If you require any further information or have specific questions about any aspects of your care, before or after your operation, contact:
Ward 10 (Elective Orthopaedics) - 01592 648010
Physiotherapy - 01592 643355 ext 21105
' �,a• -I Fife
Occupational Therapy - 01592 643355 ext 2_1186
If you have any problems with your wound contact Ward 10 on 01592 648010
Total Knee Replacement
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issue No. Date of Issue:
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Physiotherapy Orthopaedic Department
Victoria Hos ital Kirkcald
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Lying on your back in bed place a rolled up towel under your operated leg.
Push the back of your knee onto the towel and lift your he�I off the bed.
Hold for 5 seconds Repeat 10 times
Lying on your back in bed with your operated leg straight and your leg bent.
Exercise your operated leg by pulling your toes up, push your knee down onto the bed and lift the leg up off the bed.
Hold for 5 seconds Repeat 10 times
Sit or lie with your operated leg out in front of you in bed. Put your heel on a rolled up towel so you are stretching the back of your knee.
with all the relevant information to prepare you for your upcoming joint replacement and can be used to guide your recovery after your surgery
Hold for 30 seconds Repeat 10 times
Sitting in your chair.
Pull your toes up, lift your leg off the floor to straighten your knee.
Hold for 5 seconds Repeat 10 times
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We strongly encourage .you to begin these exercises prior to admission for your surgery, as pain allows. After your surgery, you should complete these exercises frequently throughout the day - three or four times daily
What is Enhanced Recovery After Surgery (ERAS)?
The Fife Orthopaedic Unit (Ward 10) is now operating a "short stay admission" in keeping with ERAS and discharge home as soon as possible.
The aim of ERAS is to get you back to your full health as quickly as
Lying on your back in bed or in sitting. Bend and straighten your ankles briskly.
Do this exercise for 30 seconds every half hour when you are resting in bed. This will improve the circulation of blood in your lower leqs.
Lying on your back in bed with legs straight.
Pull your feet up towards you. Push your knees firmly against the bed until you feel your thigh muscles tighten.
Hold for 5-10 seconds Repeat 10 times
Lying on your back in bed with sliding board under your leg.
Bend and straighten your hip and knee by sliding y'our foot up and down the board.
Repeat 10 times
possible after your surgery, the quicker you are up out of bed and resuming normal activities the better. This will lead to less complications and get you back home sooner.
Prior to Hospital Admission
Healthy steps to improve your recovery before your operation:
·Food & Drink
- Eat a healthy diet and have frequent drinks. You should aim to drink 1 - 5 litres of water a day on the weeks leading up to your surgery.
- Stay physically active prior to your admission to hospital. This will help you get back on your feet quicker after your surgery.
Smoking & Alcohol
- If you do drink or smoke, use this as an opportunity to stop or cut down. This will help your recovery and reduce the risk of
Please contact ward 10 on telephone no. 01592 648010:
- Evening prior to admission (between 6pm and 8pm) for fasting instructions
- Mornin_g of admission for bed availability
Generally, if your surgery is planned for the morning you cannot have anything to eat from midnight the night before.
However, if your surgery is planned for afternoon you may be allowed a light breakfast.
It is important to keep drinking fluids and the nursing staff will advise you when to stop this. It is beneficial to have a bottle of water with you to drink on the way to hospital.
Please bring all your regular medication into hospital with you in the containers provided by the chemist (including tablets, inhalers, creams, lotions and sprays) - this is so we can use your own medication during your stay, with your permission. Please note that Nomads and Dosette boxes cannot be used. On discharge from hospital you will be given a 7:-day supply of medication that you will require for home.
You will be able to dress in day clothes from the morning after your surgery. Please bring in comfortable, loose-fitting clothes as well as loose-fitting night clothing. It is useful to have slippers with backs in them for good support when walking. A larger size than usual if being bought new as your feet and ankles may swell after your surgery. During the day, if preferred you may wear your shoes which should be well fitting with low heels.
If possible, please bring in toiletries to use for the duration of your stay (soap, flannel and shower cap, if you wish). Hand wipes can be
. beneficial for use until you are walking to/from the toilet.
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 been completed frequently throughout the day and continued for at least 3 months after surgery.
- If your new joint fails to gain it's full movement, you may require further surgery to improve this (which at times can be available with exercises).
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.
Can I go swimming?
- You can go to a pool with .steps as soon as your wound 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 will I get better?
- It can take up to 12 months to get the full benefit from you 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. Sports such as golf, cycling, swimming and walking are Other acceptable activities include bowling and dancing. Avoid activities that cause high impact on your joints such as running, jumping or very heavy jobs.
Frequently asked questions
Why have I still got swelling and bruising?
- It is normal for the knee to be swollen and inflamed for several weeks to months as it heals.
- Swelling into the rest of the leg can. also be If you do not put full weight onto the leg, your calf muscle will'not work
as a pump to get rid of the fluid.
What can I do about it?
- Continue your ankle exercises (Exercise 1) to encourage your calf muscle to pump away the fluid.
- Try to put equal weight through each leg and "push off' from your toes when you walk.
Why do I stiffen up?
- Sitting down for a period of time can increas� the swelling and stiffness in your 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 The patch usually gets smaller but a small amount of numbness may remain.
Why does my joint click or clunk?
- This can be nor,:nal and it is usually a sign that the swollen tissues are moving over each other differently than before your This should not worry you, as it should improve as your knee continues to heal.
If there are any changes to your health or fitness prior to admission to hospital please inform your Consultant's Secretary as soon as possible. This wjll include any change in medications or hospital admissions.
