit if you require assistance with mobility please bring a family member friend with you on your visit 8
Guidelines for Patients Having Total or Partial Knee Replacements Preparing for Admission Pre operative Joint Education Classes This pre operative meeting is a time for you to speak with the Physiotherapist and the Orthopaedic Nurses and ask any questions you may have regarding your surgery and rehabilitation We recommend and encourage all patients for knee replacement surgery to book in and attend one of these classes preferably at least 2 weeks prior to their surgery You will be contacted by the scheduling team to arrange this Also please watch the Pre Op Education Videos on our website You will find a link to these at the end of the booklet Dentist It is important that your teeth and gums are healthy before your operation as bad teeth can be a source of infection Please make sure that you have had a dental check up in the last six months You will need to get a dental clearance letter or certificate from your dentist to allow you have your surgery Nutrition Aim to follow a well balanced diet which includes protein fats and carbohydrates It is important to be well nourished to promote wound healing so eat well during your post op recovery Protein is considered important for wound healing It is found in meat fish eggs milk cheese yoghurt beans and pulses We usually advise against trying to lose weight during the first few weeks of your post op recovery On admission if you have any specific dietary requirements please discuss these with the nursing or catering sta If you are on a special diet or have any queries please discuss with your Doctor Nurse or Dietician 9
Guidelines for Patients Having Total or Partial Knee Replacements Smoking It is advisable to stop smoking or at least to reduce the number of cigarettes you smoke a day as smoking interferes with wound healing It also impairs bone growth and repair and will delay or even prevent healing of the joint after surgery If you do smoke please inform your pre op assessment Nurse and your admitting Nurse Clothing Daytime attire of loose comfortable clothing is advised e g long shorts tracksuit bottoms or loose three quarter length trousers Footwear Slip on shoes with a low heel and back are recommended Elastic shoe laces can turn your laced shoes into slip on shoes You may not be able to bend down to tie your shoelaces after your surgery Loose fitting socks are also recommended We do not recommend slippers or backless shoes Back on shoe Valuables Please leave all valuables and jewellery at home Skin preparation Your skin will have to be prepared for surgery This involves showering with a disinfectant agent and using special anti microbial wipes on the area the night before and the morning of surgery More information on this is provided to you when you attend the Pre Assessment Clinic You should avoid all shaving except for facial shaving for the 2 days prior to your surgery Any shaving to the area will be carried out in the Operating Theatre Fasting pre operatively The scheduling department will phone you prior to admission If you are coming in on the day of surgery they will confirm on how long to fast for Morning of Surgery Admission If you have been asked to come to the hospital in the morning for admission then you must not eat solid food or drink fluids after 12 midnight Afternoon of Surgery Admission If you have been asked to come to the hospital in the afternoon for admission then you may eat a light breakfast as long as you are fasting from food and drink for six hours and from water for 2 hours before your surgery 10
Guidelines for Patients Having Total or Partial Knee Replacements Pre Admission Checklist Pre Assessment Clinic attended Dental Clearance certificate or letter Watch on line Pre Op Education Videos on Beacon Hospital s website Made arrangements for discharge to home or convalescence Arranged appropriate clothing footwear for after surgery Aware of fasting times from food and drink including water before surgery What to Bring to Hospital All of the medications you are currently taking including supplements A list of your allergies if any Loose pyjamas or short nightgown dressing gown Correct footwear Appropriate clothing Personal toiletries Anything else you use on a daily basis for example glasses or contact lenses hearing aids etc 11
