Knee Replacement - Operation

Usually the patient is admitted to the hospital a few hours before surgery giving them a chance to become accustomed to the room and to make the acquaintance of the staff who will be helping to take care of them.
Before the operation the Consultant will go to the room to explain again what he is going to do and the patient will sign the consent form.

After the operation the patient usually rests in bed for 24hours. They may initially have a drip and a urinary catheter. A check xray will be taken at some point –either in the theatre or first thing next morning. Their blood will also be tested to see how their body reacted to the operation. If it results that the blood count (haemaglobin) is low then they may be transfused the two units that were cross matched prior to surgery. The patient will be mobilised according to the Consultants instructions – usually in the morning after the operation. Some Consultants like to begin mobilising the knee as soon as possible after surgery and will refer the patient in the evening on the day of surgery for CPM – continuous passive movement- which is a machine that bends the knee for the patient (passively) to a pre set degree and then straightens the leg out again. The patient may have none, one or two drains after the surgery depending on the surgeon and the technique used, and these will stay in for up to two days. The patient will begin to mobilise with a zimmer frame on the first day post op and will quickly move onto crutches or sticks depending on individual progress.

The Consultant will visit on a daily basis to decide patient management but the hospital doctors will be overseeing the hospital stay. It is important in the initial stages that the patient is painfree and they may have a PCA to self administer the painkiller. This is usually Morphine. It is self regulating and so the patient cannot overdose themselves with it. When this is removed the patient will be given regular pain killing tablets which they should take. They will also be given a daily injection of a heparinoid – usually Clexane under the skin to prevent thrombosis. The physiotherapists will visit as often as is necessary, at a minimum of twice a day. The CPM is done twice daily and the angle of knee bend will be gradually increased at these visits. The physiotherapists will also give the patient exercise programmes and walking practice so that patients gait will be normalised as soon as possible. The patient will be encouraged to be independent and the physiotherapist will show the patient the best way to get in and out of bed. Special seats are available for the toilet in the initial stage and whilst the patient is recovering they may make us of special mattresses and monkey pole for the bed. Stairs are usually practiced on the 5th day. Most patients are discharged with a stick but this can be discarded as soon as they can walk normally without limping. There is no set time limit on how long they should keep the stick, in fact some of the patients leave hospital without it. Painkillers should continue for as long as the patient needs them and ice can be used regularly should any swelling persist. The ice should be put into a plastic bag and should be applied over a layer of towelling or tissue for 20minutes only. It should never be applied directly onto the skin. The patients may need to continue taking the injections to prevent thrombosis for a length of time following surgery – the Consultant will decide this upon discharge.