Contents Page
Enhanced Recovery .......................................................................................4
Pre-Admission Discharge Planning ..............................................................5
Pre-operative Assessment ............................................................................6
What is a Knee Replacement? .....................................................................7
Alternative Treatments..................................................................................7
Benefits of Surgery .......................................................................................7
Risks and Complications of Surgery and Knee Replacement .....................8
Pre-op Exercises 9 The Day of Surgery .......................................................11
The Operation .............................................................................................11
After the Operation ....................................................................................12
Pain Relief ....................................................................................................12
Post Op Exercises ..........................................................................................13
Mobility .........................................................................................................16
Stairs ..............................................................................................................17
Daily Expected Post Op Goals and Achievements ......................................18
Getting Ready for Home ..............................................................................19
Medication ....................................................................................................19
Wound Care ..................................................................................................19
Once at Home ...............................................................................................20
Out Patient Appointments ...........................................................................21
Patient Agreement to Treatment ................................................................25
Further Information .....................................................................................27
Contact Information .....................................................................................27
Enhanced Recovery;
At Blackpool Teaching Hospitals NHS Foundation Trust we aim to provide high standards of care based on current recommendations and protocols. Enhanced Recovery After Surgery (ERAS) is part of this and ensures that all members of the hospital and primary care staff work together to improve the patient experience throughout their stay in hospital. Recent research has recognized that patients who are maintaining a healthy lifestyle before surgery recover much better after surgery.
By identifying any problems after surgery early such as pain control or post operative nausea and vomiting we can ensure that patients are able to move around early after surgery, take on the necessary calories needed to recover and therefore ensure a timely discharge from hospital.
What Enhanced Recovery Means for You
- Taking an active role in your recovery – following the advice of the clinical team. • Being positive about your recovery.
- Starting normal activities eg, eating, drinking, toileting, walking (with supervision initially), as soon as possible after surgery.
- Making sure that before you come into hospital for your surgery, that you have organised any help that you will need at home after you are discharged home.
- Being aware of your discharge date prior to coming in for surgery.
- Knowing your estimated length of stay. This will be two days following your surgery, in some cases patients can go home the following day if they manage to move around the ward independently on crutches.
Patients who actively participate in their recovery;
• Feel better, sooner.
• Leave hospital sooner.
• Return to normal living sooner.
• Ensure you have help in place ready for discharge and relatives / friends are aware of the estimated date of discharge.
• Ensure that you follow a healthy diet on the weeks prior to your surgery in order to prepare your body for surgery and aid with recovery.
• Bring loose fitting clothes, you will be encouraged to move around the ward within 24 hours, often on the day of your surgery. You will also be encouraged to walk on the first day after your surgery (depending on your consultants advice).
• It is important to look after yourself before coming in for surgery. This includes keeping your skin clean and dry and reporting any rashes or breaks in your skin a week prior to coming in for surgery to the Orthopaedic Nurse Practitioner (the telephone number can be found in the contact information at the end of this booklet).
• You need to complete your exercise programme as recommended.
We would expect you to stay in hospital for 2 days following your surgery. Prior to coming into hospital you need to think carefully about any adaptations to your lifestyle or possible assistance that you may require when you return home. These could be such things as;
• Preparing meals in advance, to keep ready in the freezer.
• Using microwaveable pre prepared meals.
• Having plenty of supplies in store including long life milk for emergencies.
• Internet shopping.
• Recruiting friends and family to help with shopping/housework/looking after pets.
• Removal of any clutter that may impede you walking with walking aids.
• Removing any loose rugs, that you could catch with your walking aids.
• Plan your transport to and from the hospital. It is important to eat and drink before surgery.
Please make sure you eat a good meal the evening before surgery and have a light supper at 10pm before you go to bed. If you are on the afternoon list you will be able to eat breakfast on the day of surgery. You will be told if you are able to eat breakfast. You will be able to drink water on the day of surgery up until the time you are admitted. Once at the hospital the preadmission nurses will tell you when you need to stop drinking
To ensure a safe and timely discharge home, we will ensure that:
• Your blood count (HB) is checked to see that it is at an acceptable level.