Guidelines for Patients Having Total or Partial Knee Replacements Morning of Your Surgery Step 1 You will be admitted into Beacon Hospital either the day before or the morning of your operation On admission you will check in at the reception area of the Surgical Day Unit where you will be asked to confirm your details for your medical file A member of the admissions sta will accompany you to the Admitting Unit where you will be greeted by the Nursing Sta The Nursing Sta will show you to your bed and check your weight height temperature blood pressure pulse and respiratory rate The Nursing Sta will also update and complete the nursing assessment that was started in the Pre Assessment Clinic You will also see other members of the team at this time If you have any questions please do not hesitate to ask a member of sta Prior to your procedure you will be asked to Pack belongings away in your own bag or we can provide you with a bag Your belongings will be secured in a locker while you are in Theatre Dentures and contact lenses must be removed before your procedure You will be permitted to keep these with you during the admissions process Please leave anything of value at home or with your next of kin prior to surgery This includes large quantities of money all jewellery and wedding bands Once they are ready for you in Theatre a Nurse will bring you to an area called the Holding Bay Here you will see your Consultant and sign your consent form if you have not already done so You will also meet your Theatre Nurse and your Anaesthetist Your Theatre Nurse will receive a handover of care and complete a safety checklist 12
Guidelines for Patients Having Total or Partial Knee Replacements Step 2 The Theatre Nurse will accompany you to the Anaesthesia Room where induction of anaesthesia takes place Your Anaesthetist will explain the type of anaesthesia that you will be receiving If you have any questions please do not hesitate to ask the Anaesthetist After receiving the anaesthetic you will be transferred to the Theatre Room where the operation takes place Step 3 After your operation you will be transferred to the Post Anaesthetic Care Unit PACU The first phase of recovery takes place here Some post op pain is to be expected however we will endeavour to maintain your pain at a manageable level Once you have met the criteria to return to the Inpatient Ward your PACU Nurse will hand over your care to your ward Nurse 13
Guidelines for Patients Having Total or Partial Knee Replacements Evening of Your Surgery Once you are back on the ward the Nurses will continue to monitor you You will have your blood pressure pulse etc checked regularly and your wound dressing and drain if present will also be checked It is important to let your Nurse know if the medication you are receiving is managing your pain su ciently You will start taking sips of water as soon as you come back to the ward and gradually you will be allowed to eat and drink as you would normally Many people feel sick after surgery and this can be due to the anaesthetic and or medication that you were given during the operation Once you are eating and drinking again the IV fluids drip will be removed This is usually about 24 hours after the operation If you need to pass urine or have your bowels opened then the Nursing Sta will assist you in using a bedpan or commode as you will not be able to walk to the bathroom just yet 14
Guidelines for Patients Having Total or Partial Knee Replacements Physiotherapy Your Physiotherapy may start a couple of hours after your surgery The Physiotherapist will help you get out of bed and take your first steps Thereafter you will continue to be seen by a member of the Physiotherapy Team to ensure you are walking with your crutches sticks and carrying out your exercise programme correctly It is important that you practice your walking and exercise in between your Physiotherapy treatments as advised by the Physiotherapist We will aim to have you climbing For physiotherapy the stairs and be walking on your advice please scan own with crutches as soon as this QR Code possible 15
Guidelines for Patients Having Total or Partial Knee Replacements Exercise Programme Exercise is very important following knee replacement surgery When muscles are not used they become weak and do not perform well in supporting and moving the body Your leg muscles may be weaker because you may not have used them very much due to your knee pain The surgery will aim to correct the knee problem but the muscles can remain weak and will only be strengthened through regular exercises Exercise will also help reduce the risk of a blood clot You will be assisted and advised how to do your exercises but the responsibility for exercising is yours Please be sure to read the exercises carefully and ask your Physiotherapist any questions that you may have before you leave the hospital Remember you may feel uncomfortable at first but these exercises will speed up your recovery You should ensure that you have had adequate pain medication prior to seeing your Physiotherapist please discuss your pain with the Nursing Sta Please scan this QR Code to find your knee replacement exercise plan 16