Admission to Hospital
On admission, a nurse will check that· all your pre-assessment information is correct. If there has been any change to your health or medication since then, please inform your nurse. The nurse will also assess your general heath by monitoring your blood pressure, pulse rate and breathing rate. The staff will also discuss any medicines, inhalers and/or herbal medicines that you use. Any allergies that you have will also be recorded.
You will meet your consultant again who will answer any questions you may have.
You wil_l meet your anaesthetist who will discuss the type of anaesthetic which you will have:
Spinal Anaesthetic: This will numb you from the waist down for approximately 4 hours. It is also possible to have sedation so you feel relaxed, and may sleep during your surgery.
General Anaesthetic: This produces a controlled state of unconsciousness during which you feel or sense nothing.
Following Your Surgery
In the Recovery Room
After your surgery, you_ will be transferred to the recovery room.
The recovery nurse will monitor your blood pressure, heart rate and breathing regularly. You will be given fluids via a drip and will be on oxygen via a facemask.
The nurse will regularly assess your pain score. You will be given regular pain medication in relation to this. Anti-nausea medication will al�o be given if you require it.
If you received a spinal anaesthetic, your legs will be numb for a lengthened period following your surgery.
Return to the Ward after Surgery
You will be closely monitored by the nursing staff on return to the ward. Your blood pressure, heart rate, breathing and pain score will continue to be monitored.
As your anaesthetic wears off, you will begin to experience pain in the operated knee. You will be prescribed pain medication, and are encouraged to ask for this as required. You will also receive anti coagulant medication to help prevent blood clots.
You will be encouraged to drink plenty of water and have something light to eat (e.g. tea & toast).
You will be encouraged to begin your physiotherapy exercises once able (page 14 & 15). And you will be assisted out of bed and practise walking with the physiotherapy or nursing staff. Your aim should be to sit out in your chair, and walk to the toilet if able.
Continuing Care after your Surgery
On the day following your surgery you will have blood samples taken and will be reviewed by the Advanced Nurse Practitioner to assess your body's recovery following your operation.
It is normal to have an X-Ray of your operated knee the day following youi- surgery which will be reviewed by your consultant. However you are able to get up and moving before this has taken place.
The physiotherapist will speak to you prior to discharge to discuss if you need referred to recei�e further treatment once at home.
Things to look out for at home:
Please seek medical advice from your GP if:
- You . experience worsening pain and swelling in the calf muscle of the operated leg, along with redness and heat from the muscle.
You would require a home visit as will be unable to travel to the GP surgery if this is the case
- You experience increasing pain around your knee joint and difficulty bearing weight (however it can be normal to experience increasing knee pain as you begin to progress your mobility)
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front of the thigh. In turn this will help you progress off your walking sticks more quickly.
What are you aiming for?
- A straight knee
- A strong knee
- A good knee bend
You will be shown the correct technique for using stairs prior to discharge from hospital, if this is relevant to you.
As soon as you have gained enough bend and strength in your knee you will be able to walk up and down stairs normally.
Non-operated leg Operated leg Stick
Stick Operated leg
You should expect to experience increased pain in the operated knee on the days following your surgery. Taking regular pain relief is advised.· Along with this pain relief, continuing your exercises and getting walking will help reduce your pain.
You will be seen by both a member of the physiotherapy and occupational therapy teams to review:
- Bed, chair and toilet transfers
- Walking with appropriate walking aid
- Stair practice
Discharge planning from hospital begins as soon as possible, and is determined by:
- When you are medically fit - when medical & nursing staff are happy with your condition.
- When you have achieved your physiotherapy and occupational therapy goals for home.
Discharge Home from Hospital
When you are discharged home from hospital, the nursing staff will ensure you have the following:
- Your routine and any additional medications (i.e. pain medication, anti-coagulants), along with instructions for their
- A copy of your discharge letter with advice about wound care and removal of wound clips, if appropriate (an electronic copy of your discharge letter will be sent to your GP).
Routinely your surgeon will apply a dressing to the wound with instructions to leave it in place for 14 days after your operation. There should be no need to change this dressing.
Your wound is likely to be tender for 2-3 weeks, but do look for signs of inflammation or leaking - fiery red, painful and hot around the area of the wound.
If you are concerned, use the wound care- card given at pre assessment to contact the hospital.
- Arrange your transport for getting you home - hospital transport is only for people who meet specific eligibility
- Make sure you have all your belongings leaving hospital - we strongly encourage that you do not bring valuables to
- Make sure you have suitable clothing and footwear at home if you are not already using. them in hospital.
- Make sure you have access to your house
- Make sure you have a supply of food and drink at home, and if necessary ask someone to turn on your heating.
- Please let us know in advance if you require a medical
Once at Home
- Follow advice from medical and nursing staff
- Take regular pain relief
- Do something every hour
- Regular walks
- Regular exercises
- Eat and drink regularly
- Complete your personal goals
When leaving hospital you will be walking with 2 sticks. Oyer the· following weeks (when you feel able) you can begin to walk with 1 stick. This will be used on the opposite side to your operated knee.
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 limp gets worse as they get tired.
When you sit down, bend your knee. Sit straight in your chair with your knees bent. Do not sit with your knees at an awkward angle which you may have done before your operation.
You should continue the exercises given once at home to prevent your operated knee becoming stiff and to improve the muscles at the
NHS Fife provides a range of ways in which you can communicate with us. You can use our website with its accessible functions, these will help you find and understand the information you need. You can also find a variety of translated materials in community languages and in British Sign Language.
If you require interpreting services, you can contact us by emailing fife.EqualityandHumanRights@nhs.scot, by calling 01592 729130, or using the NHS Fife SMS text service on 07805800005 which is available for people who have a hearing or speech impairment.