Total Knee Replacement

The procedure is commonly performed to alleviate pain and restore mobility, particularly in cases of osteoarthritis and other conditions that affect the knee joint.

The information provided here details:

1. The National Treatment Centre
2. Preparing for your surgery
3. On the day of your surgery
4. Going home after your surgery
5. Frequently asked questions
6. Therapy advice

1. National Treatment Centre - Fife

The National Treatment Centre (NTC) in Victoria Hospital, Kirkcaldy is our centre supporting planned orthopaedic surgeries. The centre was opened in March 2023 and offers both inpatient and outpatient areas, and a 3-theatre surgical unit.

For more information visit our website:

www.nhsfife.org/services/hospitals-and-wards/hospitals/national-treatment-centre-fife-orthopaedics

The NTC ward is an Advanced Nurse Practitioner led unit. This means your care after your surgery will be managed by the Advanced Nurse Practitioner team, so you may not see your surgeon after surgery or prior to discharge.

The NTC offers a flexible visiting policy, with no set visiting times. It is, however, important to be aware that your visitors are likely to be excused during times of assessment or treatment by the ward team.

To comply with infection control policies, we ask visitors to respect the following:

• Use of hand gels on entering and exiting ward

• Avoid sitting on patients beds or chairs, there are seats provided for visitors

• No flowers permitted on ward

Returning home the same day as your surgery

Due to the NTC being staffed with a team of expert surgeons, anaesthetists, nurses and allied health professionals, many of you may not need to stay in hospital overnight, and will be ready to be discharged home on the same day as your surgery. This is the usual, and preferred, discharge pathway in many orthopaedic centres across the country.

Some patient, however, may not be ready for discharge on the same day as surgery and may need a little longer. We will only discharge you when you are recovered and the team is happy with your progress.

Recovery and expectations

It is important for you to remember that how much effort you put into the immediate phase after your surgery will determine the quality of your recovery. A successful outcome after a total hip replacement is dependent on how quickly you get your hip moving and how quickly you get walking.

It is also important for you to have realistic expectations about the period after your surgery. For example, you are having major surgery so you should expect to experience pain. You will be given pain relief medication, which should be taken regularly to ensure you are moving well enough (Figures 2 and 3).

2. Preparing for your surgery

Prepare ahead

After your surgery, you should expect to be returning home on the same day, or staying one night in hospital. Therefore, you should plan ahead and have a think about how to make things easier for yourself on your return home.

Arrange your transport

You should plan for your transport home from hospital as we are unable to do this for you. If you have any concerns about transport, please discuss this with a member of staff at pre-assessment clinic or contact your Consultant's Secretary directly.

Help for after your surgery

You are likely to have been living with quite significant joint pain for some time, and will already have figured out ways of managing things that are difficult at home. In the early stage, however, after your surgery you may also have difficulty with cooking, household tasks and shopping.

Prior to coming in for surgery, we would encourage you to arrange any help you think you might need after surgery. You may wish to have someone stay with you on the first few days after surgery; however, if you are going home on the same day as your surgery, it is essential that you have someone stay for the first night.

Prepare your home

• Try to complete heavier household tasks prior to coming into hospital

• Ask if someone can assist with more frequent household tasks, for example, vacuum cleaning, laundry, changing bed linen

• Set up online supermarket shopping or ask a relative/friend to help

• Prepare meals in advance that can be frozen or purchase easily cooked meals

• Place a stool or chair in your kitchen next to the work surface as you may be unable to carry your meals into another room for eating. Alternatively, use a flask or Tupperware for transporting hot food or drinks in a carrier bag

• You may find it easier to get your lower half dressed using equipment like a long handled shoe horn. Any equipment you feel may be beneficial should be purchased prior to coming into hospital

• Arrange common items you use regularly to be at an easily accessible height and close to hand

• Tend to any gardening prior to coming in, and arrange someone to help with your bin collection

• Arrange for a relative/friend to look after any loved ones or pets that you are responsible for
• Remove any rugs or obstacles that may get in the way of your walking

Improve your health before your surgery

The healthier you are before your surgery reduces the risk of any complications during or after surgery.

