HemiCap Knee Resurfacing and Joint preservation Post-operative Instructions

Transcription

1 BEACON CENTRE FOR ORTHOPAEDICS: ORTHOPAEDIC WARD: / PHYSIOTHERAPY DEPARTMENT: HemiCap Knee Resurfacing and Joint preservation Post-operative Instructions Please stick addressograph here PT.PIL.038 Last updated May

2 Table of Contents 1. Introduction 2. What is a Hemicap? 3. Potential Complications 4. Physiotherapy 5. Your Rehabilitation Goals 6. General recommendations 7. Discharge Instructions 8. Conclusion 9. Individual Patient Notes Introduction This information booklet has been written to give you and your family a basic understanding of what is involved when you require a Hemicap TM Knee resurfacing. In this booklet we provide information, including things you should know before and after your operation. Throughout your stay in Beacon Hospital, you will receive continuous advice and support from all members of the team. What is a Hemicap? A Hemicap TM is a technological advanced system designed to match the shape and contour of the individual patient s cartilage surface. It is a patch for an area of damaged cartilage designed to protect the remaining normal cartilage in an attempt to prevent further damage. It is designed for one side of a joint either medial or lateral, that has been disabled by early degenerative or post traumatic degenerative disease. The Hemicap TM system matches not only the diameter of the damaged area but also the precise radius of both curvatures of the joint surface from top to bottom and inside to outside. The technology for mapping the joint curvatures comes from eye surgery where it is used to make products to protect the corneal surface. The mapping is done in the operating room by the surgeon. Once the mapping points are defined an appropriate sized implant is chosen and then implanted into the patient. Different diameter and curvature are available to provide a proper fit for each patient. Hemicap TM resurfacing is preformed under general anaesthetic unless there is a medical reason for a spinal anaesthetic. PT.PIL.038 Last updated May

3 Manage Your Pain Pain is a common occurrence following any surgical procedure. It can be well managed with medications, special pain management devices and ice. The pain will naturally reduce as your wound heals and with regular use of analgesics (pain killers). Initially you may have PCA patient controlled analgesia or epidural for pain relief and this will lead on to regular oral medications when you are ready. You will be asked to rate or score your pain regularly after your surgery. The score will depend on how your pain feels to you. 0= No Pain, 10= worst pain imaginable (Please point to the number that best describes your pain) Physiotherapy When muscles are not used, they become weak and do not perform well in supporting and moving the body. Your leg muscles are probably weak because you haven t used them much due to your knee problems. The surgery can correct the knee problem, but the muscles will remain weak and will only be strengthened through regular exercise. You will be assisted and advised how to do this, but the responsibility for exercising is yours. EXERCISE PROGRAM Exercise is very important following knee replacement surgery. Frequency: You will need to exercise at least three times a day to ensure you reach your rehabilitation goals. Please be sure to read the exercises carefully and ask your physiotherapist any questions that you may have before you leave the hospital. Assign the number you feel best describes your pain. The nurses will administer appropriate treatments/ medications depending on your pain score. The nurse will reassess your pain score after the treatment to make sure it has worked to reduce your pain. The following exercises start as soon as you are able. You may feel uncomfortable at first, but these exercises will speed your recovery. PT.PIL.038 Last updated May

4 HemiCap Knee Resurfacing and Joint preservation 1) Ankle Pumps With your legs straight, bend your ankles up and down, towards and away from your face. Repeat 10 times Continue this exercise until you are fully recovered 3) Inner Range Quadriceps: Keeping knee in the brace Place a pillow or folded towel under your knee. Push the knee straight into the towel, hold for 5 seconds. Repeat by 10. 2) Quadriceps Setting. With your leg straight out in front of you, tighten the muscles at the front of your thigh, pushing the back of your knee down into the bed. The result should be straightening of the knee. Hold the contraction for 5 seconds. Repeat 10 times PT.PIL.038 Last updated May ) Knee Flexion Lie on you back with your legs straight Slowly bend your knee by sliding your foot up towards your buttocks. Hold for count of 5 Relax and repeat 10 times 4

