Total Knee Replacement
Information for patients
Understanding
arthritis and knee
replacement
Patient Name_________________________Hospital Number________________
Consultant______________________
Please
Pleasekeep
keepthis
thisbooklet
bookletand
andbring
bringit itwith
withyou
youtotoallallyour
your
appointments,
your
inpatient
stay
and
your
follow
up
appointments, your inpatient stay and your follow up
appointment.
appointment.The
Theblank
blankpages
pagesare
areprovided
providedfor
foryou
youtoto
write your own notes
Important Dates
Pre Assessment Clinic ______________________________
Notes
Operation Date_____________________________________
Admission Time____________________________________
Notes
Expected discharge Date______________________________
6-10 week Follow up Appointment______________________
Notes
1 Year Assessment___________________________________
2
Understanding arthritis
and knee replacement
Joint deterioration can affect every aspect of a person’s life. In its early stages, it is
common for people to ignore the symptoms of osteoarthritis, but as the disease
progresses, activities like walking, driving and standing become challenging and may
become difficult. This brochure will help you understand some of the basics of the
normal knee, arthritis and knee replacement surgery. This brochure is for educational
purposes only and is not intended to replace the expert guidance of your orthopaedic
surgeon. Any questions or concerns you may have should be directed towards your
orthopaedic surgeon.
The first knee replacement procedure was performed in 1968. Since then, millions of
people have received knee replacements. In the UK about 70,000 Total Knee
Replacements are done each year and here at The Great Western Hospital we carry
out 500 every year. Knee replacement surgery is a fairly routine procedure and is
usually an extremely successful surgical procedure. The term “replacement” leads one
to believe that surgeons remove the entire knee. In truth, your surgeon removes thin
sections of bone, cartilages and the thickened joint lining and worn/ damaged cartilage
found at the ends of the bones in your joints.
The Knee
The knee is a complicated rotating hinge joint formed by the tibia (shinbone), femur
(thighbone) and patella (kneecap). The ends of the bones in the joint are covered with
cartilage, a tough, perfectly smooth lubricating tissue that helps cushion the bones
during movement. Arthritis is any condition that affects joint cartilage and it usually
develops over years of constant motion and pressure in the joints. As the cartilage
continues to wear away, the joint becomes increasingly painful and difficult to move.
There are many different kinds of arthritic conditions that can affect the human body
and there are millions of people who are affected with arthritis each year. The
commonest is osteoarthritis.
3
Osteoarthritis
Osteoarthritis, often referred to as OA, is the most common reason for joint
replacement surgery. Osteoarthritis is a degenerative disease that destroys the joint
cartilage, often leading to painful bone on bone contact. It can cause pain, stiffness,
swelling and loss of motion in the joint, which may vary in duration and severity from
person to person. Some doctors, textbooks and literature have different names for
osteoarthritis, such as osteoarthrosis, degenerative arthritis, and wear and tear
arthritis.
Treatments such as the relief of pain, physiotherapy exercise, support braces, walking
aids and weight reduction can help control the symptoms of osteoarthritis for a time.
When these treatments fail to provide adequate relief from pain, total joint replacement
4
may be recommended. Your surgeon will assess your individual condition and
prescribe a treatment that will give you the best results. It is known that younger
patients (under 55) do tend to continue to suffer from residual pain and instability in
their knee following knee replacement surgery. In fact, research has shown that 20%
of younger patients are dissatisfied with the functional outcome of their knee
replacement. This is compared to 5% dissatisfaction in the older age group. Surgical
alternatives to total knee replacements are keyhole operations or partial knee
replacements; though these are only effective in patients with very specific patterns of
wear.
Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune syndrome, meaning the body’s immune system
attacks and destroys healthy joint cartilage. Rheumatoid arthritis can occur at any age,
even in children, and it is considered a systemic disease that affects multiple organs.
In the joints, rheumatoid arthritis causes inflammation of the joint lining, called the
synovium. Inflammation of the synovium can cause pain, stiffness, swelling, warmth
and redness, and can eventually lead to cartilage loss.
Rheumatoid arthritis often affects many joints such as the hips, knees, and hands. This
disease can have periods of flare-ups followed by a quick remission of symptoms.
Rheumatoid arthritis is a chronic condition that may last a lifetime. However, treatment
is available to help reduce pain, swelling, and slow joint destruction.