• You can walk independently with walking aids.
• You are able to walk up and down steps (where applicable).
• Your pain relief is sufficient.
• A routine check x-ray of your knee has been performed.
Pre-operative Assessment
In preparation for surgery, you will be asked to attend a pre-operative assessment clinic where blood tests, x-rays, infection screening and a check of your general health may be performed by the health care team. If you have a long term illness, heart, lung or a metabolic (diabetes, thyroid) condition, a consultant anaesthetist may see you in an anaesthetic clinic to make sure you are medically fit for an anaesthetic.
The anaesthetist will discuss with you the different types of anaesthesia and pain management methods available to you. It may be necessary for you to be seen by a specialist if you have a more serious health problem. If you are not considered fit for anaesthetic and surgery your operation will be cancelled. You will receive an out-patient department appointment with your consultant surgeon who will discuss alternative treatment options.
This may include the following:
- medication.
- injection.
- physiotherapy.
- an appliance.
- arthroscopy (key hole surgery)
It is important that you inform the nursing staff if you take any form of medication. If you are on blood thinning tablets e.g. aspirin, warfarin, clopidogrel or dipyridamole please inform the nursing staff as you may have to stop taking this medication before the operation. This would only be under the direction of a doctor or nurse practitioner.
It is also important to let the staff know if you have ever experienced any problems such as allergies or stomach upsets, when you have previously taken pain relief. You should also advise the pre op staff if you are already taking regular pain relief. In some cases, you will need to have some investigations repeated 1-2 days prior to your surgery. The pre op nurses will provide you with the necessary completed forms if this is the case.
If you need to have a repeat blood test, you will need to attend the Pathology Lab with your completed blood test form. The Pathology Lab is open between the hours of 8.30am and 4.30 pm Monday to Friday and is located at the far end of the main hospital corridor in the older part of the hospital.
If you need to have a repeat X ray, you will need to attend X ray North with your completed X ray card. X ray North is open between the hours of 8.30am and 4.30 pm Monday to Friday. X ray North is located near to Orange Reception, where you will have been on another occasion to visit the Orthopaedic doctors.
Following your x ray, you may be given a blue slip. Please discard this and DO NOT attend the Outpatient Department as stated on the blue slip. The blue slip is routinely handed out to all patients after their X ray to advise the clinic staff that they have had their X ray, however you are NOT attending clinic that day, therefore please discard the blue slip.
What is a Knee Replacement?
A knee replacement is an operation to replace a worn or damaged knee joint. Knee replacements are performed usually because you are suffering pain and movement difficulties.
A knee prosthesis (artificial joint) is made from metal, plastic, ceramic or a combination of these materials, and can last 10 to 15 years. However, over time the prosthesis may become worn and loose and a replacement (revision) of the knee may be required.
The operation is advised for the relief of knee pain, caused by arthritis. It is a major operation with risks attached, it should only be undertaken if your tablets are not controlling your pain and severely affecting your lifestyle.
Initially your doctor may suggest changes to improve symptoms e.g. weight loss if necessary, physiotherapy and exercise to reduce stiffness, and the use of walking aids. If these treatment options do not improve pain and imobility, a partial (unicondylar) or a knee replacement operation may be advised. Your doctor will discuss treatment options with you. If you are unsure of your treatment please discuss this with a member of the health care team.
Provided that you work hard with your exercise programme before and after your operation, you can expect to improve significantly the quality of your life, reduce your pain, improve your mobility and benefit from your new knee replacement.
Risks/complications of surgery and total knee replacement
All surgery and anaesthetics carry some risks, particularly if you have other medical problems or are overweight. The healthcare team looking after you have been trained to make sure that these are minimised and your treatment is carried out safely. There are, however, some specific risks relating to knee surgery that you need to be aware of:
- Infection – sometimes despite the strictest precautions, infections can occur. Superficial infection may occur at your wound site.
