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Total knee replacement

Mater Private Hospital Redland was established in September 2000 as an extension of the Mission of the Sisters of Mercy to provide the highest quality health care services for the people of the Bayside region. With a growing community in the Bayside districts, Mater Private Hospital Redland offers patients exceptional care close to their families and friends.

Collated with the Redland Public Hospital, Mater Private Hospital Redland features a three level main hospital building incorporating 60 inpatient beds, two operating theatres, endoscopy procedure room, three obstetrics birthing suites and day procedure unit. It is combined with a single-level building housing a specialist medical centre, radiology and pathology services.

Our Mission

In the Spirit of the Sisters of Mercy, Mater offers compassionate service to the sick and needy, promote an holistic approach to health care in response to changing community needs and foster high standards in health related education and research.

Following the example of Christ the Healer, we commit ourselves to offering these services to all without discrimination.

Visiting hours:8 am to 1.30 pm and 3.30 pm to 8 pm.

Rest period is between 1.30 pm and 3.30 pm.

Reception phone:07 3163 9444

At Mater Private Hospital Redland, we understand that having an operation 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 information 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, a guideline as each person may require differing treatments. If you have any questions about your treatment please ask your doctor and/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?

A total knee replacement operation replaces a knee joint that has been damaged, usually by arthritis. No implant can make your knee feel totally normal again, but in most cases the operation will help to:

• decrease pain
• decrease stiffness
• improve your ability to get around and to do things.

The knee joint is a hinge joint, formed by thigh bone (femur) and the shin bone (tibia). Usually
the surfaces of the bones are covered with a smooth coating (articular cartilage). When
arthritis occurs this coating wears away. The joint surfaces become rough, which causes
pain and stiffness.

A total knee joint replacement operation removes the damaged areas of bone and replaces them with metal and plastic parts.

Surgery complications and risks

You could end up with an infection

Despite every possible precaution, including the use of antibiotics during the operation, infection occurs in approximately one per cent of knee replacements. Infection is a major potential complication, and may need further surgery and hospitalisation. This would severely affect the success of your operation. 

You could develop blood clots

• The risk of blood clots occurring in the deep veins of the leg is more than 20 per cent. 
• Risk is reduced through circulation exercises and medication. The risk of a clot travelling to the lungs (pulmonary embolism) is approximately one per cent and may be fatal.
• Total knee replacement is major surgery and there is a small risk of heart attack or other generalised medical problem.

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).

You could have problems with the anaesthetic

• Problems can occur, but serious problems are very rare.
• Most knee replacements are done under a spinal and/or epidural anaesthetic with a light general anaesthetic. If you have had previous problems with an anaesthetic please tell your surgeon, anaesthetist or your admitting nurse.

Your new knee could fail

Your new artificial knee will slowly wear out and/or loosen. A revision joint replacement may then be required. Your knee could also dislocate. Breakage of the artificial knee joint is possible, but rare. If this happens a second operation will be required.

There may be other complications

Many other complications are possible but the risk is only around two per cent. These include nerve injury, vessel injury, superficial infection, haematoma and others. These are not life threatening and generally are treatable. During the operation, problems may occur with weak bone breaking or nerve injury. These can usually be overcome with appropriate treatment. You may wish to discuss these with your doctor.

Anaemia due to blood loss during your operation

A blood transfusion may be needed during or after your operation. This is rare.

Expected length of hospital stay = five days

Date of ddmission..............................................................................................................

Planned discharge date.....................................................................................................

Actual discharge.................................................................................................................

Surgeon...............................................................................................................................

Anaesthetist........................................................................................................................

Physiotherapist...................................................................................................................

Community liaison nurse...................................................................................................

Our expectations

Prior to discharge it is expected:

• your observations are within normal limits
• your pain will be controlled on oral analgesia
• your would will be clean and dry with no signs of redness/inflammation/no joint deformity noted
• you will be tolerating normal/high fibre diet and fluids
• you will be transferring safely as well as mobilising safely and independently with walking aids
• your knee flexion should be at least 650'.

Your expectations and goals

What are your expectations of your hospital stay and recuperations?