Total Knee Replacement
A total knee replacement replaces your diseased knee joint and eliminates the
damaged bearing surfaces that are causing you pain. The design of the implant offers
you renewed stability and minimizes the wear process. Total knee replacement offers
the greatest quality of life improvement of all operations. It has one of the highest
success rates and one of the best outcomes. Once your new joint has healed
completely which can take up to18 months, you should experience the following
benefits from the surgery.

Reduced or no joint pain
5

Increased movement and mobility

Correction of angular leg deformity

Increased leg strength (if you exercise)

Improved quality of life

The ability to return to most normal activities.
It is worth knowing that the knee continues to be painful for the first few months after
surgery and initially you may feel that the surgery has not been of benefit to you.
Total knee replacement is performed while you are under spinal anaesthesia with an
injection to control the pain in your leg, which your surgeon will explain to you before
surgery. Your surgery will last approximately 1 ½ hours. Care before your surgery and
time spent in the recovery room can add an additional 1-2 hours before you are back in
your hospital room.
The lower part of the replacement knee joint is comprised of a flat metal plate and stem
that your surgeon will implant in the tibial bone. This tibial tray can be either cobalt
chrome alloy or titanium alloy. It can be fixed by either cement or bone “ingrowth”.
Next, a polyethylene (hard plastic) insert is clipped into the tibial tray to serve as the
new knee bearing surface. The upper part of the replacement knee joint consists of a
contoured metal shield that fits around the lower end of the thigh bone (femur). The
inner surface is fixed to the cut bone surfaces by the surgeon’s choice of bone ingrowth
or bone cement. The outer surface of the contoured metal shield is shaped to allow
the knee cap (patella) to slide up and down in its groove. The surgeon may choose to
retain the natural knee cap or re-surface it. In this case a polyethylene button will be
cemented in place.
6
Blank for your notes
7
Standard TKR
Blank for your notes
8
Preparing
for
Preparing
for surgery
surgery
We aim to see and treat all patients within 18 weeks from referral from the GP;
however there will be exceptions depending on any other investigations and treatments
which may be required. During this time you will attend several appointments. You will
meet one of the orthopaedic surgeons and have x-rays to decide that you really do
need a knee replacement.
You will also need to attend a pre-assessment clinic to make sure that you are fit
enough to have the surgery. During this visit you will attend a pre-operative education
class during which you will be told a lot more about the operation. You will also have to
undergo further tests, depending on your specific problems to ascertain your suitability
for surgery. Some patients may need review by an anaesthetist at this stage,
depending on your medical history.
At this appointment, you may be asked to sign a consent form and the complications
associated with surgery will be explained to you before you give your consent. This
form is very important and you need to listen carefully to the information given to you.
Sometimes this form is completed on the day you come into hospital.
Physical Conditioning – It is important to be as fit as possible before undergoing joint
replacement. Participating in a doctor-prescribed exercise program before surgery can
help patients make a more rapid recovery. Moderate exercise is an integral part of
treating arthritis. Activities such as walking, swimming, riding a bike or gardening can
assist in keeping your bones strong and your joints supple, which may help relieve
stiffness. Low-impact exercise will not wear out your joints. Although exercise may
sometimes cause discomfort, proper exercise will help nourish the cartilage, strengthen
the muscles, and prolong the life of your joints. Your knee may be so painful and stiff
that exercise is not possible, in which case try to keep as active as you can. Having
your muscles in good condition prior to surgery will help you in the recovery phase after
the operation.
9
Nutrition
Proper nutrition is a concern for joint replacement patients. Orthopaedic surgeons
recognise that many joint replacement candidates may not be in peak nutritional
health. Try to eat a well balanced diet; more information is available from Preoperative assessment clinic. Proper nutrition can assist in your recovery by assisting in
wound healing and energy levels. A high intake of Vitamin C the day before your
operation is recommended, fruit and vegetables are a good source of this.
Stopping Smoking
Before surgery it is absolutely essential to stop smoking. It is necessary to stop
smoking at least two to four weeks before the planned procedure. Smoking impairs the
transfer of oxygen to the healing tissues, which may increase healing time and the
possibility of other complications. The hospital is a non-smoking site so you will not be
able to smoke during your hospital stay. There are lots of national initiatives available
to help you stop smoking. Patches may help you during your hospital stay.