- Deep infections – may occur early after the operation or much later. For this reason we recommend any infection that you develop in any part of your body is treated promptly and that you tell your Dentist when you see them that you have had a knee replacement.
- Deep vein thrombosis (DVT) – despite taking precautions to try and prevent a blood clot (a thrombosis) forming in the veins of your leg after surgery, this still remains one of the commonest risks after knee replacements. Occasionally these clots can dislodge and travel through the heart to the lungs. This is known as a pulmonary embolism.
- Very rarely even death can occur.
- Loosening of the prosthesis (new joint) – this is a risk of all artificial joints and is caused by a weakening of the bond between the new joint and your bone. It is hoped that your new knee will last at least 10-15 years, but it may loosen before this time, particularly if you are overweight or damage the joint by falling on it or return to heavy employment. If it does loosen then it is usually possible to remove it and replace it with another one although this is a more complicated operation with greater risks.
- Persistent pain – the operation may not relieve all of your pain and you may continue to experience some mild discomfort. Complex regional pain syndrome, while uncommon, may be the cause of pain, swelling, stiffness and skin changes.
- Nerve damage – very occasionally nerves can be damaged or stretched during your operation. This usually recovers over a period of time.
- Persistent knee stiffness – sometimes despite your exercises your knee joint may become very stiff. This seems to be due to excessive scar tissue forming around and within your joint. Sometimes this is helped by a further operation to manipulate your joint. It is very important that you do your exercises regularly after your operation.
- Other recognised risks of knee surgery include bone fracture, bruising, urinary retention and the risks associated with anaesthesia and blood transfusion
Pre Op Exercises;
In the weeks before your operation, it is important that you maintain the mobility of your knee joint and the soft tissues around it. You also need to strengthen the muscles around the knee. By strengthening the muscles around the knee, you will help to support your new joint, improve your posture and walking pattern, as well as greatly aiding your progress after your operation.
A member of the Pre Op Physiotherapy, ‘Homeward’ team will arrange to visit you at home prior to your surgery to assess your mobility and to give you some pre op exercises to start doing. Start these exercises as soon as you have been given this booklet. You should not feel too much pain or discomfort with them.
Please do all of the exercises on BOTH legs
Exercise 1
Lie on your back or sit up with your legs out straight in front of you on your bed. Bend your ankle up and push your knee down firmly against the bed. Hold for 5 seconds. Repeat 6 times, 3 times a day
Please do all exercises on BOTH legs
Exercise 2
Lie on your back, or sit up with your legs out straight on your bed. Exercise your knee by pulling your toes up, straighten your knee and lift your leg 10cm off the bed. Hold for approx 5 seconds, then slowly relax. Repeat 6 times, 3 times a day. Increase to more than 10 repetitions each time if you are able.
Please do all exercises on BOTH legs
Exercise 3
Sit or lie as shown. Put a rolled up towel or block under your knee. Exercise your knee by pulling your foot up, tightening your thigh muscle and straightening your knee. (Keep the back of of your knee on the towel or block). To make the exercise harder put a small weight on your ankle. Hold for 5 seconds. Slowly release. Repeat 6 times, 3 times a day. Increase to 10 or more repetitions, as it feels easier.
Please do all exercises on BOTH legs
Exercise 4
Sit on a chair. Pull your toes up, tighten the front of your thigh muscle and straighten your knee slowly. Hold for approx 5 seconds. Slowly release. To make the exercise harder put a small weight on your ankle. Repeat 6 times, 3 times a day. Increase to 10 repetitions each time if you are able.
Please do all exercises on BOTH legs
Exercise 5
Sit on a chair with your feet flat on the floor. Slowly bend your knee as much as possible. Hold for 5 seconds. Then straighten your knee as fully as you can. Repeat 6 times, 3 times a day. Increase to 10 repetitions each time if you are able.
Please do all exercises on BOTH legs
Exercise 6
Lie on your back or sit semi reclined on your bed with a plastic board/bag under your leg. Bend and straighten your hip and knee, as much as you can, by sliding your foot up and down the board. Repeat 6 times, 3 times a day. Increase to 10 repetitions each time if you are able. If you wear a sock, your foot will slide easier and the sock will help to protect your heel from any soreness.