Nutrition

Eat a healthy, well balanced diet and stay well hydrated. You should aim to drink at least 1 to 2 litres of water a day on the weeks leading up to your surgery.

Smoking and Alcohol Consumption

You should use this surgery as an opportunity to stop smoking or excessive alcohol consumption. Smokers have been shown to be at increased risk of wound infection, poor healing, blood clots, early loosening of replacement implants and the need for earlier surgery to address complications.

Stay Active

The more active you are prior to your surgery, the quicker you will recover.

Pre-Assessment Clinic

The pre-assessment process is important for ensuring you are fit and well enough to undergo your surgery. It is also both an opportunity and essential for you to share any important information on your health and anything that will influence your post-operative care and discharge.

The pre-assessment staff will ask you a series of questions about any current or previous medical conditions, any previous surgeries and anaesthetics and medications that you are taking. You may have the following investigations:

• Examination of your heart and lungs

• Blood pressure and other vital signs

• Blood tests

• Electrocardiogram (ECG) - a tracing of your heart

• Infection control testing

Often you may require additional tests once the results of the above have been reviewed. The pre-assessment team will make you aware of any further testing required.

A green medication bag will be provided for you to bring your medications into hospital with you. Anything you may need to know about your medication will be discussed with you at pre-assessment, and documented on a sticker on this green bag.

Begin your exercises

The exercises in this booklet can be done before and after your surgery. By doing these exercises before your admission it will strengthen your muscles and help you to recover more quickly after surgery.

Contact from Ward Staff

A member of nursing staff from the ward will contact you approximately 5 days prior to your operation. They will ask you a few questions about your health and explain what to expect on the day of your surgery. This is an opportunity for you to ask any questions you may have.

You will be advised to telephone the NTC ward on the evening prior to your surgery date to ensure your surgery is still going ahead, and to get your fasting instructions.

NTC Ward Telephone Number: 01592 648010

Generally if your surgery is planned for the morning, you cannot have anything to eat from the midnight before your surgery date. If your surgery is planned for the afternoon, you may be allowed a light breakfast (for example, a bowl of cereal and toast). On the day of your surgery, you can continue to have sips of clear fluid (water) until you go to theatre.

What to bring to hospital

• All of your current medication, including the packaging

• Loose, comfortable day clothes to get changed into after your surgery. Your leg might be swollen after your surgery so ensure that your clothes can account for this

• Flat, sturdy footwear with a back in them, for example, trainers

• An overnight bag in case you are not ready for discharge home on the night of your surgery

• Glasses, hearing aids or walking aids that you use at home
  
  
• Portable music device or iPad with headphones

• Activities to keep you occupied on the ward, for example reading material, puzzles, etc.

3. On the day of your surgery

Arriving at the hospital

When you arrive at the NTC, please go to the Admissions Area on Level 1, via the lift or stairs. You will be greeted by a member of the team.

If the entrance door is looked, please use the intercom system on the wall to the right of the door to alert staff of your arrival.

Surgical Team

You will meet your surgeon again prior to your surgery. You will also meet the anaesthetist that will be present during your surgery. The advanced nurse practitioners and nursing staff will also be present to fill in your admission paperwork.

Consent Form

The surgical team will discuss the surgery that you are planned to have, and ask you to sign a consent form to ensure you are happy with this. They will then draw an arrow on your leg that is to be operated on.

Getting ready for your surgery

When it is time to make your way to theatre, you will get changed into a theatre gown and walk there with a staff member. You will then meet the rest of the surgical team to begin the operation.

You will have some equipment attached to you to monitor your oxygen levels, blood pressure, heart rate and breathing during your operation.

The anaesthetist will give you some medications through the drip in the back of your hand (cannula). This will include antibiotics, anti-sickness medication and fluids.