High Blood Pressure
High blood pressure can result in your operation being postponed. If, at pre- operative
assessment clinic or on admission to the ward, your blood pressure is high, you will be
asked to go home and seek advice from your GP. This would obviously be a great
disappointment to you and your family as it could delay your surgery until your blood
pressure is better controlled.
Feet
Your feet are very important and need to be well looked after prior to joint surgery.
You may have found difficulty in bending due to pain and have been unable to treat
your feet, resulting in corns, in growing toe nails etc.
If you have any of these problems then a chiropodist can help you. Getting problems
sorted out before your admission will help you to regain your mobility quicker. It is
probably best to talk to your GP or practice nurse about getting referred to a
chiropodist.
10
Healthy Skin
For your operation to go ahead your skin needs to be healthy and free from sores or
open areas. People who suffer from eczema, psoriasis, leg ulcers or any other skin
conditions need to be extra careful. In the weeks leading up to your operation you must
ensure that any open areas on your skin are healed and there is no infection present.
For advice and treatment of any skin complaint you must consult your GP or practice
nurse.
There is a possibility that your operation could be cancelled if your skin is not healthy.
A swab from your nose and possibly your groin will be taken at pre-operative
assessment clinic to ensure you are not carrying the bug Methicillin Resistant
Staphylococcus Aureus (MRSA). If this swab is positive you will receive treatment
through your GP and re-screening. You will not be able to have your operation until the
swabs are negative.
Urinary Problems
This is a problem that nobody likes to talk about. Up to three million people in the UK
suffer from stress incontinence (leaking when laughing or coughing). It can be very
embarrassing having to rush to the toilet because of dribbling. Incontinence can cause
urinary infection and complications following surgery including wound infection.
Help is available. You can have a professional assessment with your own GP,
community nurse or continence advisor. Getting help with this problem will reduce the
risk of infection. A urine sample will be taken at pre- assessment. If positive, you will
need antibiotic treatment before your operation. It may possibly delay your surgery
date. If you are experiencing any symptoms of a urine infection it is a good idea to visit
your GP before your pre-assessment date.
Support on discharge
You will need further assistance on discharge as you may not be able to manage some
housework and fitting special compression stockings used to prevent thrombosis (see
risks and complications section). Please ensure that you have somebody to help you
with these tasks on discharge for a temporary period of time. There is some help
available in the community but this will need to be paid for.
11
In Hospital
Before Surgery
You will be admitted to the theatre admissions lounge (TAL). This is a dedicated area
within the operating theatres where patients can be assessed and prepared for
Orthopaedic surgery.
When you arrive the nurse will assess you, take a blood sample and prepare you for
theatre. You will also be seen by the anaesthetist who will discuss the type of
anaesthetic you are going to have for your operation.
The surgeon will see you and mark the leg that is to be operated upon. The surgeon
will also check your consent formed is correct and signed. This will be completed if not
already done at the pre-assessment clinic.
Your belongings and medications will be taken up to the ward while you are in theatre.
Please do not bring any valuables. The only items needed are sensible footwear, not
new as your feet may be swollen, washing items, a set of day clothes which are easy
to put on, and nightwear/dressing gown. You must also bring your current medications
with you. A small amount of change may be needed for newspaper magazines during
your stay.
The Anaesthetic
While you are in the Theatre Admissions Lounge The Anaesthetist will come to see
you to talk about your anaesthetic.
Generally the type of anaesthetic used for knee surgery is:
Regional anaesthesia with sedation.
This is a spinal anaesthetic which is injected into your spine and makes you numb from
the waist down. You will be given sedation to feel fully asleep and you will not be aware
of the operation. There is a lesser risk of blood clots and chest infection and less
sickness associated with this type of anaesthetic. This will be supplemented with nerve
blocks to numb your leg. You may need a urinary catheter and will not be able to feel
your legs for 4-6 hours after surgery.
If you are unable to have a spinal anaesthetic then a general anaesthetic will be used.
12
This anaesthetic can make you quite sleepy and nauseas after surgery. The nausea
can be controlled with medication.
The Anaesthetist will discuss with you which procedure is best for you.
After Surgery
You will be collected from the recovery unit by a nurse from the ward. You will be
wheeled back up to the ward in your bed.