The Day of Surgery
It is usual for you to be admitted, to the surgical admissions unit on the day of your surgery. You will be sent further information regarding the time to come into hospital and which unit to attend nearer to the time. Most people get out of bed on the day of surgery and sit in a chair. The first day after surgery we would expect you to be up and mobilising on the ward.
The orthopaedic ward has both male and female patients, in order to protect patient dignity we encourage everyone to dress in day clothes rather than night wear. You will need to bring some loose fitting clothes that you feel comfortable to mobilise in. The nurses will need to see your wound so trousers need to be loose fitting to enable access.
Please ensure you bring suitable footwear to wear after your operation. This needs to be:
- Flat.
- Supportive.
- With a back/heel strap to it. Not backless.
- A reasonable fit even if there is some swelling in your foot.
Please DO NOT bring in new slippers, if your foot is swollen you will not be able to wear these.
You also need to remember to bring into hospital;
- This booklet – as you will need it in order to be able to follow your post op exercises and advice.
- Your green bag with your medications - the pre op nurses will have given you this.
- Your completed PROMS form, which the pre op nurses will have given you too.
See also the supplementary booklet, ‘Coming into Hospital for an Operation’.
On the morning of your operation please take a shower/bath before coming in to hospital. When you are admitted to hospital, members of the health care team will prepare you for theatre. The limb to be operated on will be marked before the operation. A member of the health care team will escort you to the operating theatre.
You will spend a short time in the recovery area of the operating theatres before you are taken to the ward. You will be offered drinks in the recovery area and you should be able to eat and drink normally when you go to the ward. You will have a cannula in your hand which will be used to give you some antibiotics after the operation which help to reduce the risk of post operative infections. Some discomfort will be experienced following the operation so pain relief medication will be given to help ease the discomfort. You may have an intravenous drip in your hand to give you fluids and antibiotics after the operation. An antibiotic is given before the operation and sometimes for 24 hours after the operation to help reduce the risk of post-operative infection. The drip will be removed 24 to 48 hours after surgery.
All operations which involve cutting the skin or muscle result in some pain. We work very hard to reduce the amount of discomfort that you will feel after any procedure. It is rare to be able to completely remove all postoperative pain but we strive to reduce it to a level that is easily bearable. We have a number of methods of achieving this, together with a team of specialist staff whose role it is to help in the management of acute pain should it be needed. An operation will inevitably result in some pain, however, pain can be a very different experience in every person and the best way to treat it can be different as well. What you experience may not be the same as your family or friends.
The different types of pain relief include:
- Tablets or syrup/liquid You will need to be able to drink and not feel sick before taking these pain relief medicines. They may take 30-45 minutes to work and it is important that you take the medication before the pain becomes too bad.
- Injections These can be used if you are not eating and drinking properly. They are given either into your drip or through a small needle just under the skin in your arm or thigh. These usually take 20 minutes to work.
- Local anaesthesia A one off dose of local anaesthetic medicine as an injection may be given in the anaesthetic room before the operation starts, it may be done whilst you are awake or asleep. This will be discussed with you by the anaesthetist prior to the operation. It will numb the area which is being operated on and will stay numb for a few hours after the operation ends. Other forms of pain relief described above will be used in addition to the local anaesthetic medication
Post-operative exercises ;
It is essential that you commence the following exercises as soon as you can after your operation. These exercises replace the previous exercises that you were doing before your operation.
Exercise 1
After your operation it is very important that whilst you are not as mobile as usual, that you do deep breathing exercises, to try to prevent the occurrence of any chest infections. You can start this exercise yourself after your operation.
Sit upright in bed or your chair. Take a normal breath in through your nose, allowing the air to flow to the bottom of your lungs, so that your abdomen rises slightly on inhalation. Breathe out through your mouth. Repeat 5 times.