Anaesthetic

There are two types of anaesthetic that can be used for your surgery:

1. General Anaesthetic: This provides a controlled state of unconsciousness where you are unaware of anything and do not feel anything
2. Spinal Anaesthetic: This will numb you from the waist down for the duration of your operation. It is also possible to have sedation so you feel relaxed, and may even sleep during your operation.

The operation

Once you are in the operating theatre, your leg will be washed with a coloured cleaning solution and covered with drapes, so you will not be able to see your operation (if you have a spinal anaesthetic).

You may find it relaxing during your operation to listen to music, if you don't have your own earphones the theatre staff can provide you with some. Also, light sedation can make you unaware of your operation - if this is appropriate for you it will be discussed by your anaesthetist prior to your surgery.

The operation will last around 1 hour 30 minutes.

After your operation

After your operation you will be moved from the operating theatre to the recovery room where the nursing staff will monitor you for a short period. Once all your observations are stable you will be returned to the ward.

Return to the ward

Once returned to the ward, you will be offered something to eat and drink. It is important you try to eat and drink as soon as possible to give you energy to get up and mobilising once your anaesthetic has worn off. The nursing and therapy teams will guide you on getting out of bed, getting dressed and mobilising with appropriate aids within a few hours of returning after your operation.

As part of the therapy teams, you will meet a physiotherapist and occupational therapist after your surgery to guide you on your recovery and rehabilitation.

In order for you to be discharged from hospital, you need to meet the discharge criteria set by the ward team. These criteria can be met as early as a few hours after your surgery.

Everyone reaches their discharge criteria at different times, so it is difficult to determine this date prior to your admission to hospital.

4. Returning home after your surgery

Arrange for transport

When you have been advised that you are fit to be discharged, please arrange for someone to collect you from hospital.

Wound Care

Your wound will be covered by a waterproof dressing, so as soon as you feel able you can shower and allow this to get wet. This dressing should remain in place for 14 days until you are seen by a healthcare professional to assess your wound. There should be no need for you to change this dressing. Your wound is likely to remain tender for 2-3 weeks and it is important to keep an eye out for signs of infection:

• Fiery red

• Inflamed

• Hot to touch

• Unpleasant smell

• Fever

If you are worried that your wound has become infected or if your dressing is leaking, please contact:

NTC Single Point of Contact (SPOC) Number: 

01592 643355 ext. 22685

If your concerns are out with 08.00am to 19.30pm, please contact NHS 24 or the Accident and Emergency (A&E) Department.

If you have any concerns from 6 weeks after your surgery, please consult your GP.

Swelling and bruising 

It is normal to have swelling and bruising of the operated leg for a few weeks after your operation. Swelling will tend to get worse after periods of rest, e.g. sitting for a prolonged period, often getting up to walk will help this.

Pain relief

Knee replacement surgery is a painful operation - you should expect to be painful for a few weeks after your surgery.  It is vital, however, that you stay active and continue to do your exercises. You will be given a short supply of pain relief on discharge from hospital; however you will still experience some pain. You should not expect to be 100% pain free.

Other medications

You will also be required to take additional medication to reduce the potential for blood clots, and may also be given medication to reduce any feelings of nausea or vomiting that you may have. You will be given clear instructions about these medications by the ward staff before discharge.

Sleeping

It is common to experience issues with sleep after your surgery - this usually resolves with time. You are able to sleep on any position in bed, however may find it most convenient to sleep on your back.

Walking

You will be walking with two walking sticks when you are discharged home from hospital. There is no timeframe for the duration that you should use these walking sticks for, but you should try to wean from them as soon as possible. Initially you should begin to walk with one stick; this will be used on the opposite side to your operated leg.

Stop using your walking stick when you can walk as well without it as with it. Many people choose to bring a stick outdoors for a few months after surgery as they find their walking gets worse as they get tired.

Stairs

If you have stairs at home, you will have the opportunity to practice these with a member of staff before being discharged home.