You will have an Intravenous Infusion (IVI) in a needle in the back of your hand or arm
when you return to the ward; this will continue for a short while until you are drinking.
There may also be drain coming out from your knee to drain away any blood which
might otherwise accumulate in the operation site. A urinary catheter may also have
been inserted.
The anaesthetist will advise you before the operation as to the best method of pain
relief for your operation. Your pain will be controlled by a local anaesthetic which is
injected into your knee while you are in theatre. The nurses will be giving you regular
painkillers. If these are ineffective the please ask the nursing staff to review the
painkillers that you are receiving. Keeping your pain controlled enables you to start
physiotherapy as soon as possible after your operation.
The physiotherapist will start with gentle exercises and ask you to bend your knee and
try to straighten and lift your leg. The large padding around the knee should not stop
you from bending your knee. It is also important to start moving as soon as possible
after surgery to encourage blood flow, to regain motion and to facilitate the recovery
process. Early mobility also helps to prevent complications, see page 18. The
physiotherapists will come and help you to stand and maybe take a few steps as early
as 2 hours after you return to the ward. If you are going to stand up on the day of your
surgery the nurse looking after you will put some extra fluid into the intravenous drip in
your arm just before you stand and you should eat something. A positive frame of mind
is vital to your recovery and you will be encouraged to spend the day out of bed and in
comfortable day clothes, returning to your night wear and bed only for sleeping.
Although they will look after you and care for you, the hospital staff will encourage
you to take responsibility for your recovery and you will be expected to become
independent as you progress following your surgery.
13
While you are in hospital your progress will be reviewed by medical staff. You may not
see your consultant or the surgeon who carried out your operation but members of his
or her team will assess your recovery and make any changes to your drugs or
treatment that is deemed necessary. Any concerns about your recovery will be
discussed with your consultant via the medical team.
Discharge
You can expect to stay in hospital for 1-3 days after your surgery, but this is dependent
on your medical condition. Please be organised with transport home and put other
domestic arrangements in place
You will be shown how to safely climb and descend stairs, how to get into and out of a
seated position and how to care for your knee once you return home. It is a good idea
to enlist the help of friends or family once you do return home. Before you go
in to hospital you will be shown a variety of exercises designed to help you regain
mobility and strength in your knee. You will be shown them again before you go home.
You should be able to perform these exercises once you are at home. You may
experience increased pain with exercise, but this will settle with rest.
Most people are ready to go home very soon after surgery; your surgeon should
discuss this with you before surgery. When at home, it is important to continue with
your exercises as instructed by your surgeon and physiotherapist, see page 21
Wound
Your wound will be redressed prior to you going home. Some slight oozing of blood
through this dressing is perfectly normal and should settle down after a couple of days.
The dressing only needs to be changed if it becomes saturated and if so, the wound
should be checked by a nurse or doctor. It is normal for your wound to be warm and
reddish for a week or two as this is part of the healing process. The wound must be
kept dry until the sutures/ staples are removed 12-14 days after the surgery. You will
be asked to make an appointment with your practice nurse for removal of sutures or
clips on a specified date. You must do this as soon as you are at home.
14
Swelling and bruising
Not only the knee but the whole leg can become significantly swollen and bruised. You
can help reduce this by raising your leg on a small stool whilst sitting. You will be
advised to use an ice pack on your knee; a bag of frozen peas wrapped in a towel will
work very well. Normal post operative swelling should improve (but not always
completely disappear) overnight while your leg is elevated and rested. You will find that
your leg swelling gets worse during the day while you are using it. If the swelling does
not improve overnight or the calf or thigh gets very hard and warm please contact your
GP. This swelling can remain for 3-6 months after surgery with some swelling
remaining for up to a year.
Pain
It is normal for the knee to be painful for a few months after surgery, especially once
you go home and start to walk more and exercise it. If there is a sudden increase in
pain associated with extra activity, try using an ice pack, taking painkillers and reducing
the activity for a day. It may pass but if it doesn’t and is stopping you from walking
and/or bending your knee, contact your GP or the ward for advice on 01793 646333. It
is important that you keep your knee moving and therefore you may need to take pain
killers regularly for the first couple of weeks or even longer. We will give you a supply
of painkillers when you are discharged. If you need any more, you will need to visit
your GP.
Rehabilitation
Exercise is necessary to help promote the healing process and ideally you should start
with gentle exercise prior to your surgery to build and strengthen your muscles. A
positive mental approach to your recovery will help.