Follow this with 3 deep breaths, allowing your lungs to fully expand to their maximum capacity. If you hear any secretions in your chest or throat, when doing your deep breaths then try to cough them up. Repeat another 2 times. Do for 10 seconds every hour. Continue this exercise daily until you are up and about as normal and your chest is normal ‘for you’.
Please do this exercise on BOTH legs
Exercise 2
Start this exercise yourself, as soon as you can after your surgery. This exercise is very important as it can reduce your risk of getting a DVT. (Deep vein thrombosis). Lie on your back or sit on your bed or chair.
Slowly move your toes and ankles away from you so that you are pointing your toes, then pull your toes and ankles up towards you – as far as you can. Moving your ankles up and down like this is more effective at preventing a DVT than moving ankles round in circles. Do for 10 seconds every hour.
Please do this exercise on BOTH legs
Exercise 3
You can start this exercise yourself straight after your operation. Lie on your back or sit up with your legs out straight in front of you on your bed. Bend your ankle up and push your operated knee down firmly against the bed. Hold for 5 seconds. Repeat 4 times, slowly every hour.
Exercise 4
This exercise is important as it helps to provide support to your new knee by strengthening your quadriceps (at the front of your thigh) muscles. Lie on your back, or sit up with your legs out straight. Exercise your operated knee by pulling your toes up, straighten your knee and lift your leg 10cm off the bed. Hold for approx 5 seconds, then slowly relax. Repeat 2 times, every hour, until you can easily do this and then reduce to 2 every other hour.
Exercise 5
This exercise is very important as you need to ensure that your operated knee can go as straight as possible, to support you whilst you are walking. Lie on your back, or sit up on your bed, with your legs out straight in front of you. Place a rolled up towel or an exercise block under your ankle.
Relax your operated leg and try to allow the back of your knee to rest on the bed. Rest in this position for 2 - 3 minutes every hour. It will be quite uncomfortable, but getting a straight knee will help to prevent it from giving way whilst you are walking
Exercise 6
This exercise is important as it helps to get your operated knee moving after your operation. During your operation, your knee will have been in a flexed, (bent) position throughout most of the procedure. The surgeon will have checked that your knee does fully bend and straighten before the end of your operation.
You now need to work hard to ensure that you can fully bend your knee yourself. Sit with the heel of your operated leg on a plastic or wooden board or plastic bag. If you wear a sock, your foot will slide easier and the sock will help to protect your heel from any soreness. Bend your knee as far as you can, by sliding your foot towards your bottom, along the slippery surface.
When you cannot bend your knee any further with your muscles, place your hands under your thigh to assist you to bend your knee further. Hold your knee at the peak of the bend for a couple of seconds. This will feel painful.
Take your hands away and slowly straighten your knee. Repeat 6 times, slowly every 4 hours. Remove the board immediately after completing the exercises. This exercise will be very painful. It will be less painful if you try to relax as much as possible whilst trying to bend your knee.
Please do this exercise on BOTH legs
Exercise 7
From the SECOND day after your operation, you can practice this exercise whilst you are sitting in your chair. Pull your toes up, tighten the front of your thigh muscle on the operated leg and straighten your knee slowly. Hold for approx 5 seconds. Slowly release.
Repeat 6 times, every 4 hours. When you are sat in your chair, you MUST ensure that your operated leg is placed up on a stool, fully straight at all times, unless you are doing these exercises. Elevation will help to ease the swelling, which will make your exercises more difficult and could delay wound healing.
Exercise 8
You should also make sure that you massage your knee and thigh firmly in an upwards direction for a few minutes every hour. Do not massage directly over your dressing.
Mobility
If you normally use a stick/walking frame/elbow-crutches, please bring these with you to hospital as this will allow the physiotherapist to check them for safety and possible use after surgery. You will be assessed by the physiotherapist or physiotherapy assistant for a suitable aid to use after your surgery. This will normally be elbow-crutches and you will be provided with these.
As a general rule you will be allowed to walk on the day after your operation. Some patients will be able to get up out of bed to stand on the day of their operation. The staff will do this with you. Do not worry if this is not the case for you. You will be told as soon as possible when you will be able to get up. Do not attempt to get up after your surgery without the assistance of the staff.