Any expectations that fall beyond reasonable should be reported to the medical officer before surgery.

Preadmission service

Mater Private Hospital Redland provides a preadmission health assessment on the information you have provided to us. You may receive a phone call, if required, to clarify any health information you have provided.

You can expect to stay in hospital for five days or until you have met the expected outcomes for your procedure. To prepare for your discharge we must discuss what support and potential needs you will have at home.

This preadmission service gathers information, initiates investigations to prepare you for your surgery, provides information regarding your specific operation and identifies discharge needs.

Things to do before you come to hospital

• It is important for you to bring x-rays and any medications that you take. Your medications need to be in their labelled containers or Webster pack.
• If you are taking any blood thinning or arthritis medications please follow instructions provided by your specialist, as sometimes it is important that these medications be stopped in preparation for your surgery.
• It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. Please follow instructions provided by your doctor.
• It is important for you to shower then dress into clean clothes prior to coming into hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder). The condition of your skin is also important. Skin scratches, pimples or sores may result in your surgery beingcancelled. Please contact your surgeon if you have concerns about the condition of your skin. It is important NOT to shave your operative leg. Shaving may cause skin rashes or pimples resulting in cancellation of your surgery.
• Smoking is a factor that can impair healing and increase the likelihood of infection. Smoking also increases the chance of complications related to your anaesthetic which may sometimes be serious. Whilst it is best to give up smoking permanently, giving up smoking at least six weeks before your anaesthetic would reduce many of these complications.
• CPAP—if you suffer from sleep apnoea, it is important that you bring your CPAP machine to hospital. Your machine is taken to theatre with you.

What to bring to hospital:

• your Medicare card
• all regular tablets or medications in their original boxes/bottles
• any relevant x-rays, scans or ultrasounds
• glasses, contact lenses and hearing aid if required
• night clothes and toiletries (shampoo, soap, toothbrush, toothpaste)
• day clothes that are loose fitting and comfortable (e.g. track suits, elasticised waist pants)upportive shoes—these should be flat with a rubber sole. Make sure the shoes are not tight as your feet may swell a little. Do not bring heeled shoes, scuffs, or thongs. Slippers are okay as long as they have a closed heel.
• Any sticks or walkers that you normally use (mark your belongings with your name before you come to hospital)
• this information.

As Mater Private Hospital Redland is unable to accept liability for losses it is highly recommended that you leave your valuables at home for safety and security purposes. Please bring essential items only.

The day of your operation

Before your operation

• Your surgeon will advise you when to stop eating and drinking in preparation for your surgery.
• It is important not to have food or fluids for at least six hours before your operation. Failure to comply will require your operation be cancelled. You may brush your teeth the morning of your surgery without swallowing any water.
• It is important not to smoke cigarettes or tobacco products for at least 24 hours prior to your operation.
• It is important not to drink alcohol (including beer) for at least 24 hours prior to your operation.
• When you come to hospital proceed to reception within the Mater Private Hospital Redland foyer. You will be directed to where you will be admitted. 
• The assessment form completed at the preadmission service will be reviewed and your health team will plan for your individualised care while in hospital and any support you may require after discharge. Your nurse will also check that your consent form has been signed or organised to be signed before your operation. You can expect to be going home five days following your surgery or when all outcomes of your surgery have been met.
• It is an infection control requirement at Mater that, if you have transferred from another health care facility or you have a history of previous colonisation of multi-resistant organisms, nasal, wound and perianal swabs need to be taken. 
• The medications you brought to hospital will be collected and locked in your bedside locker for safety reasons. Please remember to ask for these to be returned to you when you leave the hospital. Please inform the nurse admitting you if you have been taking any blood thinning or arthritis medications prior to your admission, as these may have needed to be stopped before your operation day. It is usual for you to continue taking your other prescribed medications.
• You will have an identification armband applied. This will stay on for the duration of your stay for identification and safety reasons. For your safety, if you have known allergies, please notify staff. These allergies will be documented on your identification arm band.
• Any blood tests, x-rays or other procedures that your doctor has ordered and are not yet completed will be completed soon after your arrival to the ward.
• Your nurse will take a set of baseline observations (for example, temperature, pulse, blood pressure) and weigh you. 
• Your physiotherapist will visit with you today and guide your rehabilitation by giving you exercises you must do regularly, which will help you walk again with your new knee. Breathing and leg exercises are also important for you to do following your operation, whenever you are awake. It is important to practise these before you go to surgery so you will be ready to do them as soon as possible following your surgery.
• It will be necessary for the nursing staff to clip any hair in the surgical area. You will then be required to have a pre-op shower and your nurse will prepare your operation site according to your doctor’s requirement.
• You will be asked to dress into theatre clothing.
• You will be measured for special stockings (TEDS) and compression devices (SCDs) or foot pump and will need to have these put on prior to going to theatre. They assist with blood flow through the blood vessels of your legs and decrease the risk of blood clot formation while you have decreased mobility.
• Before you leave for theatre a preoperative check list will be completed with you by your nurse. This checklist will be repeated in the operating reception area. Apart from your wedding band, no jewellery or metal can be worn to theatre. 
• The operation takes about two hours but you will stay in the recovery room until the anaesthetist assesses you are stable enough to return to the ward. Total time in the theatre suite is approximately four hours.
• You will be escorted to the operating suite.

