Total Knee Replacement

Please note, this page is printable by selecting the normal print options on your computer.

You have been added to the waiting list for a knee replacement on the Rapid Recovery Programme. Providing every patient with kind, effective, quality care and the best possible experience whilst you are in hospital is our priority.

This journal is designed to help you increase your understanding of the programme. By you writing and updating this journal it enables you and your family to take an active part in your recovery. Please bring this journal with you to all hospital appointments. As part of the Rapid Recovery Programme the aim is to enable you to be well enough to go home after 1- 2 nights in hospital.

Knee replacement surgery involves replacing a damaged or diseased knee with an artificial one. The total knee replacement operation will replace the damaged joint with metal and high density polyethylene components.

Osteoarthritis – What is it?

This a common disease affecting the joints in the body, most commonly the knee and hip. The joint surfaces, which are covered in smooth cartilage, become damaged and gradually thin and roughen -this produces pain. Eventually, there may be no cartilage left in some areas of the joint. There are other diseases which cause joints to be replaced because of pain, such as rheumatoid arthritis.

What causes the need for a knee replacement?

Covering the surface of the bones in the knee joint is a smooth compressible gristle known as articular cartilage. When arthritis occurs, this gristle is worn away and the bone becomes exposed which results in pain.

Other reasons for knee replacement include rheumatoid arthritis, gout or knee damage due to injury.

What determines the need for a knee replacement?

The pain of arthritis may be helped by anti-inflammatory medicine and simple pain relief. Physiotherapy may also help to reduce pain and improve movement.

Only if these measures are ineffective will your doctor suggest treatment with a knee replacement.

What type of knee replacement will I have?

There are many different types of artificial knees available for total knee replacement surgery. The types of knee replacements used in this hospital are all tried and tested, with many years of proven experience. In a younger patient, your surgeon may discuss using an uncemented knee replacement and he will explain the risks and benefits of this with you as an individual.

How long should my new artificial knee last?

Artificial knee joints last for 10 – 15 years or more depending on the age and weight of a person.

The operation

During the operation the damaged surface of the knee joint is removed and replaced with metal and polyethylene (plastic) components (parts).

Anaesthetic

You may have a spinal anaesthetic for this procedure, although sedation or a general anaesthetic is also sometimes performed. This will be discussed at the joint school appointment and also with the anaesthetist on the day of surgery.

What are the benefits of the operation on the disease or symptoms?

The new total knee joint aims to relieve pain, decrease the stiffness and provide improved mobility and a better quality of life. Approximately 95% of patients are satisfied with the outcome of their new replacement knee joint.

What are the complications of a total knee replacement?

Complications are rare but include:

Risk of infection – there is a 1% risk of infection which is a serious complication and may require removal of implant and a repeat procedur
Numbness of the area around the wound scar will occur, but should improve over time although there will be a small area that is permanently
Deep Vein Thrombosis (DVT). This is when clots form in the deep veins of the Surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, e.g. pressure stockings to keep the blood in the legs moving, medication that thins the blood and prevent clots forming and probably the most effective is getting you moving around as soon as possible. Refer to this page for more information.
Joint replacements do work loose with time, and this is more likely to happen if you are a younger patient at the time of the joint r If a joint does loosen, then it tends to cause further discomfort and eventually the joint will need to be replaced again.
Nerve damage occasionally occurs after knee replacement surgery.
Persisting Some knees remain painful after ‘total knee replacement surgery’ for reasons we do not yet understand, and are not infected or loose. The incidence is 4.5% and pain settles within time.

How long is the average stay in hospital?

As part of the Rapid Recovery Programme the aim is to enable you to be well enough to go home between 1-2 nights.

You will only be discharged if there are no signs of complication, and you are independently mobile. If required, the district nurse will monitor your progress once discharged and provide assistance depending on your needs.

Anaesthetic

You will have a spinal anaesthetic for this procedure, along with sedation or a general anaesthetic. This will be discussed at the joint school appointment and also with the anaesthetist on the day of surgery. Refer to page 22 for an more in depth explanation.

Pre assessment

All patients who are having a knee replacement will be either seen immediately once listed for surgery or booked to attend an appointment at the Treatment Centre.

From this assessment we will decide if you are fit for an anaesthetic and your operation. You will receive MRSA screening as part of your pre-assessment, via a nasal swab. The results will be checked and patients will only be informed if the swab results are positive and treatment is required. If you know that you have been a carrier of MRSA please inform the pre assessment nurse.

The pre assessment nurse will inform you of the following:

If you are fit for the operation and anaesthetic.
Whether you will go through the Same Day Admissions or if you will report directly to the ward.
If you are suitable to come in on the day of your operation, or if necessary a day or so before your operation because of medical reasons.
The starving guidelines that you need to follow.