Guidelines for Patients Having Total or Partial Knee Replacements Perform the following exercises 15 times each 3 times daily 1 Ankle Pumps With your legs straight bend your ankles up and down towards and away from your face Repeat 15 times Continue this exercise until you are fully recovered and all ankle and lower leg swelling has subsided 2 Knee Flexion Lie on your back with your legs straight Slowly bend your knee by sliding your foot up towards your buttocks as far as you can Hold for the count of 5 Relax and repeat 15 times Every day you should be able to bend it a little further Your Physiotherapist will measure the amount of bending 17
Guidelines for Patients Having Total or Partial Knee Replacements 3 Quadriceps Contraction With your leg straight out in front of you tighten the muscles at the front of your thigh pushing the back of your knee down into the bed The result should be straightening of the knee Hold the contraction for 5 seconds Repeat 15 times 4 Inner Range Quadriceps Place a towel in at the back of the knee of the operated leg Push the back of the knee into the towel and lift the heel up o the bed Hold the contraction for 5 seconds Slowly return to your starting position Repeat 15 times 18
Guidelines for Patients Having Total or Partial Knee Replacements 5 Knee Extension Heel Prop It is critical that you are able to straighten your knee fully for normal knee function Place a small rolled towel under your heel Tighten your thigh muscles trying to push your knee downwards fully straightening your knee Hold for 5 seconds Repeat 15 times You are also encouraged to put your foot on a foot stool when sitting out for long periods both to reduce swelling and to maintain knee extension 6 Straight Leg Raising Start by tightening the muscles at the top of your leg Keeping your operated leg straight raise the leg about 6 to 10 inches o the bed Hold for 5 seconds Lower the leg slowly to the bed Repeat 15 times 19
Guidelines for Patients Having Total or Partial Knee Replacements 7 Sitting Knee Flexion Practice knee bends sitting on the bedside or in a chair Cross unoperated good leg over the operated leg at the ankle Using your unoperated leg to assist bend your operated knee as far as possible Straighten and repeat Repeat 15 times 8 Standing Knee Extension While holding on to a supportive surface bend your operated knee slightly Gently pull back your knee by tightening your thigh muscles straightening your knee Hold for 5 seconds Repeat 15 times 20
Guidelines for Patients Having Total or Partial Knee Replacements Walking In most cases after an uncomplicated first knee replacement primary total knee replacement you will be encouraged when using crutches for support to put your full weight through the operated leg Your Physiotherapist will advise you when you can reduce your support to one crutch or progress to a stick in the opposite hand If you have had a complicated primary total knee replacement or a revision total knee replacement you may be instructed to reduce the amount of weight bearing on your leg In such a case you will be given specific instructions on how to proceed Walking Pattern with Crutches 1 Stand in the middle of your crutches 2 Place crutches in front of you They should be a comfortable arm s length away 3 Push down on the hand grips Step forward to the crutches with your operated weaker leg 4 Step past the crutches with your unoperated stronger leg 5 Repeat the same sequence 21
Guidelines for Patients Having Total or Partial Knee Replacements Tips for Walking with Crutches Carry items in a backpack Maintain good posture when walking Wear shoes that fit well support your feet and are comfortable Be careful when walking on uneven or wet surfaces Walk at a safe comfortable pace Strong foot Weak foot Crutch Position Stairs Technique Going Upstairs Going Upstairs Maintain crutches walking stick on the step below Lead with the unoperated good leg up onto the step above Take your weight onto the unoperated leg by pushing on crutches walking stick and banister Follow with the crutch walking stick onto the same step 22
Guidelines for Patients Having Total or Partial Knee Replacements Going Downstairs Going Downstairs Put crutch walking stick down onto the step below Follow with the operated leg Take weight onto the operated leg using the crutches and banister for support Follow with the unoperated leg onto the same step TIP The good leg goes up the stairs first and bad leg goes down the stairs first 23
Guidelines for Patients Having Total or Partial Knee Replacements Rehabilitation Goals Knee Replacement Goals of Care The goals on the following pages have been developed to assist you in understanding your patient journey and also to outline your rehabilitation goals as a patient in Beacon Hospital Your goals are divided into two areas Nursing and Physiotherapy These start right after your surgery so you have some goals that remain the same from day one with new goals added each day 24