After your operation

• You will stay in the recovery room within the theatre suite after the operation while you waken from the anaesthetic. When you are ready to return to your room, you will be transferred on your bed.
• You will have a dressing over your wound. It will be necessary for you to have a drain in place to remove excess fluid from your operation site. 
• Your nurse will take frequent observations of your vital signs (for example, temperature, pulse, blood pressure etc), colour, warmth, sensation and pulses of your operated limb and wound for several hours after the surgery. As you recover, these become less frequent but remain regular until you leave hospital.
• Immediately following your surgery, you will be resting in bed. Your nurse will assist you with your toileting needs and hygiene needs as required as well as a post-op wash.
• You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.
• The drip (IV) is necessary to maintain your fluid intake.

Pain relief

 

• While we try to relieve your pain as much as possible, some times it’s not possible to take your pain away completely, however, your pain must be controlled well enough for you to move, do your physiotherapy exercises and to sleep. If your pain relief is not adequately controlled for this please tell your nurse. Also tell your nurse if you have an itch, you feel nauseated or feel like vomiting. These may be side effects of the pain relieving medication and are usually easily managed.
• A Patient Controlled Analgesia device allows you to manage your own pain. PCA involves specialised equipment which is connected to a drip (IV). You will have a button to push which allows a small amount of pain relieving medication to be delivered directly into your vein via the drip. The equipment has a specialised safety programme to reduce the risk of you receiving too much medication. You will remain on PCA until you are able to eat and drink.
• Your pain will then be managed with tablets. There is no risk of becoming addicted to strong pain relieving medication when i i’s used appropriately.
• If you have a PCA, you will more than likely be prescribed paracetamol (Panadol) four times a day. Paracetamol works well when used on a regular basis and helps to reduce the amount of stronger pain-relieving medication you require which therefore reduces their side effects.
• You will be given oxygen via nasal prongs or a mask while you have the epidural or PCA in place. It is important to always keep this on when sleeping.
• For the first 24 hours you will have a catheter in place which will drain your bladder.
• When you awaken it is important to remember to do your deep breathing and circulation exercises. Your nurse will also remind you to do these hourly. In addition to your deep breathing and circulation exercises—it is possible that CPM (Continuous Passive Movement—refer to ‘Mobility’) could commence as early as post-op day of surgery depending on your doctor’s orders.

Breathing and circulation exercises after your operation

The following exercises help prevent complications such as chest infections and blood clots in your legs. You should do these every hour that you are awake and while you are on bed rest.

Breathing exercises: take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.

Circulation exercises: firmly move your ankles up and down to stretch and contract your calf muscles.

Post-operative care

Consults:

• Your doctor will visit you throughout your hospital stay and will identify the day you will be discharged.
• Your physiotherapist will visit you daily, increasing your mobility to allow for your safe discharge home.

