What is a knee replacement ?
A knee replacement is a procedure to remove your damaged knee joint and replace it with an artificial one (a prosthesis) – this is made out of metal and plastic. Afterwards your knee should be much less painful and the joint should move more smoothly.
Why do I need a knee replacement ?
Over time, the surfaces on the knee joint can start to wear. This can be caused by osteoarthritis or a previous injury to the knee. Osteoarthritis is painful as joints become stiff and inflamed when the smooth lining between the joints gets damaged or wears away. Without the protection of this lining, the rough surfaces of your bones rub together as you move, causing the pain that is all too common to sufferers.
Simple, everyday things, like going for a walk or even getting dressed become difficult. There’s no cure for osteoarthritis and it can get worse with time. However, joints can be replaced successfully, improving mobility and reducing pain. You may have a knee replacement if your knee joint is worn beyond repair and medication and walking aids no longer help. If both knees are affected you will usually need two separate operations.
How we treat you ?
A knee replacement is normally performed under general anaesthetic, which means you are asleep during the operation. During the operation, your whole existing knee joint is replaced with a new prosthetic knee joint this takes between one and two hours. You will have a cut (incision) of about 15 cm (6-8 inches) at the front of your knee where the replacement will take place. Usually, you will stay in hospital for 4-6 days, but you may have to stay longer if necessary.
The benefits of a knee replacement are reduced joint pain, increased mobility and an improved quality of life, with the ability to return to routine activities of daily life.
Before your operation
Before you come into hospital for your operation, you will be asked questions about your health by one of our nurses. Further ‘pre-assessment’ questions may be asked over the phone, or you might be asked to come into the hospital for some simple tests, such as a blood test, a urine sample etc.
To further reduce the risk of any infection, we would ask you to have a shower or bath before you come to the hospital. Please ask any friends or family with infections (especially sickness or diarrhoea) not to visit you in hospital. Please let us know if you are taking any regular or herbal medication. We need to know everything about all the medication you take. Be sure to bring your medication with you on the day of your operation in the original containers. If you do take prescribed medicine on a regular basis, we will give you specific advice about continuing your medication, and what to do on the morning of your operation.
If you’re a diabetic you’ll be given instructions about your medication on the day of surgery and told when to stop eating and drinking.
It’s particularly vital you tell us if you are taking any type of blood thinning medication (anticoagulant). Medication of this kind can make your blood clot more slowly. We need to ensure your blood is clotting normally before we operate. If you are having a general anaesthetic, you will be asked not to eat or drink anything for a period of time which could be four to six hours before your operation. This helps to prevent any regurgitation of stomach contents during the anaesthetic, as this can cause damage to the lungs.
When you come home, you’ll need some help with shopping and household chores. So you should arrange for someone to stay with you for at least a week. Also, it’s best to leave plenty of time to get to the hospital on the day of your operation, so you’re not rushed and arrive as relaxed as possible.
On the day of surgery
At the hospital, we’ll show you to your room where one of our Healthcare Team will meet you to explain each stage of your treatment and recovery. They’ll take notes on your general health, medical and surgical history and ask if you have any allergies. Your blood pressure, pulse and temperature will be taken and an identification band with your name and hospital number on it will be placed on your wrist.
You will be shown where the alcohol hand rub is and how you and your visitors should use it. You will also see staff members using this before they treat you; please feel free to ask us if we have washed our hands. Don’t forget to wash your hands with soap after going to the toilet at any time.
Your consultant will come to see you. And if you haven’t signed a consent form already, you’ll be asked to sign one by your consultant. This is to confirm that you understand the details of your operation, the benefits and the risks associated with it, both during and after your operation. When it’s time to go to the operating theatre, our ward staff will take you. There, our theatre staff will take you to the anaesthetic room. They are very reassuring – they will understand how you feel and will try to help you in every way possible.
After the operation
Once your operation is over, you’ll be taken to the recovery room where you will wake from the anaesthetic. Your wound, blood pressure and pulse will be checked carefully. You will have a large dressing covering your wound. You may have a small tube coming out of your wound – this is to drain away any excess fluid from the inside of the wound.