Your need for physiotherapy on discharge will be assessed by the Physiotherapist
during your hospital stay. If you are able to bend your knee to 90° by the time you are
discharged you may not need formal physiotherapy but will need to carry out the
exercises shown on page 25-26 and later in your recovery, the exercises on page 2930.
You will practice climbing stairs before you leave hospital, but initially you may find it
15
easier to go upstairs leading with the ‘good’ leg first, downstairs with the ‘bad’ leg first.
You may find that this is how you were managing before surgery. In the initial couple of
months some people feel that they have gone backwards or that surgery has not
benefited them. This should pass.
Blank for your notes
16
An example timetable explaining what will happen to you during your hospital stay
Day One
You will be assisted out
of bed to sit in the chair.
You may walk with a
Zimmer frame if you feel
able.
You need to do your
exercises and use ice
therapy.
Day two/three
Day three/four
You will start to mobilise
with a Zimmer frame and
assistance.
You will need to continue
your exercises and
practice walking with the
frame around the ward.
You need to do your
exercises.
You may progress onto
sticks and practice stairs
with the Physiotherapist.
You may go on the CPM
machine.
You may go on the CPM
machine.
Ask for ice therapy.
Your drip will be taken
down once you are
drinking well.
Take regular painkillers and
also laxatives to prevent
constipation.
Continue with your
exercises and ice
therapy.
Continue with the CPM if
needed.
The padding around your
wound will be removed.
The drain (if you have
one) may be removed if it
has stopped draining.
You will have a blood test.
Take regular painkillers
and also laxatives to
prevent constipation.
The Occupational therapist
(OT) will discuss your home
situation.
You may have an x-ray.
Your catheter should be
removed tonight if you
have one
Try to drink plenty of fluids
and eat a normal diet.
Try to drink plenty of
fluids and eat a normal
diet
You may want to get
dressed today.
Take regular pain killing
tablets.
Talk to the nurse about
going home/transport etc
Try to drink plenty of
fluids and eat a light diet.
You will be discharged as
soon as you are
considered medically fit.
17
Risks and
complications
Whilst rare, there are some risks and complications associated with knee replacement
surgery. Some complications include infection, blood clots, implant breakage, mal-alignment,
and premature wear. Although implant surgery is extremely successful in most cases, some
patients still experience pain and stiffness beyond the standard post-operative period, which
are the commonest causes of unhappiness in patients overall. No implant will last forever
and factors such as the patient’s post-surgical activities and weight can affect longevity of
the implant. Be sure to discuss these and other risks with your surgeon.
There are many things that your surgeon may do to minimise the potential for complications.
You may need to have your dental work up to date and may be shown how to prepare your
home to avoid falls.
Advice is available from the ward if you are worried about your recovery once at home. The
number is 01793 646333.
Infection
Infection of the knee joint occurs in one out of every hundred patients. This usually makes
the knee painful again and sometimes even requires extensive surgery to eliminate the
infection.
Obviously we take precautions to try to prevent infection. The techniques used to dress the
wounds and the dressings we use all help to reduce the risk.
Breathing Exercise.
It is important to regularly take several deep breaths every hour; this will help to reduce the
complications that can be experienced following joint replacement surgery.
18
Deep Vein Thrombosis
This is a blood clot in the veins of the leg, most commonly in the calf, but can also occur in
the thigh/groin. Precautions are taken to avoid this happening but orthopaedic surgery
means that you are at risk. When you are seen in pre-assessment clinic you will be
assessed for your risk of deep vein thrombosis and the treatment you are given will depend
on your risk factors.
The main way to avoid a blood clot is to keep the muscles in your legs working and the best
way to do this is to walk around. Whilst you are in bed you should do the following exercises.
You will receive medication every day to help prevent DVT during your hospital stay. You will
be given medication to take home and some anti- embolic stockings to wear during the first 6
weeks at home.
Anti embolic stockings help to prevent DVT by increasing blood flow to prevent pooling of
blood in the veins. They help to keep the veins tight and stop dilation of the veins.
You will be measured for and given a pair on admission by the nurse admitting you; you
need to wear your stockings to go to theatre.