Guidelines for Patients Having Total or Partial Knee Replacements Knee Replacement Goals of Care Nursing Goals Your Physiotherapy Goals Day of You will Procedure Receive adequate pain relief Be started on intravenous IV antibiotics On your return from Theatre you will be given something light to eat and drink Commence use of your cryotherapy ice therapy May have an x ray of your new joint completed on this day or on Day One Have the wound dressing checked Anti DVT medication will commence this day or on Day One You may receive Physiotherapy on the day of your procedure Your Physiotherapist will help you to Complete your knee exercises under supervision Get out of bed Walk a short distance with crutches or a frame Understand your rehabilitation plan If your Consultant has requested continuous passive motion CPM machine the Nurse or Physiotherapist may apply this machine to your knee Day One Onwards You will Receive adequate pain relief Be given medications to prevent clots and be given IV antibiotics Have bloods taken to check your blood count after surgery Have a wash and get dressed with assistance Have cryotherapy applied to your knee using the cryotherapy for 15 20 minutes a minimum of three times per day Be encouraged to drink plenty of fluids A continuous passive motion CPM machine will be applied once daily for one hour per session The flexion bending range is increased as high as is comfortable Have your wound dressing checked to ensure it is clean and intact Be encouraged to mobilise with the appropriate aid under the supervision of the Nurse or healthcare assistant and avoid the use of bedpans or commodes Your Physiotherapist will help you Complete your knee exercises under supervision and encourage you to complete the exercises independently throughout the day Walk with crutches or a frame outside of your room and progress daily until you are independently mobile Participate in Physiotherapy on the ward or in the gym where you practice walking knee exercises and using the stairs Understand the importance of rehabilitation and follow up Physiotherapy 25
Guidelines for Patients Having Total or Partial Knee Replacements General Recommendations Call Bells Use the call bell to ask for assistance with any transfers in out of bed on o toilet Do not attempt to transfer until you have been taught how to transfer safely and have been cleared by the Physiotherapist to do so Use the call bell when the side rails of your bed are raised Sleeping While in hospital some patients find it harder to sleep for various reasons e g di erent bed and environment It might be helpful to bring earplugs and headphones for music Before coming to hospital you could explore apps to help you sleep or learn relaxation techniques You can use these when you are recovering from surgery After the day of the procedure you can sleep on your side or back unless told otherwise by your consultant If you decide to lie on your side then a pillow between the knees may provide additional comfort 26
Guidelines for Patients Having Total or Partial Knee Replacements Nausea Some of the medications you may be prescribed can cause nausea Please inform the nursing sta if you feel sick or are getting sick Your medications may need to be adjusted or you may need additional medications to prevent or treat nausea Pain Management Pain is a common occurrence following any surgical procedure The pain will naturally reduce as your wound heals Medications and ice will also be given to you regularly to manage pain You can ask your nurse for extra painkillers if you need them before your exercises It is important to report pain to the nursing sta who will help you to keep your pain controlled so you can mobilise comfortably perform your physiotherapy exercises and resume normal activities after your surgery You will be required to rate or score your pain regularly after your surgery You will be asked to give a number between 0 and 10 where 0 represents no pain and 10 represents the worst pain you can imagine Your score will depend on how intense your pain is General Safety Advice for Home Please be aware of the hazards in your home as this will make your recovery easier and safer Move electrical cords phone lines and ensure clear pathways Remove rugs including bath mats and entrance mats Be careful with pets and children Be aware of water spills slippery floors and always think before you move Pace yourself and take your time Caution should be taken when wet leaves are on footpaths 27