You may also have a drip (infusion) going into your arm. This will keep you hydrated until you are able to drink, and can also be used to give you pain relief. When you are stable and comfortable, a nurse will take you back to your room.
Back in your room
Once back in your room, our nursing team will continue to check on you to make sure you are recovering well. Try not to touch or disturb your dressings as this can introduce infection. If you notice any bleeding or have any pain, don’t hesitate to speak to one of the nurses. After you’ve recovered from the effects of the anaesthetic, you can have something to eat and drink.
While you are in bed, you may have help with the circulation in your legs, in order to prevent blood clots (DVT). The first day or so you could wear boots on your legs that are inflated with air. You will also wear support stockings to help your circulation, and may have daily injections to help prevent blood clotting which may continue for up to six weeks. Also we may encourage you to move your legs if you are able. You may have some deep breathing exercises to do, to help prevent any chest problems after surgery. The day or so after surgery you will have an X-ray of your new knee to check its position. We will do all we can to help and reassure you.
Getting up for the first time
We understand that you may be anxious or worried about getting up, but we will do all we can to help and reassure you. Don’t worry, a member of our Healthcare Team will be there to help you, whenever you are ready. The reason for getting you moving is to improve your circulation and avoid stiffness.
You may be feeling tender and sore, but you can get pain relief medication to deal with any discomfort – just ask one of the nurses if you have any pain. Once out of bed, you will continue to wear support stockings to help your circulation. The physiotherapists will work with you during your stay to help give you the best start with your new joint.
A physiotherapist will give you some exercises to help get your new knee moving. These are important to help you make a good recovery. After three or four days, you should be walking with walking sticks . When you are able to walk up and down stairs, you can go home. You won’t be able to drive, so you will need someone to come and take you home from the hospital, once you have been discharged.
It’s usual to return to see your consultant as an outpatient after your operation. You may also need to have stitches removed. You’ll be given information about these appointments before you go home. We’ll also give you some pain relief medication to take with you.
Getting back to normal
After three weeks you should be getting about relatively easily, and this will continue to improve over the next six months. Your scar should fade to a thin white line.
Depending on what type of job you do, you should be able to return to work within twelve weeks. After six to eight weeks, you should be able to drive but only if you can comfortably operate the pedals and control your car in all situations. This includes an emergency stop. If you are in any doubt about your insurance cover, it’s best to contact your insurance company. You can resume sexual activity after four to six weeks, if it’s comfortable.
Complications and risks
As with all surgery, there are risks involved. Your consultant will be well informed about all of these and can talk you through them. Complications are rare. Don’t worry, your Healthcare Team is there to reassure and help you if anything unusual happens.
Risks specific to knee replacement surgery are : -
- Numbness on the outside of the knee caused by a nerve being cut during surgery
- Stiffness – there may need to be further, minor surgery to improve this
- Pain when kneeling
- Bleeding around the joint – this usually settles but may need to be drained by a surgeon
- Fluid build -up around the joint
- Rejection of the prosthesis
- Infection in the joint
Some complications to be aware of: DVT (deep vein thrombosis) is a risk after any operation, but is more common with major surgery. Being immobile during surgery causes the blood flow to slow and increases the chance of a clot occurring, usually in the leg. This clot can occasionally break off and move through the blood stream to the lungs and cause difficulty in breathing (pulmonary embolism).
Signs and symptoms of a DVT to look out for : -
- Swelling in the leg
- Pain or tenderness in the leg
- Increased warmth in the swollen leg
- Red or discoloured skin on the leg
Infection of the wound is a risk of any surgery. Your wound will be monitored while you are in hospital and if an infection is diagnosed antibiotics may be prescribed.
Signs of a wound infection to look out for when at home : -
- The wound may be warm to the touch
- Pain or tenderness
- Redness or swelling around the wound site
- Oozing of pus or fluid
- Offensive smell
- Your temperature may be raised
Bleeding is a risk with any type of surgery and can result in bruising that may cause discomfort. Severe bleeding leading to a blood transfusion is uncommon but can occur. Scarring occurs where the surgery took place and usually heals leaving a thin white line. Sometimes, however, there can be an overgrowth of the scar tissue making it unsightly.
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