It is important that you bring the following information to your pre assessment:

All home, work and mobile numbers for yourself and 2 people that you state as your next of kin
All prescribed medication and any herbal preparations (inhalers, creams).
A note of anything you are allergic to g. medication, latex and food.
Inform us if you use any special equipment or services at home.

After your pre assessment it is important that you contact the clinical surgical unit or your pre assessment nurse if anything changes after your assessment and prior to your surgery, such as:

If you change your mind.
If you visit your GP for a new problem.
If your GP starts, stops or changes your medication.
If you are taken into hospital for any reason.
If, when you have a date for surgery, you are unwell with a cold, high temperature, or chest infection.

What if the pre assessment nurse finds something wrong?

Depending on the reason, it could be that your blood pressure is too high. The nurse may delay your surgery, or you may be asked to either visit your GP or an Anaesthetic assessment will be organised. We may have to remove you from the waiting list if you are not fit for surgery. Once the problem has been resolved you may then be recalled for another pre-assessment.

Pre assessment will discuss discharge arrangements and may refer you to the Social Work team. They work with the Reablement at Home Team and will triage the referral.

Octenisan® Wash

Preventing wound infection

Because skin is not sterile, your skin needs to be as free of germs as possible before your operation. The nurse at Pre assessment will give you a bottle of Octenisan® wash lotion with your name on it.

Octenisan® wash lotion is a special antiseptic wash that helps reduce the number of germs on your skin and the risk of a wound infection.

What do you need to do before the operation?

Two days before your operation date, you should start showering daily (washing your hair at the same time if possible) using the Octenisan® wash lotion and following the instructions below. This should be repeated daily and for the first two days after your operation. A shower is recommended, however if you are unable to use a shower, please use the product instead of your usual soap when washing in the bath or at a sink.

You can use the table below to tick off when you have completed the body wash.

2 days before my operation

1 day before my operation

At home on the morning of Operation Day

1 day after my operation

2 days after my operation

Date:

Completed:

How to use the Octenisan® body wash

Wet your skin and hair thoroughly in the shower, then turn the water off.
Put about 15 ml (a dessertspoonful) of Octenisan® body wash onto a clean wash cloth or flannel.
Apply the Octenisan® using a gentle circular rubbing motion over your body, paying special attention to your armpits, groin and feet.
Ensure all skin surfaces from the neck down are covered by the Octenisan® body wash.
Shampoo your hair with some more Octenisan®.
Ensure that the Octenisan® stays on your skin for one full minute.
Rinse thoroughly under the shower to remove all soap residue.
You may apply conditioner to your hair if needed.
Dry your skin thoroughly with a clean, dry towel.
Put on clean underclothes or nightwear afterwards.
It is recommended that bed linen and towels are changed daily and washed on the highest possible temperature.

Octenisan is hypo-allergenic and should be suitable for all skin types, even skin that is sensitive to soap or susceptible to allergies. If you do experience any skin reaction such as severe burning, itching, redness, blistering, peeling, swelling, rash or any other severe irritation discontinue use of the Octenisan® and tell your doctor.

On the day of your operation

Please remember to bring your Octenisan® wash into the hospital with you as you will use this to wash with the day after your oper If you are coming into the hospital from home, please shower using the Octenisan wash (including hair wash) before you leave.

Do not apply lotions, powder, or deodorant to your body.

After your operation

Please use the Octenisan® body wash for at least 2 days after your operation, or until the bottle is finished. After this you can revert to your usual products.

PROMS (Patient Recorded Outcome Measures)

You will be asked if you want to complete a PROMS (Patient Reported Outcome Measures) questionnaire. Please see the here for more information.

Joint School

The Joint School gives you the opportunity to learn about your surgery. The Joint School is held on alternate Tuesday afternoons between 2pm and 3.30pm. You need to ensure you attend the Joint School for Knees.

To book (or to reschedule your appointment): 01908 997006

To find out more about the Joint School, click here.

Home Preparation

It is important to plan your discharge before surgery to prevent any delays in getting home.

Things to consider are:

Don’t undertake any major decorating prior to admission that leaves your house unsafe Think about someone coming to stay with you if you think you may need help after surgery
Ask friends or family to help with shopping, cleaning or looking after pets if you think you may find it difficult
Ensure there is sufficient room to manoeuvre around the room with your walking aids. If necessary, consider removing excess furniture or ornaments
Remove or move loose rugs, trailing electrical flexes and make sure the lighting is good to reduce the risk of tripping or falling
If stairs are difficult consider making space for a bed downstairs and arrange for it to be brought down before you come into hospital
If your washing machine is low down, you may need assistance with laundry
You may not be able to bend to low cupboards and drawers, or to low shelves in your fridge or freezer. Rearrange items you use regularly to higher shelves
Arrange your kettle, cup, saucer, coffee/tea and sugar in one designated area Stock up the freezer with microwave meals or pre cooked food
You may need a commode if you decide you cannot manage stairs, your local red cross could supply one for you. The physio team will practice the stairs with you prior to your discharge
Think about personal hygiene as you may find it difficult to bath or shower
Have a phone by your bed, or carry a cordless phone in your pocket if you live alone
Ensure you have a night light next to your bed so you can make your way to the toilet safely at night Move regularly used clothes and shoes out of low cupboards and drawers
Keep everyday items within easy reach
Think about enough prescription medication for after your surgery Arrange discharge plans i.e. lift home.