At first, the physiotherapy team or nurses will help you to get yourself out of bed. You will be instructed on the use of crutches/walking aid and the correct way to walk. Once assessed by the physiotherapy team, you should then be able to walk as frequently as possible with the staff. The aim is to help you regain your independence with the crutches/walking aid as quickly as possible, allowing you to walk with minimum supervision or independently as soon as you are able to do so.
The staff will tell you when you are safe to walk on your own. However, it is important to understand that you are all individuals and that the appropriate amount of help is given to you. ‘Little and often’ in walking and changing position is important. If your walking distance has been limited, it is best to gradually increase your distance and speed. Try to have a little walk every hour or so during the day.
Do NOT walk on your own until you have been advised that you are safe to do so, by a member of staff.
Exercise 9
Make sure that you try and have a short walk with your frame or crutches every hour during the day and the evening. This will help to promote your mobility and strength and greatly reduces the risk of you developing a DVT. It will also help to reduce the risk of chest infections and pressure sores.
Do NOT walk on your own until you have been advised that you can do so, by the physiotherapists or nurses.
You should also continue to have short hourly walks around your house when you go home.
Stairs
Once you are walking well enough, you will be taught how to manage stairs or a step (according to your needs).
- Take one step at a time
- Going upstairs: use the banister on one side and the crutch/stick on the other side.
- Leading with your non-operated leg first place your foot on the step and then with your operated leg, place your foot on the same step, and lastly your crutch/stick. In the picture below the operated leg is the right leg.
- Going downstairs: use the banister on one side and the crutch/stick on the other side. Place your crutch/stick first on to the step, then your operation leg onto the step and then the non operated leg onto the same step. In the picture below, the operated leg is the right leg.
- Steps without rails or kerbs: as above but use crutches/sticks together.
Daily Expected Post-Operative Goals and Achievements Day of Surgery;
- Eat and drink within 1 hour of returning from surgery.
- Stand up with physiotherapists or nurses.
- Start first few exercises myself, as described in this booklet.
First Day Post op;
- Drink lots of fluids.
- Have had bulky dressings reduced from operated knee.
- Get dressed in day clothes, NOT NIGHT WEAR.
- Walk by myself with a walking aid – if allowed.
- You can walk to the dining table for meals.
- Sit out in chair for a few hours with leg elevated.
- Manage/nearly manage to lift leg off the bed.
- Get my operated knee to within 10 degrees of being straight.
- Bend my operated knee to more than 65-70 degrees.
- Have a normally functioning bladder.
- Have had bloods taken.
- Have had a routine check X ray.
- To be taking effective pain relief.
- To be taking effective anti sickness medication, if required
Second Day Post Op;
- Continue to drink lots of fluids.
- Get myself out of bed with minimum assistance.
- Get dressed in day clothes, NOT NIGHT WEAR.
- Sit out in chair for most of the day with leg elevated.
- Walk with crutches/frame with/without assistance.
- You can walk to the dining table for meals.
- Have a short walk every hour, during the day.
- Manage to lift my operated leg fully off the bed.
- Get my operated knee to within 5 degrees of being straight.
- Bend my operated knee to more than 80 degrees.
- Have a normally functioning bladder.
- Have had a routine check x ray, (if not done yesterday.)
- Get myself into bed without any assistance.
- To be able to get on and off the chair and toilet by myself.
- To be continuing with effective pain relief.
- To be continuing with effective anti sickness medication, (if required).
- I have had my bowels open
Your hospital stay may last about 2 days. Before you are able to go home you will need to meet several goals:
- Walk independently with your crutches/ frame.
- Bend your knee.
- Extend (straighten) your knee fully.
- Get in/out of bed and on/off the chair and toilet by yourself. The aim is to be able to get on/off. ordinary heights of furniture as this encourages you to strengthen your muscles and bend your knee.
- Be able to get up/down stairs if you need to be able to manage this at home.
- Do the prescribed home exercises regularly and independently.