Emotional Support and Education

• If you or your family have any concerns or questions throughout your hospital stay, do not hesitate to talk with your nurse who can assist you or refer you to the pastoral care service.
• As you progress each day your doctor, nurse and/or physiotherapist will provide you with instructions regarding treatment, mobility and your ongoing care beyond discharge.

Tests and procedures

• Day one: you will have an s-ray to check the surgical results of the prosthesis. You will also have a pathology test to check the haemoglobin level of your blood.
• Throughout your hospital stay you may have blood tests to check the clotting level of your blood is safe.
• When you go home you will have scheduled blood tests via home visit through a pathology service to continue to monitor the clotting levels in your blood.

Observations

Your nurse will continue taking your vital signs (fore example, temperature, pulse, blood pressure etc); colour, warmth, sensation and pulses of your operated limb; wound and drain observations. As you recover, these become less frequent but remain regular until you leave hospital.

Treatments

Drains: your drain will remain in place for approximately 24 hours following your surgery. The removal of your drain will be dependent on the amount of drainage. This is regularly monitored and will be removed upon your doctors orders (usually day one following your surgery).

Wound: when your drain is removed your wound dressing is changed to a water proof dressing and then monitored daily. 

TEDs/Foot pump: TED stockings are to remain in place throughout your entire hospital stay. Nursing staff will conduct regular checks of your skin to ensure circulation is adequate. Stockings will be removed for showering and pressure care, then re-applied.

As you become more mobile the foot pump will be ceased.

Urinary catheter: on day one or two after your surgery you can expect your catheter to be removed. This will occur when you are able to sit out of bed and mobilise short distances.

Medications

• Day one: you will still be requiring your IV for fluids, antibiotics and pain control. Oxygen therapy will also continue. In preparation for stopping your IV pain control on day two, oral pain medication will commence today. You will also be administered a blood thinning injection assisting in the prevention of blood clots through out your hospital stay. Your surgeon may also choose to order other oral blood thinning medications as part of your treatment.
• Day two: today your IV fluids, pain control, antibiotics and oxygen will all be discontinued, however, your doctor may decide it necessary to leave the IV cannula in place. Your IV pain medication is now replaced by regular oral pain medication. Your nurse will check regularly on your pain control. It is important for you to inform your nurse if you are in pain.
• Day three to discharge: Your pain relief will be maintained using oral medication. It is important to take this medication regularly as ordered as this pain control will assist in your mobility and discharge. The blood thinning medication may continue after discharge. Your nurse will educate you or your carer on how to administer this medication.

Mobility:

• It is important to maintain your knee precautions while in bed, sitting in your chair and mobilising. 
• Knee precautions: avoid sitting in low chairs, squatting, jumping, running, high impact sports—NO pillow is to be placed under your operated knee.
• Exercises: While on bedrest remember to keep up your deep breathing and circulation exercises (pg13). It is also important to follow the exercises given to you by your physiotherapist.
• CPM—(this treatment is only provided upon the Doctor’s order): Continuous Passive Motion (CPM) is a postoperative treatment method that is designed to aid recovery after joint surgery. In most patients after extensive joint surgery, attempts at joint motion cause pain and as a result, the patient fails to move the joint. This allows the tissue around the joint to become stiff and form scar tissue, resulting in a joint which has limited range of motion and often may take months of physical therapy to recovery that motion. Passive range of motion means that the joint is moved without the patient's muscles being used. Continuous Passive Motion devices are machines that have been developed for patients to use after surgery.
• Day one: as soon as you are able you will be instructed how to move in and out of bed safely. Today, depending on your condition, you may be assisted to sit out of bed for 30 to 60 minutes and walk three to five metres with your physiotherapist and/or nurse. 
• Day two: the number of times you sit out of bed will increase and it is expected you will be walking 12 to 15 metres by a minimum of two walks today (assisted by physiotherapist and/r nursing staff).
• Day three: it is expected you will be walking as far as comfortable—a minimum of three walks today (assisted by physiotherapist or nursing staff). If confident and safe, you may be encouraged to begin independent short walks.
• Day four: you will continue increasing mobility independently.
• Day of discharge: You will be independently walking using crutches, and safely mobilising on stairs. you will be assisted by your physio and nurse to transfer to your car maintaining precautions.