Managing Household Tasks

The way you carry out some activities of daily living may need to be altered temporarily.

What to bring with you

Loose night and day wear, we encourage patients to get dressed into their day clothes 1st day post operation – bring in underwear
Dressing gown and socks
For comfort health and safety reasons you should have a pair of flat supportive shoes. Slippers should also be fully enclosed. (Not open backed mules)
Toiletries: soap, shampoo, toothbrush/paste, 2 flannels, towels, hand wipes Octenisan® wash
Comb/brush/shaving equipment Books/ Magazine
Loose change. Please bring enough with you if you wish to use the Hospicom TV.

It is also important that you bring with you the following items if you normally use them at home

All medication in correct containers for your complete stay in hospital. Bring them in their original boxes and not in dosette boxes. Inform nursing staff on the ward that you have brought them in (Pharmacy bag available at pre assessment). Please leave the following medication at home Tramadol, Oramorph, MST, Butrans and Fentanyl patches
Inhalers/sprays
Glucometer (diabetic patients)
Anti-coagulant therapy yellow book Hearing aid/spectacles
Denture pot/denture cleaner Mobility aids (sticks etc) Other aids – (CPAP machine) Juice
Hand wipes
Long handled shoe horn
‘Helping hand’/grabber (available at The League of Friends Shop, mobility shops or larger chemists)

Please do not bring with you:

Valuables Credit Cards Pension Books Jewellery
Electrical Equipment – this needs to be checked by the hospital prior to use The Trust cannot be held responsible for your valuables.

Preparing for surgery

If you smoke it is important that you do not smoke for 48 hours before your anaesthetic.
Do not drink alcohol or take any recreational drugs for at least 48 hours before your
Please remove any body piercing, make up, eyelash extensions, acrylic nails, nail polish from fingers or toes before coming in for your operation/procedure
Diet – you will recover more quickly from surgery if you are healthy beforehand. Try to eat a healthy diet in the time leading up to your operation. It is quite common to experience constipation following your surgery. A healthy diet will reduce this risk.
Octenisan® wash to be used as instructed.

Please arrive at the stated time on your letter. It is important that you follow the instructions carefully or your operation will be cancelled. Please call the relevant Clinical Surgical Unit if you have any questions: 01908 997 006 – Trauma and Orthopaedic

If you no longer wish to proceed with your operation, please let the hospital know as soon as possible.

Book yourself into the ‘Joint School’ held on alternate weeks on a Tuesday 2-3.30 pm. You need to ensure you attend the joint school for Knees.

You can book at reception immediately today or tel: 01908 997 006 (or to reschedule your appointment)

National Joint Registry consent form – please complete the ‘Patient Detail section’. An up-to-date list of all your medication (repeat prescription sheet).

All tests were completed during your Pre-assessment and these results (if normal) will be suitable for your date of surgery.

The tests that were taken today are only valid for: days / weeks / months. Please follow the instructions below.

You have/do not have a date for surgery but still require tests to be done. Please make an appointment at least 6 days/week in advance for tests, when you have been given a date for your operation.

To book an appointment for all blood/tests call Treatment Centre Reception: 01908 995452. Failure to have blood/tests performed may result in your surgery being cancelled.

Surgery in the morning

If you are having surgery in the morning you will be requested to attend the hospital at 7.15am.
Food and any other drink (tea, coffee, milk, juice etc) can be taken until 2.30am.
You may drink water only from 2.30am.
At 6am please have a glass of water; please ensure you finish your glass of water by 6.30am.
You must not suck any sweets or chew gum.
If you have DIABETES and you usually take tablets or insulin for diabetes please do not take your morning dose.
Please bring ALL YOUR REGULAR MEDICINES with you in the original containers and not in dosette boxes. Inform nursing staff on the ward that you have brought them in. This includes all over-the-counter medicines, herbal preparations, ointments, creams and inhalers. You will be provided with a pharmacy bag to bring your medicines in. Please leave the following medication at home Tramadol, Oramorph, MST, Butrans and Fentanyl patches.
If you take any medication, the Pre-Assessment Nurse will advise you of the medication that should be taken at home on the morning, of the day of your admission and operation.