5 HemiCap Knee Resurfacing and Joint preservation 5) Straight Leg Raise: Tighten the muscles at the top of your leg Keeping your operated leg straight, raise the leg about 6 to 10 inches off the bed. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10 times. Your Rehabilitation Goals You will be required to be independent in getting in and out of bed. You will be required to be able to walk independently with crutches on a level surface. You will be required to be independent walking up and down stairs. You will have achieved your target joint range of motion as set out by your consultant and physiotherapist. You will be required to be independent with exercise programme. Post Operatively You will be asked to do deep breathing exercises and ankle exercises hourly. Use of Ice: Your knee may be hot red and swollen after surgery. Ice may be used therefore during your hospital stay and at home, to help reduce the pain and swelling in your knee. A bag of crushed ice may be placed in a towel over your knee for minutes. Your sensation may be decreased after surgery, so use extra care. You may continue to ice regularly during the day both as an in patient and on discharge home in order to help control swelling and any pain and also to encourage healing. PT.PIL.038 Last updated May 2014 Once referred for physiotherapy, your dressings will be reduced by the nursing staff and you will be given a tubigrip to wear on your knee. Cryo-cuff (Ice therapy) will be applied to your knee to help reduce the swelling. The Physiotherapist will assess your knee and will also provide you with an exercise program. You will walk with 2 crutches. Regular exercise throughout the day is required to increase your knee movement and strengthen your leg muscles. Walking is part of your exercise programme and you should be increasing your walking distance daily. You will be advised to continue to use your cryo-cuff to ice your knee. The physiotherapist will have escorted you to the stairs and by discharge you will have climbed a flight of stairs safely and independently. 5

6 Walking You will advised by your physiotherapist how much weight to put through your operated leg post surgery. Following 2 weeks, you will attend physiotherapy and the Physiotherapist will progress your weight bearing status. Stairs Technique Going up-stairs Going Downstairs Put crutch down onto the step below. Follow with the operated leg keep knee straight. Take weight onto the operated leg using the crutches and banister for support. Follow with the un-operated leg onto the same step. Maintain crutches/walking stick on the step below. Lead with the un-operated leg up onto the step above. Take your weight onto the un-operated leg by pushing on crutches and banister. Follow with the operated leg and crutch onto the same step. PhysioTools Ltd PhysioTools Ltd PT.PIL.038 Last updated May

7 General Recommendations Sleeping While in hospital some patients find it harder to sleep for various reasons, i.e. different bed and environment. If you find that you are having this problem please let the nursing staff know as you may require something to help you sleep. Nausea Some of the medications you can be prescribed can cause nausea. Please inform the nursing staff if you feel sick or are getting sick as your medications may need to be changed/adjusted and the nursing staff can also get a medication prescribed to help relieve this nausea. Driving In order to be safe driving a motor vehicle, you must be in control of the pedals effectively. It is recommended that you do not drive a motor vehicle until you have complete control over your leg. This does not normally occur until at least 4 weeks after your surgery. When you do become capable of handling a motor vehicle, a trial period to accustom yourself to your new knee in an empty car park is recommended. Travel Prolonged periods of sitting on airlines may predispose to leg swelling and deep venous thrombosis, and it is recommended that you avoid this until 6 weeks after your surgery. If you must travel, wear your elasticised stockings and keep your leg elevated as much as possible. Please discuss with your consultant any imminent travel arrangements. Activities During the first 4 weeks after your surgery, we recommend limiting your activities to walking, continuing to use 2 elbow crutches. We recommend that you refrain from more strenuous activities such as running for a period of 3 months. You may however return to swimming from three weeks and cycling at three-four weeks. General Safety Advice for Home Please be aware of the hazards in your home as this will make your recovery easier and safer. Move electrical cords, phone lines and ensure clear pathways. Store items within easy reach specifically in the kitchen and bathroom areas. Remove rugs including bath mats and entrance mats. Be careful with pets and young children. Be aware of water spills, slipper floors and always think before you move. Car Transfers You are allowed to drive again four weeks after your operation. When travelling in the car you should sit in the front passenger seat. It is important that you avoid long journeys if possible. PT.PIL.038 Last updated May