The signs and symptoms of a blood clot are extensive swelling in the calf which may also be
warm and tender to touch. Walking on the leg can also cause pain in the calf. As already
mentioned, swelling occurs after knee surgery but normal swelling usually improves when
the leg is elevated for a period of time. If the swelling does not improve overnight when the
leg is elevated, shows any signs listed above, or you are worried please seek advice from
your GP.
Occasionally a blood clot can move to the lungs and this is called a pulmonary embolus
(PE). This is a serious condition if you experience any chest pain which is worse when taking
a deep breath or any unexplained shortness of breath please come to the emergency
department for urgent assessment.
19
1. Circulatory exercise. When lying or sitting, rotate both ankles in a clockwise
and anti-clockwise direction.
Repeat 10 times every hour
2. Extension exercise. Lying on your back with your legs straight. Pull your
toes up towards you, and then tighten your knees by pushing them down
firmly towards the bed. Hold for 5 seconds then extend your toes away
from you and hold for 5 seconds and relax.
Repeat 10 times every hour.
20
The Anaesthetic
As with any surgery there are risks associated with anaesthetic. There is an increased risk of
heart attack, stroke, deep vein thrombosis, a clot in the lung or even death either during the
operation or shortly after it. This risk is minimised by the assessment process at pre
admission clinic where blood tests, heart recordings and x-rays will be carried out. Following
this you may be referred to see an anaesthetist in the Cherwell Pre Assessment Clinic.
Unfortunately unexpected complications do still occur.
Stiffness
Although the new knee is very good at removing pain and making walking easier it may not
move as far as a normal, natural knee joint. Sometimes the knee joint becomes quite stiff
because of excessive bone or scar formation in the muscles around the knee. Most people
find, however, that the relief of their arthritic pain is so good that a certain amount of stiffness
does not worry them.
Swelling
Your leg may be swollen for a surprisingly long time after your operation for some time (up to
12 months), though most of the swelling will improve over the 1st 3 month period. Elevate
your leg on a foot stool on and off during the day, particularly in the initial 2 month period.
Pain and discomfort
Having the soft tissues and main muscle groups split, bones of your knee removed with
power tools and a new implant impacted into place, constitutes a major injury to your knee. It
will therefore be painful. The degree of pain does vary dramatically from patient to patient in
terms of severity and duration. Most patients will need regular pain relief for the 1st 6 weeks
following surgery.
21
Wearing out and loosening
All knee replacements wear with the passage of time and this leads to loosening of the knee
replacement within the bone. The younger you are at operation the more likely you are to
wear the knee out. Approximately 1% of knee replacements fail per year so that by 10 years
10% may have failed. If the knee wears out and fails it may become painful again and the
underlying bone may get damaged by the loose knee replacement. It is the quality of the
remaining bone and your health at the time that determines whether a new knee
replacement can be done. This is known as a revision knee replacement.
Continuing pain
Occasionally, patients do have some remaining discomfort after the operation. Infection, misimplantation, stress fractures and loosening can also produce pain, however the majority of
patients have none of these complications, but a prolonged recovery from the major trauma
of the knee replacement surgery. A very small group of patients have what is known as
neuropathic pain or a complex regional pain syndrome. We estimate this occurs in 1% of our
patients. Some patients’ knees can be extremely painful and in some cases we can ask the
Pain Team to treat patients with severe pain.
Constipation
Unfortunately the medications required to control your pain can cause constipation. This
causes you to be unable to open your bowels properly and in rare circumstances your bowel
becoming completely blocked, which is very serious. Please be aware of this and increase
the fibre in your diet, drink plenty of fluids and take the laxatives which are prescribed for
you. If you become very uncomfortable, are not passing wind and/or your bowels are not
working normally, please seek advice from your GP
22
Numbness
You will have a numb patch on the outer side of your leg about the size of the palm of your
hand. This is normal and a direct result of the surgery. This normally settles after about 18
months and is nothing to worry about. Some people, however, find that they have a small
area remaining even after that time.
Rarer Complications
Damage to the main nerves that run around the knee resulting in numbness and weakness
in the leg or ankle, called a drop foot, which may be permanent. This may mean having to
wear a splint to hold the ankle steady while walking.
Occasionally the bone gets cracked in the placement of the new knee. If this happens the
consultant will speak with you and discuss the changes that will be made to your recovery. It
may mean having to use crutches for the first few months while the bone heals.