- Have had a routine check x-ray of your new joint.
You will NOT be seen routinely by the occupational therapist.
A referral to the ward occupational therapist can be made before you go home if a need is identified. The occupational therapist will then assess your needs.
The ward physiotherapist will arrange for you to attend your local hospital for further out patient physiotherapy. Your local hospital will contact you. The ward physiotherapist will give you more information on this when you are due to be discharged home.
The Surgeon, Physiotherapist or GP can advise you when it is safe to return to normal activities.
Pharmacy will supply you with any new medication that you have commenced whilst you have been in hospital. This will include any pain relief. Please ensure that this is what you have been taking whist in hospital. The nursing staff will check your medication with you.
- DVT Prophylaxis – whilst in hospital you will have commenced on medication to assist in the prevention of blood clots. This will be by tablet or injection. If you are on injectable medication the nursing staff will have assessed your ability to self inject. If you are unable to do so, they should have taught a relative or organised a District Nurse. If you were previously on, or have been started on warfarin you should have an anti-coagulant appointment booked prior to discharge. The ward staff will arrange this for you. It is important to take this medication for the prescribed time to help prevent clots forming in the weeks after surgery.
- Antibiotics – If you have an infection you may be discharged with a course of antibiotics. You will be informed of the course length on discharge. All antibiotics have side effects. If you feel you are unable to cope with these side effects please contact your GP.
- Pain relief – You will be sent home with a small supply of the pain relief that you have been taking in hospital. You will need to contact your GP to arrange further pain relief prescriptions. Please do this 2-3 days before you are going to run out of medication.
- Keep your wound area clean and dry. A dressing will be applied in the hospital and usually does not need changing. If you have any problems with your wound please contact the ward who will arrange a clinic appointment where you wound will be reviewed.
- The dressings are water resistant so you may have a quick shower but do not bathe until until your wound is dry and the sutures or staples have been removed, usually two weeks after your surgery. The district nurse at your local practice may phone you to discuss your suitability to visit the treatment room, rather than visit you at home. The nurses on the ward will give you a paper Page 20 copy of the referral; this will include a date your first appointment is required. The nurses on the ward should also provide you with any equipment the district nurse will need.
- You will be referred to have your clips removed by either a practice nurse or district nurse depending on the type of surgery you have had and your clinical need.
- You will have a clinic appointment for review 2-3 weeks after your surgery.
Please remember you have undergone major surgery and your recovery can take up to 12 months. It is very important that you follow these guidelines when you return home:
- Continue to take the pain relievers or anti-inflammatories as prescribed to you once you go home to enable you to exercise effectively and manage your pain and swelling. It is common for other joints in your operated leg such as your ankle, hip and even your lower back to become a little achy due to the changes in your overall posture. If in doubt, please speak to your physiotherapist for advice, or your contact your GP.
- Keep your operated leg elevated whilst sitting, to help reduce the swelling and minimize the amount of time spent in one position. • Make sure that you continue to have short hourly walks.
- Gradually try to increase your walking distance. Walk a little and often throughout the day.
- Try to walk at least once every hour but be guided by your own limitations • Your Physiotherapist will advise you on how long you need to use your crutches for. They will progress you onto a stick when you ready. Continue to use the stick – in the opposite hand for as long as you continue to have a limp. When you no longer walk with a limp, you can start to wean yourself off your stick, by walking without it for short distances.
- It will initially be difficult to carry items if using two crutches. You may be able to slide items along a surface or use an over the body bag to carry items
- Wear sensible footwear.
- You must continue to do the exercises that you have been taught when you get home. Your operated leg may feel stiff each morning when you wake up. Do not worry about this; the stiffness should wear off, given time. Always exercise to achieve the bend that you had the previous day and then add a little bit more.
- Avoid crossing your legs as this may hinder your circulation and could predispose towards DVT.s
- Check with the ward prior to your discharge, regarding how long you need to continue to wear the compression stockings. Most consultants prefer that their patients wear them for up to 2 weeks.