Guidelines for Patients Having Total or Partial Knee Replacements Discharge Instructions You will be discharged once you are considered clinically ready This is usually from Day Two onwards after your surgery Some people go straight home while others will require some time in convalescence When you leave the hospital you may be given an appointment to see your Consultant usually around 6 weeks after the operation This is for a routine check up which will make sure that you are progressing satisfactorily and x rays may be taken then You will be advised to attend outpatient Physiotherapy within seven to ten days of discharge You can either attend a Physiotherapist in Beacon Hospital or a Physiotherapist more local to your home If you would prefer to exercise in a group setting Beacon Hospital provides weekly group exercise classes for joint replacement patients Your Physiotherapist will provide you with the details of these classes You will need to continue your Physiotherapy for a minimum of 2 3 months after your surgery Your Physiotherapists will advise you after your surgery regarding your requirements Wound Care You will be provided with wound care advice on the day of your discharge When changing the dressing it can be removed after showering Use a clean towel to dry the skin around the wound gently and apply a fresh dressing ensuring the knee is bent as the fresh dressing is applied Following removal of your sutures or staples your Healthcare Professional will advise you regarding the need for further dressings This is normally for no more than a further 3 5 days 28
Guidelines for Patients Having Total or Partial Knee Replacements Signs of Infection Infection may occur despite your very best e orts If any of the symptoms below occur then you will need to see your GP or liaise with the Centre for Orthopaedics 01 293 7575 for advice and possibly antibiotics If you develop any of the following signs of infection it is important to report them to your Doctor The signs of infection include Redness around the wound site Increased pain in the wound Swelling around the wound Heat at the wound site Discharge of fluid may be green or yellow Odour or smell from the wound Feeling of being generally unwell Fever or temperature Make sure you receive a copy of the Patient Wound Care Discharge Instructions prior to your discharge 29
Guidelines for Patients Having Total or Partial Knee Replacements Antibiotics Following knee replacement surgery there can be a greater risk of developing an infection in the knee with some procedures Antibiotics to prevent the development of an infection in the knee should be taken when having a bladder catheter inserted urinary surgery e g prostatectomy or when having infected teeth removed Always tell your dentist dental hygienist GP or any other Consultant that you visit that you have had a Total Knee Replacement Pain Medication On discharge from hospital you will be prescribed some medications Part of the prescription will include medications for pain Plan to do your exercises 30 minutes after taking pain medication as preventing pain is easier than chasing pain If these medications are not relieving your pain or you cannot take the medications due to side e ects we advise that you contact your GP We also advise that you contact your GP should you require a repeat prescription 30
Guidelines for Patients Having Total or Partial Knee Replacements Leg Swelling and Bruising Expect to experience bruising and swelling in the knee after surgery This is a normal part of the recovery phase after a knee replacement Bruising can occur to the whole operated leg and may last a number of weeks The swelling can cause pain in your knee and may restrict the amount of movement you have in the joint To reduce this take the medications that are prescribed for you and ice your knee The swelling can persist for up to 6 12 weeks and sometimes longer Stockings Your Consultant may wish for you to go home with elasticated stockings These can be an important part of preventing the development of deep vein thrombosis blood clots in the legs It is recommended to wear these for 6 weeks after surgery on both legs Information regarding care of the stockings is available on the bag in which they are provided Use of Ice Ice is recommended to the knee for 15 20 minutes You shall continue to ice regularly both as an inpatient and on discharge home in order to help control swelling and any pain and also to encourage healing This should be done at least 5 or 6 times a day for the first 6 weeks after surgery and as required after that Bowel Care Try to include sources of fibre in your diet brown bread high fibre cereals fruit vegetables Drink plenty of fluids You may also be prescribed laxatives i e Lactalose Senokot during your hospital stay 31
Guidelines for Patients Having Total or Partial Knee Replacements Activities Once Discharged During the first 6 weeks after your surgery we recommend limiting your activities to walking with support and completing your exercise programme as advised by your Physiotherapist We recommend that you refrain from more strenuous activities such as golf and social tennis for a period of three months The following are some of our recommendations Not Recommended after Surgery Jogging or running Contact sports and high impact aerobics Vigorous walking or hiking Skiing Tennis Expected Activity after Surgery Your consultant will advise you when you can return to the following Recreational walking Golf Driving Light hiking Recreational biking Ballroom dancing Normal stair climbing 32
