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Knee Replacement

A knee replacement is an operation which replaces the severely damaged knee joint cartilage and bone with an artificial joint that does the function of the natural joint. It is designed to reduce the pain and help you return to your activities.

You should aim to be in the best overall physical and mental condition possible to help achieve the best results from your surgery.

 

Preparing your body

  • stop smoking
  • manage a healthy weight
  • practice your exercises before your surgery
  • manage existing medical conditions
  • make sure there are no infections - tooth abscess, bladder infections, infected leg ulcers, insects bites, cold & flu
  • manage your medicines as instructed in the preoperative period, such as blood thinners

 

Preparing your mind

  • ask a family member or friend to support you through this process
  • ask your doctor or your surgeon if you would like any help
  • feel free to ask your surgeon if you may have any questions to about the procedure
  • feel free to make notes or print these documents for future reference

 

Preparing your home

  • create a safe home environment for your recovery
  • have a chair with firm seat higher than your knee level
  • some adaptive equipment might help you - toilet seat, ice pack, raised toliet seat, long-handled aids
  • stock up on groceries and toiletries remove rugs and mats
  • remove clutter or furniture that may cause obstruction when using a walking aid

 

Preparing for your hospital stay

  • bring essential clothing and items of personal care
  • bring your glasses, hearing aids, splints and medicines
  • do not bring any valuables or jewellery
  • make note of your fasting instructions

Hospital admission

  • Most patients are admitted on the day of surgery. You will be checked upon on admission and will meet your anaesthetist and the surgeon
  • The anaesthetist will discuss the different anaesthetic techniques for your procedure
  • A member of the surgical team will mark your limb with indelible ink

 

Surgery

  • The procedure takes approximately 60-90 minutes
  • You will have a dressing over the surgical site which will remain for approximately 14 days

 

Recovery and rehabilitation during hospital stay

  • Your rehabilitation will start as soon as on the day of surgery
  • You will have physiotherapy everyday you are in the hospital- It is normal to have some pain following surgery but pain medications will help you with this.
  • It is important that your pain does not restrict you from moving around following surgery
  • You will have a blood test and an Xray after surgery
  • You must perform ankle pump exercises when resting and remain well hydratred to minimise your risk of getting a blood clot
  • You will be given an injection or tablet to minimise the risk of getting a blood clot further

 

Checklist before your discharge from hospital

  • You will be able to walk short distances
  • You will be able to walk up and downstairs (if needed)
  • Get on and off a chair and your bed independently
  • Get on and off the toilet independently
  • You will be able to perform your home exercises independently
  • Shower and dress with appropriate support
  • Pain is manageable and have access to pain medications
  • Able to give your own blood thinning medicine (injections)

 

Knee exercises

  • Learn your exercises - ankle pumps, static quads, inner range quads, active knee flexion, gravity assisted stretched, straight leg raises, sitting knee extension, sitting knee flexion, standing weight transfer, heel raises and forward lunges
  • Practise your exercises prior to surgery
  • You will have physiotherapy everyday you are in the hospital
  • After surgery, practise your exercises everyday, 10 reps, at least 3 times a day, within limits of pain
  • Pace yourself and take regular break between activities
  • Change position every 20 minutes or so to stop your joint getting stiff
  • After surgery, practise your exercises everyday, 10 reps, at least 3 times a day, within limits of pain
  • Continue to take pain medications as prescribed
  • Pain and swelling can be related to over-activity
  • Continue to take blood thinning medication as prescribed
  • You must keep your wound clean and dry until it has fully healed
  • You will have an appointment to see your surgeon at 6-8 weeks

 

Returning to normal life

  • You can stop using your walking aid as soon as and when you're instructed by your physiotherapist or the surgeon or when you're confident to walk without limping
  • You may feel safer to continue to use walking aid if walking outdoors for long distances
  • You may start driving after 4-6 weeks, once your pain is under control and you're off strong pain medications
  • You are advised to check with your insurance provider before you start driving
  • You may return to work once your pain is under control and off strong pain medications, usually 6-8 weeks. You may have to plan how you can get to work in the early stages. It is recommended that you have a phased return to work.
  • You may travel but make sure you can move yourr joint regularly.
  • You must not travel by air for for first six weeks and flights of more than four hours after three months

Please contact your local emergency department, surgeon or your GP if you experience any of the following symptoms -

  • fever
  • increasing redness or oozing from your wound
  • increase in pain that does not respond to your medication
  • pain or swelling of your calf that is not relieved by elevation
  • trouble breathing or shortness of breath

As with all procedures, knee surgery carries some risks and complications.

COMMON: (2-5%)  

LESS COMMON: (1-2%)

RARE: (<1%)                       

 

COMMON: (2-5%)

Pain: the knee will be sore after the operation. If you are in pain, it’s important to tell staff so that medicines can be given. Pain will improve with time. Rarely, pain will be a chronic problem & may be due to any of the other complications listed below, or, for no obvious reason. Rarely, some replaced knees can remain painful.

Bleeding: A blood transfusion or iron tablets may occasionally be required. Rarely, the bleeding may form a blood clot or large bruise within the knee which may become painful  and require an operation to remove it.

DVT:(deep vein thrombosis) is a blood clot in a vein. The risks of  developing a DVT are greater after any surgery (and especially bone surgery). DVT can pass in the blood stream and be deposited in the lungs (a pulmonary embolism –  PE). This is a very serious condition which affects your breathing. Your surgeon may give you medication to try and limit the risk of DVTs from forming. Some centres will also ask you to wear stockings on your legs, while others may use foot pumps to keep blood circulating around the leg. Starting to walk and moving early is one of the best ways to prevent blood clots from forming   

Knee stiffness: may occur after the operation, especially if the knee is stiff before the surgery. Manipulation of the joint (under general anaesthetic) may be necessary

Prosthesis wear: With modern operating techniques and new implants, knee replacements last many years. In some cases, they fail earlier. The reason is often unknown. The plastic bearing is the most commonly worn away part

 

LESS COMMON: (1-2%)

Infection: You will be given antibiotics at the time of the operation and the procedure will also be performed in sterile conditions (theatre) with sterile equipment. Despite this, infections still occur (1 to 2%). 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 washout the joint may be necessary. In rare cases, the  prostheses may be removed and replaced at a later date. The infection can sometimes lead to sepsis (blood infection) and strong antibiotics are required.

 

RARE: (<1%)                       

PE: a Pulmonary embolism is the spread of a blood clot to the lungs and can affect your breathing. This can be fatal. 

Altered wound healing: the wound may become red, thickened and painful (keloid  scar) especially in Afro-Caribbeans.

Nerve Damage: efforts are 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. There may also be damage to the Peroneal Nerve, this may cause temporary or permanent weakness or altered sensation of the lower leg. Changed sensation to the outer half of the knee may be normal.

Bone Damage: bone may be broken when the prosthesis (false joint) is inserted. This may require fixation, either at time or at a later operation.

Blood vessel damage: the vessels at the back of the knee may rarely be damaged. may require further surgery

Death: This very rare complication may occur after any major surgery and from any of the above.

Learn your exercises - ankle pumps, static quads, inner range quads, active knee flexion, gravity assisted stretched, straight leg raises, sitting knee extension, sitting knee flexion, standing weight transfer, heel raises and forward lunges
Practise your exercises prior to surgery
You will have physiotherapy everyday you are in the hospital
After surgery, practise your exercises everyday, 10 reps, at least 3 times a day, within limits of pain

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