- post op. Some patients may have to wear them for longer. You need to wear them both night and day (except for up to an hour for washing). You will need assistance from another person to put them on.
- Avoid sleeping with a pillow/cushion under your knee as this will cause extra stiffness in your knee and make it more difficult for you to straighten it.
- Avoid kneeling on your operated leg until you have seen your doctor.
- Do not use lotions on your wound until it has fully healed – YOU MUST KEEP YOUR WOUND DRY. Check for signs of infection. These include redness, swelling, high temperature or pus draining from the wound. Report any of these symptoms immediately to your GP.
- If you have been taking asprin as a blood thinning agent, take these as directed on the box
- Observe your calves for any unusual symptoms such as swelling, pain, redness and heat. These symptoms may indicate a DVT. Report any of these symptoms immediately to your G.P.
- Most consultants do not allow their patients to drive until 3 months after the operation. Prior to driving for the first time, you need to ensure that you are no longer on strong pain relievers. You should be relatively painfree in your knee. You should also try sitting in your unstarted car and pressing on the appropriate foot pedal firmly to see if that causes any pain. If so, this is too soon for you. You are advised to contact your insurance company after your operation before you start driving.
- There are post op restrictions on sporting activities. These include no contact sport for 12 months, no jogging for 6 months, no light sport for 3 months and no swimming for 6 weeks.
- A healthy diet and not smoking will help to promote wound healing and overall recovery
Your out-patient appointments are all from the date of surgery. Your follow-up appointment may be carried out by a specialist nurse, registrar or your consultant. Please note that all follow up appointments will take place at the Orange Reception, Blackpool Victoria Hospital. If your appointment is not given on discharge, you should receive it within two weeks. If for any reason you do not receive an appointment through the post, please contact the ward that you were on, Monday to Friday, between the hours of 8am and 4pm. Your ward physiotherapist will also arrange for you to attend outpatient physiotherapy. The physiotherapy staff will discuss this with you prior to your discharge home.
Useful Websites;
Other useful information can be found at the following websites;
- www.nhs.uk/
- www.nice.org.uk/guidance
- www.arthritisresearchuk.org/
- www.helpdirect.org.uk/
- www.ageuk.org.uk/
- www.gov.uk/government/publications/the-eatwell-guide
- www.bda.uk.com/foodfacts
Research is undertaken to add to the existing scientific knowledge on a particular subject. There are a number of staff within the Trust who conduct Research studies. It is possible that during the course of your treatment you may be asked to take part in a research study, however, you do have the right to refuse, and this will not affect the care that you receive.
Every person registered with the NHS in England and Wales has their own unique NHS Number. It is made up of 10 digits for example 123 456 7890. Everyone needs to use the NHS Number to identify you correctly. It is an important step towards improving the safety of your healthcare. Always bring your NHS number with you to all hospital appointments or quote it if you need to telephone the hospital for any enquires. This will allow staff to check that they have the right patient details by checking this against your NHS number. To improve safety always check your NHS Number on correspondence the NHS sends to you.
If you do not know your NHS number, contact your GP or local Primary Care Trust. You may be asked for proof of your identity, for example a passport or other form of identity this is to protect your privacy. Once you have obtained your NHS Number write it down and Keep it Safe.
The Trust will keep your information secure and confidential at all times. The General Data Protection Regulation (GDPR) and the Data Protection Act 2018 state that personal data must be processed lawfully, fairly and in a transparent manner. This applies to all personal information we hold about you, whether on paper or electronically.
As a Trust, we ensure that you:
- Are always informed about what personal information we collect about you;
- Understand the reasons for us collecting and using your personal information;
- Are given opportunity to consent or opt-out of your information being collected or used when appropriate;
- Feel confident about how we handle your information;
- Are aware of your rights in relation to your information, including your right of access.
You can find further guidance about how we use your information and your information rights in our leaflet, ‘How We Use Your Health Records’, which is available in clinical areas, and via our Trust privacy notice, which can be found on our website: https://www.bfwh.nhs.uk/privacy-notice-for-ourservice-users/