Guidelines for Patients Having Total or Partial Knee Replacements 33
Guidelines for Patients Having Total or Partial Knee Replacements Car Transfers When travelling in a car you should sit in the front passenger seat A plastic bag on the seat can assist with manoeuvring in and out of the car If you intend to go on a long car journey please include regular safe stops Your family or carer should bring a cushion or pillow to place on the passenger seat keeping the seat reclined back as far as possible pillow When getting into the car lead with your bottom Stand with your back to the car lower yourself keeping your operated leg straight in front of you Slide back on to seat and let your driver assist with your legs if needed keeping both legs together Please ensure you are not twisting The driver should hand you the seat belt and have the driver close open the door accordingly When getting out of the car lift your legs out of the car first with assistance from your driver Slide towards the edge of the seat and stand up keeping your operated leg stretched out in front of you 34
Guidelines for Patients Having Total or Partial Knee Replacements Driving Your Consultant will tell you when you are allowed to drive again after your operation In order to be safe driving a motor vehicle you must be in control of the pedals e ectively It is recommended that you do not drive a motor vehicle until you have complete control over your legs and your Consultant will advise you regarding the same This does not normally occur until at least 6 weeks after your surgery When you are advised by your Consultant to drive it is recommended to complete a trial period in an empty car park to accustom yourself to your new knee Travel Prolonged periods of sitting on airlines may predispose to leg swelling and deep venous thrombosis and it is recommended to avoid this until 6 weeks after your surgery If you must travel wear your stockings and keep your leg elevated as much as possible Sexual Activity Sexual activity may be resumed at 4 6 weeks when you are physically and mentally ready and when you have a clear understanding of the precautions to be followed when protecting the new joint 35
Guidelines for Patients Having Total or Partial Knee Replacements Potential Complications of Knee Replacement Surgery Incidence The majority of patients who undergo knee replacement surgery have a pleasant experience without any complications Of all patients who undergo total knee replacements more than 96 have no complications The following is a comprehensive list of all problems that could potentially occur For informed consent it is important that you know of these problems but please be assured that the vast majority of patients su er no complications Pain The knee area will be sore after the operation If you are in pain it is important to tell sta so that medications can be given Pain will improve with time Rarely is pain a long term issue Long term pain may be due to altered leg length any other complications listed or sometimes for no obvious reason Bleeding This is usually small and can be stopped during the operation However patients with large amounts of blood loss may need a blood transfusion or iron tablets Sometimes a blood clot may form or a large bruise may be noticed at the wound site which may become painful and require surgery to remove it Deep Vein Thrombosis DVT A DVT is a blood clot in the vein This may present as red painful and swollen legs usually The risks of a DVT are greater after any surgery and especially bone surgery Although not a problem themselves a DVT can pass in the blood stream and be deposited in the lungs a pulmonary embolism PE This is a very serious condition which a ects your breathing 36
Guidelines for Patients Having Total or Partial Knee Replacements Your consultant will prescribe medication to limit the risk of a DVT forming Starting to walk and mobilising after surgery is one of the best ways to prevent clots from forming Knee Sti ness Knee sti ness may occur after the operation especially if the knee is sti before the surgery Manipulation of the joint under general anaesthetic may occasionally be necessary Prosthesis Wear and Loosening With modern techniques and new implants knee replacements last many years In some cases however they fail sooner The reason is often unknown Wear may contribute to loosening Loosening may cause pain and if loosening is significant a second joint replacement may be required This operation is significantly more complicated than the original joint replacement Infection Antibiotics are given just before and after the operation The procedure will be performed in an Operating Theatre with sterile equipment Despite this infection may still occur The wound site may become red hot and painful There may also be a discharge of fluid or pus This is usually treated with antibiotics and an operation to wash out the joint may be necessary In rare cases the implants may be replaced at a later date The infection can sometimes lead to sepsis blood infection and strong antibiotics may be required To prevent such infections persons with a joint replacement are generally given antibiotics with extensive dental procedures urinary tract infections or surgery as well as before other types of surgery If an infection occurs anywhere in the body it must be treated promptly with antibiotics 37