8 Discharge Instructions You will be seen by Mr. O Donnell prior to your discharge. You will be given a summary of the findings and procedure, and you will be shown intra-operative photographs from the procedure, as a means of explaining what was carried out. When you leave the hospital you will be asked to make an appointment to see your consultant, usually 2-3 weeks after the operation. This is for a routine check-up which will make sure you are progressing satisfactorily and x-rays may be taken. It is important to still bring your old X-rays with you at this time. You will be advised to attend outpatient Physiotherapy within two to three weeks of discharge. You may either attend a private physiotherapist in the hospital or a physiotherapist more local to your home. If you would prefer to exercise in a group setting, Beacon Hospital provides weekly group exercise classes for certain patient groups. Your physiotherapist will provide you with the details of these classes. You will need to continue your physiotherapy for 2-3 months after your surgery. Your physiotherapists will advise you after your surgery regarding your requirements. You will be given a discharge prescription tailored to suit your pain control needs. You should take the pain relief tablets regularly to prevent breakthrough pain. Plan to take your pain medication 30 minutes before exercises. Preventing pain is easier than chasing pain. If pain control continues to be a problem, contact the Centre for Orthopaedics or your general practitioner. A discharge summary will be posted to your GP on the day after your procedure. Things to look out for Swelling Post-operative swelling is very common, and can take a number of weeks to settle. Most patients describe a feeling of fullness at the back of the knee for the first 2 weeks. This then settles quickly in the vast majority of cases. You can help prevent swelling by resting and icing the knee as already mentioned. Calf pain this can be due to a number of things, but is usually related to water tracking into the Gastrocnemius muscle. DVT (Deep Venous Thrombosis) is rare following knee resurfacing (< 1%). The calf is normally extremely painful, tense, and hard in the presence of a DVT. If you have any concerns, please contact the Centre for Orthopaedics or attend the Emergency Department for an urgent Doppler ultrasound scan. Infection This is extremely uncommon (< 0.05%). The knee will usually be very swollen, red, and hot if it is infected (although not always). There may be some discharge from the incision sites. In cases of severe infection, you may have constitutional symptoms, such as fever, nausea, loss of appetite, sweating, rigors, and even confusion. Again, either contact the Centre for Orthopaedics or attend the Emergency Department if you are worried about infection. Nerve injury The common Peroneal nerve is a nerve that wraps around the head of the fibula bone on the lateral side, or outer side, of the knee. This can be bruised very rarely during surgery. It usually presents as severe pain radiating down the leg to the ankle, and is associated with pins and needles or even numbness. It normally settles by itself, but can be instantly alleviated with physiotherapy to free up the nerve. PT.PIL.038 Last updated May

9 Most people will have sutures that will need to be removed approximately days after surgery. This may be done by the GP, Dressing clinic, consultant or in the convalescence centre. Return to activities Obviously, it is not a one size fits all approach, and some return to fuller activity sooner than others. Factors such as age, overall fitness, co-morbidities, and obviously the extent and type of injury to the knee all have to be taken into consideration when advising patients regarding return to activity. Conclusion We hope that you have found this booklet useful and that it has helped to relieve some of your fears and anxieties regarding your surgery. During your hospital stay, your medical team will be available to answer any other queries you may have. If you have any further questions, Please contact the Physiotherapy department on Individual Patient Notes: Consultant Name: Date of Surgery: Surgery Note: Weight Bearing Status: Walking Device: This Patient Education leaflet was developed by the Chartered Physiotherapists in Beacon Hospital. Beacon Hospital. PT.PIL.038 Last updated May