As soon as you have gained enough flexibility and strength in your knee you will be able to walk up and down stairs normally (i.e. one leg past the other).

Exercise

You should continue the exercises given to you in hospital once at home to prevent your operated knee becoming stiff and to improve your muscle strength. In turn this will help you progress off your walking sticks more quickly.

If you find your exercises are no longer challenging, please progress to the more advanced exercises at the back of the booklet.

Frequently asked questions

Why have I got swelling?

Healing tissues will be more swollen than normal tissues, and this swelling can last for several months. Swelling into the rest of the leg can also be normal.

Continue your ankle exercises and try to put equal weight through each leg and “push off” from your toes when you walk.

Why do I get pain lower down my leg?

The tissues take time to settle and referred pain into the shin or behind the knee is quite common. The way you walk after surgery will also be altered and this can cause discomfort in other joints for a short time.

Why do I stiffen up?

You may notice that whilst up and moving you feel quite mobile. Sitting down for a period of time can increase the swelling and stiffness in your knee. To help this it is important to walk short distances every hour and regularly complete your exercises.

I have a numb patch – is that ok?

Numbness around the incision is due to small, superficial (close to the skin) nerves being affected by the surgery. The patch usually gets smaller but a small amount of numbness may remain.

Why does my joint click or clunk?

This can be normal and it is usually a sign that the swollen tissues are moving over each other differently than before your surgery. This should not worry you, as it should improve as your knee continues to heal.

How long should I continue my exercises for?

Your exercises are very important to ensure your knee joint achieves its optimal movement and that strength returns to your muscles after surgery. They should be completed frequently throughout the day and continued for at least 3 months after surgery.

How far should I walk?

This depends on how fit you are and what your home situation is. Start by walking no further than the length of two houses in your street and back, then build this up gradually. You should feel tired when you get home but not exhausted.

When can I drive?

You can return to driving when you can safely and comfortably control your vehicle. You need to inform your insurance company of your recent surgery.

Can I go swimming?

You can go to a pool with steps as soon as your wound heals. You can do gentle exercises and walking in the water. More serious swimming can be started after three months. You can do breast stroke if it feels comfortable, but start off gently.

When can I go on a flight?

This will vary dependent on each surgery. For advice on this you should ask your orthopaedic consultant either pre- or post-surgery.

When will I get better?

It can take up to 12 months to get the full benefit from your knee replacement. As you get better it is important to do everyday activities as these help to improve muscle control and movement – it is important to get back to an active lifestyle.

6. Knee exercises to start

You should begin and practice these knee exercises prior to admission for your surgery. After your surgery, you should aim to complete these exercises 3 to 4 times per day.

Initial Exercises

You should begin with the following gentler exercises first.

Exercises More Advanced

After 1 to 2 weeks (this, however, can vary from person to person), you can progress onto these more advanced exercises below. You should be able to manage the above initial exercises with your pain well controlled before progressing to these exercises.

Worries or concerns

If you have any worries or concerns after discharge, please contact:

Orthopaedic NTC Single Point of Contact (SPOC) Number:

01592 643355 ext. 22685

If you have emergency concerns that are out with 08.00am to 19.30pm and cannot wait, please contact NHS 24 or attend the Accident and Emergency (A&E) Department. For non urgent issues contact the SPOC telephone the next morning above.

If you have any concerns after your first post-operative orthopaedic outpatient clinic review appointment, please consult your General Practitioner (GP).

Feedback

We value your feedback about your patient journey. If you wish to make a complaint, or a compliment, please email:

Fife.patientexperience@nhs.scot

Alternatively, you can contact:

Telephone: 01592 648153

Or you can write to:

Patient Experience Team
Victoria Hospital Mailroom
Victoria Hospital
Hayfield Road
Kirkcaldy
KY2 5AH

We are always looking for ways to improve our service and use Care Opinion for service user feedback, please visit the Care Opinion website at:

www.careopinion.org.uk