Guidelines for Patients Having Total or Partial Knee Replacements Blood Fat Embolism PE A PE pulmonary embolism is a consequence of DVT deep vein thrombosis PE may occur if the clot detaches from the vein and travels to the lung and can make breathing di cult A PE can be treated with blood thinning medication but can also be fatal Joint Dislocation If this occurs the joint can usually be put back into place without the need for surgery Sometimes this is not possible and an operation is required followed by application of a knee brace Nerve Damage Rarely nerves in the vicinity of the knee joint are stretched or damaged during the operation a neuropraxia This is often only noticed upon returning to the ward where the patient may complain of altered sensation in the foot or in more severe cases inability to move their foot outwards Changes in sensation to the outer half of the knee may be normal Every e ort is made to prevent this however damage to the small nerves of the knee is a risk This may cause temporary or permanent altered sensation around the knee Total knee replacement surgery is done under tourniquet where a blood pressure cu is applied to your leg and occasionally a nerve by the side of the knee can get damaged the peroneal nerve which may cause temporary or permanent weakness or altered sensation of the lower leg Fortunately the majority of these neuropraxias resolve over a period of time sometimes months In a very small minority the damage may be permanent 38
Guidelines for Patients Having Total or Partial Knee Replacements Bone Damage A bone may be broken when the prosthesis replaced knee joint is inserted This may require fixation either at the time or at a later operation Periprosthetic Fracture This complication can occur after a knee replacement if the bone is weak especially in the first two months after surgery Sometimes it is caused by a fall or stumble Periprosthetic femoral fracture causes thigh pain with weight bearing and may cause shortening and rotation of the limb 39
Guidelines for Patients Having Total or Partial Knee Replacements Heterotropic Ossification There is a small risk of developing ossification or calcification in the muscle tissue around the knee after surgery In the majority of these cases this involves small islands of bone that do not cause any functional restriction and are only noticeable on x rays Rarely in less than 1 of these cases there may be more extensive ossification that may cause sti ness and pain This can be corrected by surgical removal but only after 12 months have passed since the surgery Blood Vessel Damage The vessels at the back of the knee may rarely be damaged and may require further surgery Stroke CVA Sudden Death This is a very rare complication that can occur after any major surgery and from any of the above 40
Conclusion We hope that you have found this booklet useful and that it has helped to relieve some of your fears and anxieties regarding your surgery During your hospital stay your medical team will be available to discuss anything mentioned in this booklet or to answer any other queries you may have Before you leave the hospital you will be given contact details of the relevant team members After discharge from hospital you can expect to receive a phone call from an orthopaedic nurse enquiring after your wellbeing We look forward to meeting you soon 41
Exercise Diary Following Total DAY POST OPERATION Time of Day Target Volume Repetitions x Sets DAY 1 DAY 2 Morning Afternoon Evening Morning Afternoon Evening 1 Ankle Pumps 2 Knee Flexion 3 Quads Contraction 4 Inner Range Quadriceps 5 Knee Extension Heel Prop 6 Straight Leg Raising 7 Sitting Knee Flexion 8 Standing Knee Extension Instructions The exercise programme will begin the first day after your surgery and the physiotherapist will teach you the exercises the first time you perform them
Knee Replacement Surgery DAY 3 DAY 4 DAY 5 Morning Afternoon Evening Morning Afternoon Evening Morning Afternoon Evening From then on you should record the number of repetitions of each exercise that you complete in the boxes in the table above The aim is to perform three exercise sets per day morning afternoon and evening
Guidelines for Patients Having Total or Partial Knee Replacements NOTES
Guidelines for Patients Having Total or Partial Knee Replacements NOTES
Guidelines for Patients Having Total or Partial Knee Replacements NOTES
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