Put your best foot forward
This information has been designed to give you a basic understanding of your knee replacement operation and what to expect during your hospitalisation. Please keep in mind that this is a guideline only and that each individual has different needs so you may progress at a different rate to that which is outlined.
Your Orthopaedics SA specialist will be happy to address any questions which might arise after reading this information.
A total knee replacement is an operation performed on a knee joint damaged by osteoarthritis, rheumatoid arthritis, accidents or sports injuries. It is carried only after other forms of treatment have no further benefit.
The knee is commonly referred to as a hinge joint. It is a major weight bearing joint that is supported by cartilage, ligaments and muscles that allow it to move smoothly as you bend and straighten your leg.
In South Australia over 1,500 people have knee replacement surgery each year.
There are many different types of knee replacement available but all have the same basic design.
The knee replacement components are used to resurface the damaged surfaces of the thigh bone, shin bone and sometimes the knee cap. The resurfacing components are secured either by using a bone cement or some components have a special porous surface that the bones grow into giving a "biological fixation". Often one component may be cemented and the other component may have the porous surface. As a result of the resurfacing the knee alignment is restored, pain is decreased and the knee becomes more functional.
This operation is designed to improve quality of life and is usually undertaken when all other avenues of treatment have failed and the benefits outweigh the risks. It should never be entered into lightly!
You may be suitable to give your own blood, have it stored and then given back to you during and after surgery. This minimizes the need for having banked blood (i.e. other people’s blood from the Red Cross). Up to 3 pints of blood is collected and the process takes three visits spread over three weeks.
If you are a smoker it is advisable to stop smoking or at least reduce the number of cigarettes that you smoke, in order to reduce the risk of chest and circulation problems after surgery. The hospital is a SMOKE FREE ZONE.
Anti-Inflammatory medication including VOLTAREN, FELDENE, NAPROSYN, CELEBREX and ASPIRIN should NOT be taken for seven days, prior to your surgery, as they affect the way your blood clots.
Anti-platelet medication including ASTRIX, CARTIA, CLOPIDOGREL (eg. PLAVIX, ISCOVER) and TICLOPIDINE (eg. TICLID, TILODENE) can also affect the way in which your blood clots. These medications should NOT be taken for seven days prior to your surgery.
If you are unsure about your current medications and the possible complications, please speak with your Doctor prior to surgery.
The Orthopaedic Liaison Nurse will phone you prior to your admission to hospital to arrange a suitable time for you to visit the Pre-Admission Clinic. During this visit the nurse will discuss details of your hospital stay and the recovery process and answer any questions that you or your family may have. To streamline the admission process a nursing history and health assessment will be carried out. The aim of this visit is to provide information that will better prepare you for surgery and to commence planning for your recovery.
The Orthopaedic Liaison Nurse can be contacted at any time if you or your family have any concerns or queries – phone (08) 8267 8267.
This is a good time to make sure your home will be a safe environment for you, upon your discharge from hospital.
Position furniture to give clear walkways and roll up any rugs, which might cause you to slip.
Put commonly used items within reach in your bathroom and kitchen to prevent you needing to kneel.
It is also a good time to commence some gentle exercises to tone up your muscles, especially the quadriceps. Not all exercises will be possible because of pain or stiffness. You will find examples of some recommended exercises included in this information. Your physiotherapist will advise which of these exercises will be suitable after your operation.
Most hospitals encourage a pre-admission visit to show you the hospital, streamline the admission process and explain the hospital stay.
You are also encouraged to see the Anaesthetist prior to surgery.
You will usually be admitted to hospital on the morning of surgery and will be seen by the Nursing Staff and your Anaesthetist.
Please bring with you any medication that you take regularly and your X-rays, along with your pyjamas, toiletries etc.
The length of hospital stay is usually between 5-7 days. We aim to plan your length of stay and have discharge arrangements in place prior to your admission.