Surgery in the afternoon

If you are having surgery in the afternoon you will be requested to attend the hospital at 11.45am.
You will be able to have a light, early breakfast before 7.30am at home on the day of your admission and operation. For example: two slices of toast or a bowl of cereal along with a cup of tea or coffee or juice. Please make sure that once you have had your breakfast you do not eat anything else.
You may drink water only from 7.30am.
At 11am please have a glass of water; please ensure you finish your glass of water by 11.30am.
You must not suck any sweets or chew gum.
Please bring ALL YOUR REGULAR MEDICINES with you in the original containers and not in dosette boxes. Inform nursing staff on the ward that you have brought them in. This includes all over-the-counter medicines, herbal preparations, ointments, creams and inhalers. You will be provided with a pharmacy bag to bring your medicines in. Please leave the following medication at home Tramadol, Oramorph, MST, Butrans and Fentanyl patches.

You will be asked to attend the Same Day Admission Unit which is located in the Treatment Centre. After surgery you will go to ward 24. The Same Day Admission Unit admits patients who are staying in hospital for longer than a day. There are trolleys and chairs, along with a change and wait area.

Visitors can accompany you to the Reception Area until you are taken to your waiting area. Due to limited space/privacy visitors will then be asked to leave. Please keep your property to a minimum for example a small bag (similar to a onboard flight bag). If you have any questions about your surgery please ensure you ask at this time.

Whilst you are in theatre your property will be taken to the ward. Once you have had your operation you will go to the ward. Ward 24 is a 20 bedded surgical ward, it is nurse led and we care for both male and female patients.

Visiting times are 2pm – 8pm

We ask that relatives do not visit outside the visiting times, so that patients can rest following their surgery. Please respect the patient’s protected meal times:

Lunch 12.30pm – 1pm
Supper 5.30pm – 6pm

We do not encourage very young children and babies to visit the wards due to the risk of possible infection to them. Please do not allow your visitors to eat food as many patients are not allowed to eat before their operation. We do not encourage visitors to sit on the hospital beds. It would be helpful to ask one person from family/friends to ring the ward to find out news of your progress. This person can then pass this information onto other members of your family and friends.

Please remember that staff are limited on the information they can give and will not disclose information about your procedure. If you have a concern during your stay in hospital then please raise it with the nursing staff at the time or ask to speak to the Senior Sister or Matron covering the area.

You may be booked onto an all day theatre list, which means you will arrive in the morning and may not go to theatre until the afternoon. Your anaesthetist will inform the nursing team if you are able to have a drink on the ward, due to the timing of your operation and a drink will be provided. It is essential that you are fully informed so if you have any questions please feel free to ask the nursing or medical teams.

The nursing staff will settle you into the ward environment and inform you of the ward routine.

The Surgeon, Anaesthetist and Physiotherapist will visit you before your operation. This is a good time to ask questions and tell the Anaesthetist about any worries that you have. Your leg will be marked.

All your details will be checked thoroughly, this may mean different people may ask you the same questions. Please feel that you can ask questions to understand all you need to know at any time during your stay in hospital.

You may be prescribed compression/anti-embolic stockings (AES), which are of benefit in reducing blood clot formation in your legs after surgery. Click here for more information on Deep Vein Thrombosis.

You will be asked to get into a gown. A pre medication (premed) will be given. A premed are the medicines given to you before an anaesthetic.

You will have:

12 microgramme Fentanyl patch put on an hour before your operation, this is an analgesia patch which will start working during your operation.
600mg Gabapentin which is for neuropathic (nerve) pain and helps reduce the pain in the knee during your operation.
150mg Ranitidine is a gastric protector and helps prevent sickness and reduce the acid in your stomach.
10mg Dexamethasone an anti inflammatory low dose steroid. (Diabetics cannot have this as it can raise blood sugar levels).

During your stay in hospital you will be encouraged to be as independent as possible. This means that you will be expected to do as much for yourself as you can e.g. washing, dressing and walking to the toilet. You will be expected to sit out of bed when you are well enough rather than staying in bed. You will be encouraged to get into your day clothes rather than spending all day in your nightwear. This usually makes you feel better in yourself and helps you stay independent.

What happens during my operation?

During your stay in hospital you will be encouraged to be as independent as possible. This means that you will be expected to do as much for yourself as you can e.g. washing, dressing and walking to the toilet.

You will be expected to sit out of bed when you are well enough rather than staying in bed.

You will be encouraged to get into your day clothes rather than spending all day in your nightwear. This usually makes you feel better in yourself and helps you stay independent.

Back on the ward assessment

Discharge home

You will be able to go home 1-2 nights after your operation. Your plans for discharge should be in place before you come into hospital for your surgery so that there will be no delays.