Knee Replacement Surgery

Transcription

1 Knee Replacement Surgery Physiotherapy Department Patient information

2 Experience has shown that patients undergoing an operation recover more quickly if they understand what is going to happen. Being aware of the anatomy may help you to adhere to the precautions better after your surgery. You will also find it useful to know of certain necessary changes and adaptations to your home prior to your admission to hospital. Should you have any further questions after having read this booklet, please do not hesitate to contact us at the hospital. 1

3 What is a knee replacement? We should first distinguish between a total knee replacement and a uni compartmental knee replacement. The total knee replacement replaces the full bottom and top of the joint, whereas the uni compartmental replacement only replaces half of the knee top and bottom. Both have good clinical results and a long track record. Traditional total knee replacement involves a bigger incision and is more invasive than a partial knee replacement. However only a minority of patients are suitable candidates for the partial replacement. The majority of patients have significant wear and tear on both sides of the knee. In both knee replacements the part that replaces the upper leg is made from a metal component and the part that replaces the lower leg has a metal base with a plastic liner. Note that it is actually more a resurfacing rather than a replacement since only the surfaces are replaced. There are some differences in the types of the individual replacement and these have slightly different characteristics. It is the decision of your consultant to determine which knee is most suitable for you. 2 Model of a traditional total knee replacement Model of a partial knee replacement

4 What should I expect from my knee replacement? Initially it should be expected that there is some pain from the surgery, however this pain should decrease day by day. Initially your knee may feel a bit stiff in both flexion (bending) and extension (straightening), it will also be swollen for a few weeks but with exercise this will result in a knee that functions much better than previously. Before coming in to hospital Start making arrangements for going home after surgery: A Decide who will take you home from the hospital. B If you live alone or are at home alone during the day, plan for family or friends to help you around the house for the first week or two. You will need help with laundry, TED s, cleaning and shopping after you get home. Start getting your home ready. Look around your house and see if there is anything that may be a problem for someone using a stick/ crutches following surgery. C Take up all scatter rugs and tape down edges of large area rugs. D Keep walkways clear of furniture and electrical/telephone cord. E It may be a good idea to obtain a high chair with arms to make it easier to sit/stand. F You may wish to raise your bed as well. G Place emergency numbers near or in the telephone. Make sure a telephone is near your favourite chair and close to the bed. H Stock up on groceries and pre-cooked meals so they only have to be re-heated and served. Place a night light in a dark hallway and possibly have a flash light at hand for a nightly visit to the bathroom. I Place items you use every day at arm level to avoid reaching up or bending down. 3

5 J If possible get yourself fit before the operation. Choose exercises like swimming or cycling if your knee can tolerate them. What happens when I come into hospital? A You will normally be admitted on the day of surgery. This will give you time to settle in and allows staff to introduce themselves and any necessary tests to be done. B When you arrive at the admissions office on the ground floor, your details will be taken and you will be shown to your room. C A nurse will admit you and the physiotherapist will see you to discuss the operation and the exercises you must do after surgery. D The anaesthetist will visit you before your operation and explain to you about the anaesthetic. E It is important that you understand what operation you are having and what is written on the consent form before you sign it. If you are unsure about anything, please ask any member of the healthcare team. F You will not be allowed to eat or drink anything for six hours before your operation to prevent anaesthetic complications. Your nurse will tell you when you have to stop eating and drinking. It could be from midnight or from 6am, depending on the time of your operation. Ensure you know this in case anyone offers you anything. What happens when my operation is finished? A Following your operation you will be looked after by a nurse in the recovery area near the theatres for an hour or two. 4

6 B The nurse will measure your blood pressure and pulse while your anaesthetic wears off. As a routine check the nurse will also measure the pulse in your feet. C When you wake up you will be given some pain medication. If you need anything, or are in pain, please tell the nurse. D When you are comfortable and the theatre staff feels you are ready, you will be taken back to the ward. You will have a bandage around your knee and a drain. The drains allow for excess blood to escape and will be removed 24 to 48 hours post surgery, depending on the instructions of your consultant. E Most consultants wish for their patients to use the Flowtron system. This is a DVT (deep vein thrombosis) preventative measure, where cuffs around the lower legs inflate and deflate with air, increasing the circulation, thus reducing the risk of a blood clot/dvt. What happens when I am back on the ward? A You should commence your breathing and circulation exercises immediately (as featured on the following page) to help prevent any risk of developing a chest infection or blood clot/dvt. B On the first morning after surgery, you will be seen by your Physiotherapist who will assess you and start your post operative rehabilitation and mobilisation. C On the first day you will also start with the exercise to activate your quadricep (thigh muscle) and you will also be encouraged to fully straighten your knee. D You will have a routine X-ray of the knee and a maybe a blood test. 5

7 bed exercises Breathing and circulation exercises to be done hourly 1 Deep Breathing Exercises Take a deep breath in through your nose trying to expand your lower ribs and then breath out completely through your mouth. Repeat 3 times. If this brings up phlegm, cough to clear. 2 Ankle Pumps Flex your feet towards your face and then point them away. Draw circles with your feet. Do this for a few minutes. 3 Gluteal (buttock) contractions Clench your buttocks together and hold for a few seconds. Repeat 5 to 10 times 6 Prior to the next three exercises it is important to first rest your leg fully extended. This can be done by rolling up a towel and resting your heel on this. Do this for periods of 15/20 minutes at least. This will create a straighter knee and better performance of the next 3 exercises.

