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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.
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.
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.
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.
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.
Artificial knee joints last for 10 – 15 years or more depending on the age and weight of a person.
During the operation the damaged surface of the knee joint is removed and replaced with metal and polyethylene (plastic) components (parts).
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.
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.
Complications are rare but include:
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.
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.
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:
It is important that you bring the following information to your pre assessment:
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:
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.
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
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.
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.
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.
You will be asked if you want to complete a PROMS (Patient Reported Outcome Measures) questionnaire. Please see the here for more information.
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
It is important to plan your discharge before surgery to prevent any delays in getting home.
Things to consider are:
The way you carry out some activities of daily living may need to be altered temporarily.
What to bring with you
It is also important that you bring with you the following items if you normally use them at home
Please do not bring with you:
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.
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.
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:
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:
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.
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.
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.