Blank for your notes
23
At Home
What activity range can be expected after this surgical procedure?
Diligent physiotherapy, a strong positive mental approach to recovery, proper diet and a
willingness to follow all of the recommendations your medical team makes will contribute to a
successful recovery after surgery. Most patients are able to walk with the aid of sticks or
crutches almost immediately. You should start to move without support as soon as you feel
comfortable to do so. This will vary from individual to individual. The responsibility for your
ability to drive is yours; however, it is generally advised to wait a minimum of 6 weeks. The
responsibility for when you return to work is also yours, however, you will find that your leg
gets swollen and that swelling increases with the more activity you perform. Activities such
as golf, doubles tennis and swimming can usually be resumed but only after an evaluation at
your follow up appointment. Always follow your doctor’s recommendations, as recovery time
will vary for each patient.
You will typically not be allowed to participate in high-impact activities or contact sports.
These types of activities place extreme amounts of pressure on the joints, which could lead
to complications. Ask your surgeon which activities you should avoid after surgery.
Hydrotherapy (exercise in water) is beneficial for your recovery and can be commenced
slowly once your wound has healed fully. If you would like to be referred for hydrotherapy
please mention it at your 1st follow up appointment. Swimming breaststroke should be
avoided.
Follow Up
You will be seen 6 weeks after your operation by a nurse or physiotherapist who specialise
in seeing people after joint replacement surgery. This is to evaluate your progress. You will
not have an x-ray at this appointment.
You will then be seen 1 year after surgery for an x-ray and consultation with a nurse or
physiotherapist. If everything is ok at this appointment you will be discharged.
The First Three Months
Gardening involving kneeling should be avoided for three months.
24
Exercises
1. Extension exercise. Lying on your back with your legs straight. Pull your toes
up towards you, and then tighten your knees by pushing them down firmly
towards the bed. Hold for 5 seconds then extend your toes away from you and
hold for 5 seconds and relax.
Repeat 10 times every hour.
2. Quad strengthening exercise. When lying or
sitting straighten your operated leg, pull your
toes towards you and lift your leg 150 mm (6
inch) off of the bed.
Hold approx 5 seconds, slowly lower the leg,
keeping it straight to the bed then relax.
Repeat 10 times every hour.
3. Quad strengthening exercise. When lying or
sitting, bend your un-operated knee and put
your foot on the bed. Place a firm cushion or
rolled up towel under your operated knee,
pull your toes towards you, push down on to
the cushion or towel and lift the lower part of
your leg. Hold for 5 seconds and slowly lower
your foot to the bed.
Repeat 10 times every hour.
4. Extension exercise. Sit on a chair, pull your
toes up towards you and tighten your thigh
muscles and straighten your knee slowly.
Hold for 5 seconds and relax.
Repeat 10 times every hour.
5. Flexion exercise. Sit on a chair, bend your
knee as far back as you can. Hold your knee
in this position for 5 seconds and relax.
Repeat 10 times every hour.
Blank for your notes
26
Common Questions
Common Questions
How long will my joint replacement last?
We usually say at least 10 years but many last 15 – 20 years or maybe longer.
Will my joint replacement wear out?
The more you use your new joint the faster you will wear it out but returning to
normal activities and some sports is fine. You should avoid high impact exercise
such as jumping, jogging and skiing and should also avoid twisting the knee too
much.
How long will it take for me to recover from the operation?
A knee replacement is a major operation and it can take many months for the
joint to settle down properly and for you to feel completely well again. Most
people feel a lot better in 3-6 months but you may still get some small
improvements up to 18 months after the operation.
Can I kneel on my new knee?
You can try to kneel if you want to, once the wound has healed. After this you
can try for short periods but you should use a cushion or pad. Many people find
that it is too tender or just don’t want to try.
How and when can I increase my exercise?
Many patients find that after about 3 months they want to start increasing their
exercise.
You may also be interested in going to a gym. Under a special scheme you may
be able to be referred by your GP to receive special instruction in the gym at a
reduced price. This scheme is called ‘Steps to Health’.
27
When can I travel by plane?
It is advisable not to fly for at least 6 weeks following a knee replacement. There
is an increased incidence of spontaneous blood clot/deep vein thrombosis (DVT)
on long haul flights. If you have to travel by plane before 6 weeks after your knee
replacement, it would be wise to contact your airline’s medical department and
ask them for advice. Also please discuss the issue with your GP.
