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Patient Information Leaflet : Total Knee Replacement
What happens in hospital? On Admission Most patients undergoing knee replacement will be admitted the day prior to surgery to allow them to settle into hospital and be seen by the anaesthetist to discuss the anaesthesia involved and also by myself. You will be clerked by the nursing staff and you should remember to bring in with you suitable clothing for a 7 day stay, any medication which you are taking and any notes and xrays which you may have in your possession, particularly with regard to your knee. Occasionally, if the operation is in the afternoon, you will be admitted on the morning of surgery. You will also be seen by the physiotherapists and instructed in the use of exercises and aids such as crutches. Before the operation you will be asked to sign a consent form and the appropriate knee for operation will be marked by myself. The operation will be undertaken usually mid morning and can last for 1-2 hours. You will be in recovery (an area in theatre where monitoring of blood pressure and breathing will take place) until you are stabilised, and then returned to your own ward. Occasionally patients will go to an area of more intensive monitoring called the High Dependency Unit, usually just for one night. This is normally the case for patients who have significant medical problems such as heart or lung conditions which need closer monitoring than usual.
After Surgery Once back on the ward or in
the High Dependency Unit you will be encouraged to move around as much as
comfort allows. You should move your feet and ankles, and your operated knee
within the limits of the bandaging, etc. You will notice that you have a drain
or tube coming out of the knee to take away any excess bleeding from the knee
joint. This drain will normally be left in place for 24 hours. You will
also notice that there is a small plastic needle in the veins in the back of
your hand (an intravenous cannula) which is in case you need drugs or fluid.
Apart from moving your operated leg you should also try and move around in bed
to avoid pressure sores on your bottom and heels, and also practice deep
breathing exercises to encourage good lung function. You will be able to sit
up in bed and begin taking fluids and food within three-four hours of the
operation. Normally patients who have had a knee replacement are in hospital for seven days in total and should be independently mobile getting in and out of chairs, getting in and out of bed and walking around the ward within a few days. Prior to leaving hospital you will also be asked to ascend and descend stairs just to ensure that you are capable of doing this comfortably and safely. When you leave hospital you will still be using your crutches but encouraged to put as much weight through your operated leg as possible. You may also be asked to use TED stockings (support stockings) which help blood flow both in and out of the leg, and also prevent deep venous thrombosis.
On Discharge From Hospital On discharge from hospital you will be given a note to keep at home which summaries your hospital treatment in case you have any requirement for emergency GP visits over the next two-three days. A separate letter will be sent by the hospital to your GP and also by myself, but this often takes a few days before it arrives. Your wound will normally be covered by a wound dressing and underneath that will be a series of metal clips or staples which will need to be removed 12-14 days after surgery. This will be arranged by the hospital for you to either come back to the hospital or preferably in liaison with your GP when the district nurse will come and see you at home. Once home you can shower or bathe and get the wound wet, even with the clips in but you should not let the wound soak until the clips have been removed, i.e. from two weeks post surgery onwards.
How Mobile Will I Be After Discharge? Before you are allowed to leave the hospital you should be independently mobile with your crutches and be safe, even walking up and down stairs. For this reason some patients need to stay somewhat longer than normal. The average hospital stay for a knee replacement patient is around seven days, but it can vary between five days up to two weeks. Although you will be encouraged to get outdoors for short periods, for most of the first six weeks you will be indoors and should travel outdoors preferably with a friend or family member When Can I Drive? Normally patients are advised to refrain from driving for at least six weeks, i.e. until the first clinic review with myself. After that time, once you are able to walk without crutches you are safe enough to drive but this would normally involve short journeys for the first couple of weeks, before progressing to normal driving. If the operated leg is your right knee it is often harder to recover sufficiently to allow safe operation of the brake and it could be 9 or 10 weeks before you are safe to drive. As a general rule, once you are able to walk without crutches or sticks without a limp, you are able to drive.
When Can I Return To Work? Most patients will be off work for around three months. If your work is sedentary or supervisory you can return to work in a part time capacity on light duties from six weeks post surgery, but this would only be if you have a degree of control over your working environment. Normally return to work will be discussed more formally at the six week post op clinic visit.
What Drugs Will I Need Following Discharge? You will be given the medication which you brought into hospital and if you are on medication for other medical conditions such as diabetes, asthma, blood pressure treatments, etc. these should be continued on leaving hospital. Specifically with regard to the knee operation you may require a few weeks supply of analgesics or anti inflammatories and this will be given by the hospital. You will also be instructed in the use of Heparin (a drug used to reduce the risk of thrombosis) such that you can give yourself injections of the medication once a day for up to four weeks following the operation, i.e. around three weeks after discharge from hospital. Beyond the medication provided by the hospital, simple analgesics such as Paracetamol, Nurofen (a mixture of Panadol and Ibuprofen) or stronger pain killers such as Distalgesics can be used. However, prolonged or excessive use of these medications would suggest a review by your GP or myself is required to ensure that there is no complication.
What Exercise Should I Do? Prior to discharge from hospital you will have been seen by the physiotherapists and given an exercise programme to follow. This is important first of all to get your knee working properly following the operation and secondly to help recover any muscle loss which has occurred as a result of the prolonged wear and tear process which led to the necessity for a knee replacement. Usually the physiotherapist will arrange for you to be reviewed either by the physiotherapists at the hospital or a more local physiotherapy unit. On average this would be once per week during the first few weeks following discharge from hospital. This will allow the physiotherapists to monitor progress and give further advice and encouragement as required. The amount of physiotherapy will be dependent on individual circumstances
What Does It Cost Privately? Most insurance policies cover fully the cost of surgery and I do not charge over recommended medical insurance guidelines. If you are not insured, the Fitzwilliam Hospital has a Fixed Price Package for most procedures including total knee replacement. This price includes all in patient hospital costs, i.e. surgeon’s fees, anaesthetist’s fees, hospital fees and theatre costs. Should there be any reason to undertake additional treatments such as a prolonged stay, dealing with complications either during the first week when still in hospital or up to the first month following discharge from hospital, this again will be covered by the fixed price package. An up to date fixed price package can be obtained by contacting the Fitzwilliam Hospital. Total knee replacement surgery usually costs in the order of £10,500.00 at the present time.
What Happens If Things Go Wrong? Should you be unfortunate enough to develop a complication either as an in patient or following discharge from hospital this will be dealt with either by your own GP or myself. If the problem develops at home you can phone the hospital ward and speak to the nursing staff on duty for advice. They would normally be able to deal with most queries or suggest suitable alternatives such as phoning your GP, attending the local accident and emergency department or returning to hospital depending on the circumstances.
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For more information contact varleysecretary@aol.com This site last updated 7th December 2008 |