8 Whilst doing your exercises expect some discomfort around the knee, this is normal. However don t force any movements or push into pain. Do the next exercises 4 to 5 times a day. Start with 5 repetitions initially and build up to 10 reps. Remember that using an ice pack may prove extremely helpful, both to reduce the swelling and temperature, but it will also have a pain reducing effect. The best time to use ice is after your exercises, leave the ice pack on for 15 minutes only. 4 Static Quads Contractions With your legs straight in front of you tighten your thigh muscles enough so that your heels rise just off the bed as your knee presses into the mattress. Hold for a few seconds and relax. 5 INNER RANGE Quads Place a roll or towel under the knee so that you knee is slightly bent. Now raise your foot off the mattress as you keep your knee on the roll. Aim to get the knee as straight as possible 7

9 6 Straight Leg Raises First bend your opposite (good) leg and ensure that you are not sitting too upright. Now start as exercise no 4 where you tighten the thigh muscles of the operated leg. Then raise the whole leg as straight as possible a few inches of the bed. Hold for a few seconds and lower. 7 Active Knee Flexion Start with your leg straight in front of you. Now slide the heel towards you as your knee and hip bend. Initially this may feel a bit tight because of the swelling of the knee, but this should loosen up soon. 8 Leg Extensions A First bend you knee as far as possible, sliding your heel along the floor. You may push with your unoperated leg. B Then fully straighten. 8

10 Mobilising Before you get up from the bed the physiotherapist will first assess the activity of the quads or thigh muscles. Expect to start on a zimmer frame or walking frame. After a few days this will be replaced by crutches. Soon you will use one crutch only and if your leg is good enough you may leave the hospital with only a stick. Standing Exercises It is advised to do the following exercises whilst holding on to the exercise rail or when at home to the back of a heavy chair. Again like with the bed exercises do them 4 to 5 times a day, starting with 5 repetitions building up to 10 reps. 1Mini Squats From a standing position bend both knees about 30 degrees as if you are sitting down on a chair. Hold for a second and slowly fully straighten again. 2 Hamstring Curl Bend your operated leg up behind you as far as possible. When straightening try to fully straighten before you bring your foot on the floor. 9

11 3 Calf Raises Without putting too much weight through your hands, raise your heels as high as possible. Hold for one or two seconds, relax and repeat. 4 Knee Extensions in Standing Standing with your back against the wall, brace your knees back to straighten it. Hold for 5 seconds and then relax. Repeat 10 times. 10

12 Going up and down stairs Going up the stairs Hold the rail on one side and your stick or crutch on the other side. Place the unoperated leg up first followed by the stick and the operated leg to the same step. Going DOWN the stairs Hold the rail on one side and your stick or crutch on the other side. Place the stick or crutch and the un-operated leg down first, followed by the operated leg onto the same step. Remember the stick and the operated leg move together. REMEMBER THE GOLDEN RULE : GOOD (unoperated) leg UP to heaven BAD (operated) leg DOWN to hell 11

13 When do I go home? Being ready for discharge is dependent on several different things. Most important is that the wound is satisfactory, that you are comfortable and any pain is controlled. You should also be able to manage safely at home. Sometimes a convalescent home may be a good interim solution for those who need some extra time before going home. You should expect to leave the hospital using one crutch, be able to climb stairs and to walk a short distance. It is recommended that you continue with physiotherapy after discharge, to optimise the function of your knee. General advice A B C D E F A rail installed by the bath/shower wall should provide you with some extra stability when getting in and out of the bath. Non slip mats in and possibly outside the bath/shower would be sensible. A pillow between the knees at night when lying on your side should make you more comfortable. In some cases where the good leg is not that strong a raised toilet seat will make sitting/standing from the toilet easier. Once at home try to gradually increase your level of activity, walking a little further each day. You should still use your walking aid as advised. Tell your GP that you have had a knee joint replacement and inform him/her if you are unwell or develop an infection, skin rash etc (especially if this is in the same leg). If you need dental treatment, tell your dentist that you have had a joint replacement. The same applies if you have had any other form of surgery or treatment. Antibiotics should be used with such procedures to cover you against the risk of infection. 12

14 Possible complications As with all surgeries there is a risk of complications however small they may be. It is important that you are aware of them. Early Complications One of these is the risk of infection, and although the risk is small the consequences can be significant. That is why your consultant and the medical team will do everything they can to minimise the risk of infection. Although very unlikely, it is possible that a blood clot (or DVT) develops in one of the deeper veins in the leg. To lower the risk we will mobilise you as soon as possible following surgery and ask you to do your bed exercises regularly. Some consultants also use an air pump system called Flowtron. Late Complications Sometimes a prosthesis loosens, but when this happens this is usually after years of use. It is a complication that can be caused by the dynamics of the bone and the cement bonding in the long term. 13

15 Contact Nottingham Place, London W1U 5NY Inpatient Physiotherapy: Outpatient Physiotherapy: Switchboard: bleeps 062/063/064/065 W theprincessgracehospital.co.uk