When can I drive?
It is advisable not to drive for at least 6 weeks after surgery. As a general rule
you should be able to drive safely as soon as you can perform an emergency
stop. For more information please visit the DVLA’s website (www.dvla.gov.uk)
What sort of follow up will I receive?
Most people find that after about 6 months their joint replacement settles down
and they do not experience any problems. However to ensure that the joint is
stable it is advisable to have an X-ray after one year.
What sort of problems should I look out for?
Any increase in pain, stiffness, clicking or difficulty with walking or moving the
joint. Also any redness, heat, swelling or oozing from the wound.
What should I do if I think that there is a problem?
If you start to experience any problems with your joint replacement either before
or after your appointment you should contact us on the number below or see
your GP who can arrange for you to be seen at the hospital if necessary.
Orthopaedic Specialist Nurse
01793 605312
Go for short walks regularly, remembering to take equal length strides, and
gradually increasing the distance you walk at a rate that is comfortable to you.
28
Progression exercises following unicompartmental or total knee
replacement
Once you feel strong enough and can do all the previous exercises, progress
onto these.
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. Return to starting position.
Repeat 20 times
Aim to do this exercise 3 times a day.
Stand in front of a 20-40cm step.
Step up 20 times with one leg leading and then repeat
with the other leg leading.
Repeat 5 times.
Aim to do this exercise 3 times a day.
Stand on one leg on a step facing down.
Slowly lower yourself by bending your knee to 30
degrees. Return to starting position.
Repeat 20 times.
Aim to do this exercise 3 times a day.
Sitting with your arms crossed.
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)
Repeat 20 times
Aim to do this exercise 3 times a day.
29
Lying face down with a band around your ankle.
Tighten your stomach muscles to keep your lower back
straight. Bend your knee and pull the band with both
hands until you feel tightness on the front of your thigh.
Hold approx. 20 seconds – relax
Repeat 10 times.
Aim to do this exercise 3 times a day.
Lying face down on a table/bench with your feet over the
edge.
Let the weight of your feet straighten your knees. Hold
60 seconds.
Repeat 5 times
Aim to do this exercise 3 times a day.
Sitting on a chair, with the leg to be exercised supported
on a chair as shown.
Let your leg straighten in this position. Hold 60 seconds.
Repeat 5 times
Aim to do this exercise 3 times a day.
30
Summary
Summary
We know the decision to have surgery is sometimes difficult. We hope this brochure
has helped you understand some of the basics of knee replacement surgery so that
you can make the best decision for yourself.
Millions of others have made this choice, allowing them to return back to a more
active life.
Some quotes from patients who have received joint replacement surgery here.
“Don’t give up, sometimes it hurts and is depressing but, the results can be amazing”
“sleep pattern is doing my head in, but have to put up with it”
“REALLY amazed that all the arthritis pain has gone, in fact NO pain at all, just the
aching”
“That’s 2 weeks post op, still not a whole nights sleep, no pain, just aching”
“I can really see how easy it would be to just sit around and end up with a stiff leg and
a limp! I want to get back to normal, so I MUST PERSEVERE”
“Listen to the professionals as to what you can or can’t do”
“try to know the difference between ‘ouch that REALLY hurts, I have to stop’ and ‘oh
that hurts a bit, but I need to do this’”
“Remember a couple of months hard work can give you back a quality of life that you
probably haven’t had for years”
This brochure is not intended to replace the experience and advice of your
orthopaedic surgeon. If you have any further questions, please speak with your
orthopaedic surgeon.
31
The British Orthopaedic
Association
Orthocard
Did you know that you can register your new knee joint?
Registering your new knee will protect your new joint. It will show that you have
an artificial joint, which helps prevent infection by letting your dentist, nurse and
doctor know that you have one. It also will help at the airport when going through
metal detectors and other security measures.
If you are interested, please see the nurses on the ward when you are
discharged. You will be given a pack with all the information needed, and once
registered you will be able to use your card.
http://www.boa.ac.uk/Pages/Welcome.aspx
32
Author/location
Claire Woodruffe
Information gathered from Norfolk and Norwich Hospitals
www.bonesmart.org
Review Date
September 2014
Contact telephone Number
01793 605312
Leaflet Number
PALS PiL - 0522
33