Total knee replacement

Welcome

At Mater, we understand that being hospitalised can be a very stressful experience. In keeping with our Mission to offer compassionate, quality care that promotes dignity whilst responding to patients' needs, this booklet aims to alleviate some of your concerns. It explains the general day to day events that may occur during your visit and the things to expect when you are discharged from the hospital.

It is, however, only a guideline as each person may require differing treatments.

If you have any questions about your treatment please speak to your doctor or nurse. Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.

What is a total knee replacement?

The knee is the largest joint in the body and carries almost half of your weight. Usually the surfaces of the bones in the knee are covered with a smooth coating (cartilage). When arthritis occurs this coating wears away and the normally smooth surface becomes rough. As a result, the joint cannot move smoothly. It becomes stiff and swollen causing pain and limited movement.

What happens during knee surgery?

The damaged areas of the bone are removed and your doctor will replace your knee
joint with a man-made knee joint called ‘prosthesis’. Some parts of the prosthesis are
metal and some are a tough plastic.
Once the prostheses are inserted to the different bones the surgeon checks that the
pieces fit properly and that the new joint moves correctly.

What things do I need to do to be ready for surgery?

You will have received instructions from your doctor and the pre-admission clinic.
The clinical nurse consultant will call you three days from before your surgery to
ensure you are on track with your preparations for surgery.
Please follow those instructions and complete the 'My checklist to be ready
for surgery'.

Having your home prepared before you have your operation will make things easier
when you return home after your operation. To help you with this, an occupational
therapist from Mater at Home will organise a time for you to review your home
set-up. They will review the following:

• bed height
• chair height
• walkways (to be clear of furniture, loose mats or rugs, cords or leads)
• shower, bath and toilet access and safety
• kitchen layout (re-arranging kitchen cupboards may be necessary to avoid bending).

Preparing meals in advance and freezing them, or buying frozen dinners will help
make meal preparation easier when you return home. You will need to organise
family, friends or neighbours to help with the housework, shopping, driving or
providing light assistance with showering, dressing and, if special stockings are
required to be worn, provide help in putting them on and taking them off.

What can I expect after my operation?

Operation and recovery - Your operation will usually take between one and two hours.
You will then remain in the recovery area until you are awake enough to return to the ward. This may take up to three hours.

Lines and drains - When you return to your ward you may still need oxygen, you will have IV lines for fluid and pain medication, one to two wound drains and you may have a catheter to help keep your bladder empty until you are able to manage getting up to go the toilet. These will be removed gradually from day one following your surgery.

Your operated leg will be resting in a knee immobiliser to keep it supported and protect it from movements that could harm the operated joint.

Diet - If you eat and drink normally straight after your operation it may cause you to feel sick. Eating and drinking small amounts slowly will help to prevent this. You should be eating and drinking normally by day one following your operation.

Pain - It is normal to have some pain and discomfort after your surgery. However, it is important that your pain is controlled so you are able to cough, breathe deeply and do your exercises.
Please let someone know about your pain so it can be treated and managed.

Infection control - Every effort will be made to prevent infection in your artificial joint. Hand hygiene is essential when recovering from this surgery. Please wash your hands regularly.
Some doctors choose to prescribe antibiotics to help prevent infections.
Do not disturb the dressing on your operation site.

Blood clot prevention - To help prevent blood clots forming in your legs (thromboembolism) your doctor may request that you wear a pair of white compression stockings as well as compression pumps after your surgery.
If your doctor has ordered stockings they can be removed for your shower and put back on afterwards. You will need to wear the stockings for six weeks after your operation.
Non-slip socks will also be provided. You will have blood-thinning medication which may continue when you go home. If your doctor orders this, your nurse will provide education for you or your carer to manage this when you go home.

Mobilising and exercising - Your physiotherapy will begin on the day of your operation and an
exercise program will be given to you by your physiotherapist.
This program will continue when you go home.

Bowels - Bowel function can be affected by surgery and medication. To help your bowels return to normal function you may require bowel medication. Increasing your water intake and eating food high in fibre will also help your bowel function to return to normal. Include prunes and pear juice in your diet.

Going home - Depending on your recovery, it is anticipated you will be discharged from day two or three following your surgery. We aim for discharge from the ward to be 10 am.
You should have already organised your own transport home, help with meals, driving, domestic tasks, shopping and getting your compression stockings on.
Make sure the people helping you are aware of your discharge.

What can I expect from my physiotherapist and occupational therapist?

You can contribute greatly to the success of your operation by following the
instructions of your health team. It is important to consider yourself as part of the team.

Physiotherapist: While you are in hospital your physiotherapist will give

information on:

• preventing complications—deep breathing, circulation exercises and swelling

management

• mobility advice—getting in and out of bed and a car, walking with an appropriate

mobility aid and negotiating stairs

• rehabilitation—what exercises and goals are important early, and what you need

to continue at home.

Occupational therapist: You may require an occupational therapist assessment and
if you do they will provide you with the best method for you to shower or bath in
your home and will discuss with you dressing, lifting, carrying and gardening.

What advice will the occupational therapist give me?

Bathing - Follow the occupational therapist’s advice with standing or sitting
on a shower chair while having a shower. If you have a bath,
advice will be given as to how to use a bath board safely.

Dressing - When you are dressing:

• sit down to dress yourself
• use long handle aids recommenced by your occupational therapist
• dress the operated leg first and undress it last
• use the aid to pull your clothes up past your knees
• when you stand to pull up clothes, steady yourself before pulling the garment up.

Lifting and carrying - The muscles around your knee will have lost strength after the
operation, so you should follow the advice provided to you by
your doctor/physio.

Driving - Consult your doctor prior to returning to driving.

What complications could occur

Serious problems from a knee replacement are not common but can happen.

• Soon after surgery people can get an infection or blood clots in their legs.
• The new prosthesis may become loose. Rarely the artificial joint may break.
• If the joint was extremely stiff prior to surgery, stiffness is likely to be significant after surgery.
• A major nerve may be damaged leading to poor or no leg movement.
• Most minor nerve injuries may recover completely.

If you experience redness, pain or swelling in your limb, or shortness of breath, you must present to the Emergency Department immediately. These could be signs of a Deep Vein Thrombsis (DVT - blood clot in the leg vein ) or a Pulmonary Embolism (PE - blood clot in the lung).

What will it be like down the track - getting back into life

Strength and flexibility of your knee should steadily improve over the next 12 months;
the time varies from patient to patient.
Follow your doctor’s/physio’s advice on using your mobility aid and keeping your weight off the healing knee. You should be allowed to resume driving in six to eight weeks. It is advisable to check with your doctor before you do. Recreational activities such as bowls, golf and gardening can usually resume after about three months.
Your prosthesis is designed for the activities of daily living but not for playing intense or compact sport. Jarring of the joint, caused by running or jumping can cause the prosthesis to loosen or dislocate.
Having prepared yourself well and participated actively in your treatment, you will be able to return quickly to a more active independent lifestyle.

Acknowledgements

Staff of Mater Hospital Brisbane, Allied Health and Mater at Home

Mater Hospital Brisbane

Raymond Terrace, South Brisbane Q 4101

Telephone: 07 3163 8111

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