A premedication may be given to you in the form of tablets or an injection. This is to relax you and make your mouth dry. Once this is given you will be asked to stay in bed. The nurse call button can be used if you need anything. You will then be put on a trolley and taken to the operating theatre by a nurse and an orderly.
The operation usually takes about two hours with some time spent in the recovery room.
From the operating room you will be taken to the recovery room where you will wake up and remain for about one hour before returning to your room.
During the first few days you will experience some pain. This will be controlled by intravenous or epidural medication for the first 24-48 hours. After removal of the drip, you may require injections and/or tablets. It is important initially, to take the pain relieving medication on a regular basis. This will allow you to exercise and move more freely. It may also be necessary to continue taking pain relief tablets when you return home. The nursing staff or pharmacist will instruct you on appropriate doses.
Assist you to become mobile again following your operation and teach you specific exercises.
Usually you will stand and begin walking the day after surgery. All the "tubes" are removed by two days after surgery. A physiotherapist will assist you with exercises and walking. The aim is to walk early and often. This minimizes complications.
Your mobility will gradually increase and with it, your independence. Physio continues and once your wound has healed you may go to the hydrotherapy pool with the physiotherapist to perform exercises in water.
Ice helps to reduce pain, swelling and stiffness. The nurse may apply ice to your knee. You may also apply ice at home by using crushed ice inside a damp towel. Leave the ice on for 15 minutes, then remove for 15 minutes, then reapply for another 15 minutes. This can be applied a few times a day if necessary.
Never apply ice directly to the skin.
A small injection under the skin of anti-coagulant is usually administered once a day for your stay in hospital. This helps to thin your blood and helps prevent the formation of clots in your legs.
You will have a suture line along your knee that requires a dressing while you are in hospital. The nursing staff will attend to this.
Sometimes you may have sutures that lie underneath the skin surface. These do not need to be removed and will dissolve in about 2 weeks.
Removable staples may be used and removed in about 10 days.
Prior to discharge your nurse will speak to you regarding care of your suture line once you are home. Wash your suture line daily and pat it dry with a clean towel. Avoid using any powders until the healing is complete as they may "clog" the suture line and cause bacteria to grow.
Observe your suture line for any signs of tenderness, redness, swelling or discharge. If you have any problems, contact your Surgeon, Orthopaedic Liaison Nurse or Local Doctor.
As you might expect, wound discomfort and restriction of position will mean adopting a sleep position which is unnatural for you. This may result in a disturbance to your sleep pattern and/or restlessness.
You may sleep on your side with a pillow between your legs (NOT UNDER YOUR KNEE). Oral analgesia and warm drinks before going to bed may assist in relaxation.
Your decreased activity level, limited appetite, reduced fluid intake and some medication may lead to bowel irregularity. You will be encouraged to drink fluids, increase the fibre content of your diet and, if necessary, take mild laxatives.
Resumption of sexual activity depends on when you feel comfortable. There are no restrictions if you keep to the guidelines given to you by your surgeon and physiotherapist for your daily activities.
Your surgeon will want to see you about 6 weeks after your surgery. The appointment will be made before you leave hospital by the nursing staff. It is important that you keep this appointment, as your surgeon will want to check on your progress. You will also be able to ask the surgeon questions regarding increasing your level of activity.
These exercises are recommended before surgery to help build up muscle tone and during rehabilitation after surgery. You may not be able to complete all exercises due to stiffness or pain. Your physiotherapist will advise which of the exercises are suitable for you after your operation.
Do the following exercises 10 times each and at least 3 times per day.
This information and instruction is meant to be used as a guide as you return home.
IF YOU HAVE ANY ADDITIONAL QUESTIONS, FEEL FREE TO CONTACT THE ORTHOPAEDIC LIAISON NURSE. PHONE: (08) 8267 8267
It is in your interest to read this carefully. It concerns what is going to happen to you in hospital. If you do not understand, you should approach your specialist or his secretary, for clarification of any point.
You will be liable for several accounts in relation to your hospitalisation and operation. An account may be received from: