TOTAL KNEE REPLACEMENT PATIENT INFORMATION LEAFLET This leaflet has been produced to help answer some questions you may have following your knee replacement. However if you still have any concerns or queries after reading this leaflet, ask your doctor who will explain things more fully. The Knee Joint The knee joint is one of the main weight bearing joints of the body. It is formed where the two rounded ends of the lower thighbone (femur) sit in two saucer-like depressions at the top of the shinbones (tibia). The knee joint operates like a hinge, but it can also rotate and move from side to side. The whole of the knee joint is bound together by thick ligaments, which form a protective capsule around the joint. The surfaces of the bones are covered in a very slippery, gristlelike substance called cartilage. The joint itself is filled with lubricant called synovial fluid, produced by the lining of the joint capsule (synovial membrane). The cartilage and synovial fluid help to keep the joint moving smoothly and protect the ends of the bones from the great stresses that pass through the knee joint.
What it arthritis? Arthritis is simply the wearing away of the cartilage at the bone ends within the joint. In severe cases, the cartilage is worn away completely and the bone beneath it begins to wear away too. As a result, the joint lining becomes thicker and starts to produce more synovial fluid. This leads to swelling, and the swollen joint capsule becomes stiff and painful. Often the wear in the knee joint is uneven and affects one side more than the other. This may result in either a knock knee or bow leg deformity. What causes arthritis? Any factor causing the cartilage to wear away more quickly than normal, can lead to the development of arthritis. For example: Previous injury to the joint Abnormality in the joint, Certain diseases (e.g. rheumatoid arthritis), Excessive or abnormal use e.g. Professional sportsmen and women can go on to develop arthritis. However, many of the seven million people in the United Kingdom who suffer from arthritis have no obvious identifiable cause of their condition. It is thought that such cases may be the result of hereditary factors affecting the joint. Treatment There are several ways in which the symptoms of arthritis may be eased, including drug treatment or operation on the existing joint. However in the most severe and disabling forms of arthritis, a knee replacement may be recommended. Total knee joint replacement Total knee replacement is a major operation that takes between one and two hours. The damaged cartilage and the bone ends are simply resurfaced using plastic on the end of the shinbone and a metal shell on the bottom of the thighbone. Replacing the damaged parts of the natural joint relieves pain and corrects obvious deformity. Although very effective, the new joint does not recreate the perfection of the original and small limitations will be noticeable. However, the range of movement is more than adequate for everyday activity. It takes about one year to recover fully from the operation, although, the speed of recovery varies from patient to patient.
How many are done? Around 50,000 total knee replacements are carried out in the United Kingdom each year. Over 400 take place annually at the. Immediately after the operation Immediately after the operation you will be wearing elastic stockings to help your circulation. The operated knee will be dressed with bandages but it is important to commence your exercises as soon as you come back on the ward. A physiotherapist will see you and go through the exercises with you once again. If you are feeling well enough, they will teach you how to get out of bed and start walking. Your exercises should be carried out regularly and continued once you are at home. Day 1 after your operation You will be shown the correct way to get out of bed and sit on a chair (if this was not done on the day of surgery). You will be assisted to walk short distances with a pair of elbow crutches (or walking frame). Day 2-3 after your operation You will be encouraged to progress your walking distance using a walking aid. At this stage we aim for you to be walking independently with a walking aid. You will also be shown how to go up and down stairs safely. It is important to continue with the exercises you have been shown throughout the day. Leaving Hospital Discharge from hospital usually takes place between 3-4 days after your operation although this may vary depending on your rate of recovery. Occasionally you may need to stay in hospital longer. Should this occur the reason will be explained to you. It is important to continue with the exercises that you have been doing in hospital when you get home. Your physiotherapist will advise you on which exercises to concentrate on. You will leave the hospital walking on with either crutches or sticks and you must continue to use these until your 6 week follow-up with your surgeon. At this point it will be decided if you need to continue using them. How often will you need to see the doctor after the operation? A knee replacement is a major operation, so after you leave hospital you will need to attend for several check ups during the first year after the operation. After that, you will then be invited for a routine check up once every year. These visits are important to ensure that the new joint is functioning correctly and to check for any problems. At each check up you will be asked questions about how you are coping with the new knee, and the joint will be examined. An x-ray may be taken. If for some reason you do not hear from the hospital about the time your yearly check up is due, we would ask that you contact the hospital to make an appointment. If you experience any difficulties with your new knee outside of the times scheduled for check ups please let your G.P. know.
EXERCISES The following exercises can be performed in bed or when you re sitting in the chair. They should be done throughout the day to regain your strength following surgery. 1. Lying on your back or sitting Bend and straighten your ankles briskly. If you keep your knees straight during the exercise you will stretch your calf muscles. Repeat for 2 minutes every half an hour, 2. Lying on your back with legs straight, or sitting with your leg up on a foot stool. Bend your ankles and push your knees down firmly against the bed/stool. Hold 5 seconds and relax 3. Lying on your back/sitting up in bed Tighten your thigh muscle and straighten your knee. Lift your leg 20cm off the bed. Hold 5 seconds. Repeat 10 times every 1-2 hours. 4. Lying on you back /sitting up in bed Bend and straighten your leg. Repeat 10 times every 1-2 hours
5. Lying or sitting upright. Put a rolled towel under your knee. Push you re the back of your knee down whilst trying to lift your heel up. Hold this for 5 seconds. Repeat 10 times every half hour. 6. Sitting on a chair a. Pull your toes up, tighten your thigh muscle and straighten your knee. Hold approx 5 seconds and slowly relax your leg. Repeat 10 times, every 1-2 hours b. Bend your knee as much as possible Repeat 10 times, every 1-2 hours All exercises need to be practiced for up to 3 months after your surgery, you may need to continue them for longer
Walking You will usually start to walk within a few hours after your operation. You will be assisted to walk using a walking aid frame, crutches or walking sticks You will be shown how to use the walking aid correctly by your physiotherapist. The walking pattern involves: Move the walking aid forward first Move the operated leg forward Followed by the un-operated leg then repeat the sequence Stairs You will practise climbing the stairs with the physiotherapist before you leave the hospital. Remember this rule: The non operated leg leads up The operated leg leads down Getting in and out of the car DO NOT drive a car between being discharged from hospital and having your follow up appointment with your doctor. If you do this your insurance could be compromised so it is best to contact your insurance company before starting to drive again. As a passenger it is best to avoid long journeys. If this is not possible then regular breaks are advised. It is recommended that you always sit in the front passenger seat as you can move the seat back to give yourself extra leg room. The best way to get into and out of the car is to get in with your bottom first then carefully bring your legs into the car.
Advice Post Total Knee Replacement Mobility Weight bear as tolerated using the walking aid you were discharged with. Continue to work on good heel-toe walking pattern. As soon as you can weight bear fully without pain you may start to discard walking aids. Be careful not to get into a habit of limping. If you find that without a stick/crutch you limp excessively there is no harm in using one for a few weeks longer. Exercise Continue with your exercises as instructed by your physiotherapist, to increase your strength. Increase your walking distance, as you are comfortable. You may use a static cycle. You may have to adjust the seat depending on how much bend you have on your knee. You may recommence playing golf and gardening by about 6 weeks. Wound Once the clips come out and if your wound is tender to touch you may massage it firmly using a moisturising cream to de-sensitise the skin and underlying tissues. You can use ice pack or cold therapy over your knee to ease the pain, swelling and bruising. Stairs Progress as you feel comfortable. Otherwise carry on as instructed by the physiotherapist: up with the good first, down with the bad first. Housework Increase the amount of housework that you do over the next few weeks and months. Driving You will be advised when you may recommence driving at your 6-week consultant appointment. You must be able to safely perform an emergency stop and change gear comfortably. This applies even if you have a car with an automatic transmission and have had your left knee replaced. Sleeping There are no restrictions as you what position you have to sleep. But ensure you DO NOT rest your leg with your knee bent i.e. placing pillow or towel under your knee. Sexual Relationships Resume when comfortable. Returning to work You may be able to return to work between 4 and 6 weeks provided you have a sedentary job. If you have a manual job it may be 6 to 12 weeks before you can return.
Sport/Leisure Most sporting activities can be resumed after 3 months, depending on comfort and level of competition. Low impact sports such as swimming, cycling, doubles tennis, gym work after instruction, golf present no problem. High impact sports are not recommended, therefore are participated in at your own risk i.e. jogging, singles tennis, squash, jumping activities, football. Travelling abroad We do not advise travelling abroad before 6 weeks. Your Total Knee Replacement will probably be detected at airport x-ray machines. At 4-6 weeks after your surgery if you feel you are not making any progress, you can contact the physiotherapy department for further advice. Useful Telephone Numbers Orthopaedic Surgical Unit (OSU) 01279 827612 Physiotherapy and Occupational Therapy 01279 827199 Collection of Equipment for Essex Residents 01279 698914 Collection of Equipment for Hertfordshire Residents 01707 292555