Hygiene and elimination:

• Day one: today you will be assisted with a bed sponge. Your catheter will remain in place and a bedpan will be provided, should you need to use your bowels.
• Day two: your nurse or physiotherapist will help you to have your shower today. When your catheter is removed your urine will be measured to see if your bladder is emptying adequately. If you are having difficulty opening your bowels you may require to take some medication to assist with this. A bedpan can be used at night to avoid pain and discomfort with movement in and out of bed. 
• Day three to discharge: you will be gradually increasing independence by mobilising to the bathroom for showering and toileting needs. Assistance is provided as needed.
• Nutrition: you will continue your normal diet throughout your hospital stay.

Discharge planning:

Total knee replacement is an extensive procedure and it may take up to three months for you to regain full independence. It is expected you will achieve the following prior to discharge:

• Your observations are within normal limits.
• Your pain will be controlled on oral analgesia.
• Your wound will be clean and dry with no signs of redness/inflammation/no joint deformity noted.
• You will be tolerating normal/high fibre diet and fluids.
• You will be mobilising safely and independently with walking aids/transfers safely.

Your discharge planning will be progressive throughout your hospital stay. By the time you go home each of these aspects will be planned with you:

• The day you will be going home.
• Who will be taking you home.
• Care and support available at home.
• Equipment required to support your needs at home (dressings, crutches, shower chairs).
• What medications you will be taking and having an understanding of the instructions about them. 
• Instructions regarding follow-up care and appointments.
• Ongoing support services external to Mater can be arranged if needed after discharge. Please discuss this with your doctor or nurse.

What to expect:

• You will experience some swelling and bruising to operated area.
• In the initial period after your discharge you may experience some associated pain following exercising.

Looking after the wound

If your wound dressing has been removed before you go home then you can pat dry the wound with a clean towel following your shower. Remember to dry the wound before the rest of your body.

If you have a waterproof dressing in place, leave it on until the clips are to be removed. After this you can let clean water flow over the wound area.

Your staples will need to be removed by your GP or by your surgeon at your follow-up appointment. This is usually 12 to14 days after your operation.

The long-term success of your operation depends on what you do after leaving hospital.

Here are some tips to help with an optimal recovery:

What to do:

• Continue to take tablets for pain relief as required.
• Maintain a well-balanced diet as good nutrition is important to the healing process and can assist in preventing constipation.
• Continue to wear your compression stockings (TEDs)—if advised by the hospital.
• If you are undergoing dental or other procedures you need to check with your doctor about stopping anticoagulants. 
• Your daily exercise program as advised by your physiotherapist and continue regular walks.
• Applying cold packs to your knee for 20 minutes before and 20 minutes after exercising if advised by your physiotherapist.

What to avoid:

• Sitting in low chairs.
• Squatting, jumping, running, high impact sports.
• Driving for at least six-eight weeks (check with your surgeon).
• Heavy lifting or carrying for the first six weeks after your operation.

Managing stairs safely

Once you are walking safely the physiotherapist will teach you how to go up and down the stairs.

Going up:

• Step up with your good (non-operated) leg first.
• Then step up with your bad (operated) leg.
• Move the walking stick up last.

Going down:

• Place the walking stick down first.
• Then step down with your bad (operated) leg.
• Step down with your good (non-operated) leg.

Gardening

You can still do gardening after your operation but you will need to use long handled gardening tools. Please discuss this with your physiotherapist or occupational therapist.

Driving

You need to check with your surgeon before you start driving again. This will usually be more than six weeks after your surgery.

It is important as your insurance may not cover you if you are driving before recommended by your surgeon.

Work

Your doctor will be able to advise you when you can return to work. This will vary depending on how well you recover after the operation.

Contact your GP or attend your local emergency department if you experience any of the following after discharge: 

• fresh wound ooze
• fever (high temperature)
• increased swelling, redness or warmth around your wound
• your calf or thigh becomes swollen, red and warm to touc.
• a dramatic increase in pain.

For more information, contact: Mater Private Hospital Redland Reception via 07 3821 9444

Reference: Milliman CareGuidelines 1990 – 2010