Therapy Guide following Knee Replacement Surgery Occupational Therapy & Physiotherapy Community & Therapy Services This leaflet has been designed to give you important information about your knee replacement surgery and help you prepare for coming in and going home from your surgery.
Following your Operation After being in the recovery room, you will return to the ward and be on your bed. Your knee will be bandaged, you will have the intravenous line still in your arm and an oxygen mask or nasal cannula in place. You may also have a PCAS (patient controlled analgesic system) for pain control. You will be able to sit up and start eating and drinking as you feel more comfortable. Moving after the operation is important to reduce complications. Perform the following exercises hourly when awake: Deep breathing - Take nice deep, slow breaths in through your nose and out through your mouth. Do at least 2 or 3 before having a strong cough to keep your chest clear. Ankle Exercises Pump your feet up and down and make circles with your ankles 5-10 times to keep the blood moving in your legs. Muscle contractions With legs straight. Pull your toes towards you, push your knees down into the bed and tighten your thigh muscle. Hold for 5 seconds then relax. Repeat 10 times. You will likely have some discomfort around your knee. If your pain is not controlled, please tell someone sooner rather than later. You will be encouraged to get out of bed and begin mobilising as soon as possible following your operation. You will be helped out of bed initially by one of the therapists or nursing staff. A member of the therapy team will show you the best way to walk and ward staff will help you until you feel confident. Initially you will have a walking frame, but will be progressed to crutches or sticks as appropriate. You should try to walk as normally as possible using your knee bend. Swelling often causes your knee to be stiff and painful. To help reduce this swelling, elevate your leg and use an ice pack on your knee. Continue with this at home. If you don t have an ice pack, a bag of frozen peas or crushed ice can be used. Ice should always be wrapped in a towel to prevent ice burns to the skin. Apply for 20 minutes at a time. This can be done every 2 hours after your exercises if advised.
Your Basic Knee Exercises Below are the basic exercises you need to do to improve the mobility and strength of your knee. A member of the therapy team will teach you these exercises. It is important you keep doing them regularly. Your thigh muscles and knee may feel tired or sore after your exercises. This is all normal. Do each exercise 5 times each and repeat them 5 times a day or every 2 hours unless you are told otherwise. 1) Ankle Exercises & Muscle Contractions / Knee Straightening See previous pages for these exercises 2) Straight leg raise Tighten your thigh muscle and lift your leg off the bed, keeping your knee as straight as possible. When lowering try to get your calf to touch the bed before your heel does. This keeps your knee straight 3) Knee Bending in Lying Bend your knee as far as possible. Use your hands behind your knee or a band round your foot as shown and gently pull up to stretch the bend further. Hold for 5 seconds 4) Knee Bending and Straightening in Sitting Bend your knee in the chair by sliding your foot back along the floor. Hook your un-operated leg in front of it to stretch it back a little further. Hold for 5 seconds, before sliding your foot forward and lifting your foot off the floor. Straighten your knee fully and hold for 5 seconds then slowly relax your leg back down 5) Knee Straightening Over a Roll Put a rolled up towel under your knee. Keeping your knee on the roll, lift your foot off the bed and straighten your knee. Hold 5 seconds
Occupational Therapy If required, a member of the Occupational Therapy team may assess you and provide you with advice/education on how to perform everyday activities safely and independently when at home. The following information will help you in preparing for coming into hospital and returning home, whether you live alone or not. Washing and Dressing: On the ward you will either strip wash or shower. This can be continued at home You will be encouraged to perform all personal care activities as independently as possible and there is usually no need to use dressing aids Please ensure your bring in comfortable, loose fitting clothes and suitable footwear. Women find skirts or shorts, and men find shorts, most practical to wear while on the ward Gradually return to your normal bathing routine. Take all usual safety precautions, for example, use a non-slip mat in a bath and/or shower cubicle You should not have a bath until your wound is healed and you may find it difficult getting in and out of a bath until you have gained better movement and control of your knee You may find it easier to dress your operated leg first and undress it last, but try to use it as normally as possible. Sit on the side of the bed or chair initially when getting dressed to reduce the risk of falls Transfers: Sitting down and standing up A member of the therapy team will discuss and demonstrate with you how to safely transfer on/off a bed and chair Using the toilet there is usually no need to use equipment such as a raised toilet seat. Whilst on the ward you will have the support of hand rails around the toilet. You may not have this help once you are home so practice getting on/off the toilet without this extra support. A member of the therapy team will ensure you can manage a toilet transfer safely and independently
Household Tasks: If you live alone it may be helpful to have somebody stay with you for a few days until you gain confidence to do things. You may require help with activities involving carrying items as you will be using a walking aid Make sure your meals are organised or pre-cooked and you have stocked up on groceries prior to hospital admission Make sure items in the kitchen are located so you do not have to over bend/over reach Avoid tasks involving kneeling, such as cleaning floors Other things to consider in the Home: Ensure banisters and handrails are secure on steps and stairs Make sure all rooms, hallways and doorways are clear of clutter and any loose rugs removed. You may also need to ensure carpet edges and loose cables are secure to prevent any risk of falls It may be useful to have table lamps or nightlights set up in dark hallways, to ensure good visibility at night Have a phone in areas you spend most of your time (such as sitting room, kitchen) and keep emergency phone numbers at hand Driving: Driving is not recommended in the first 6 weeks after your surgery, unless you have been told you can. This will be based on your surgery and individual circumstances (for example having a left knee replacement, but an automatic transmission in your car) There is no reason why you cannot be a passenger in a car to get out of the house. If you struggle to get into the car, you may need to move the seat back or even use a plastic bag on the seat to help slide round until you get more mobile
Steps and stairs Before discharge a member of the therapy team will show you how to go up and down the stairs, or a step if you are unlikely to be using stairs. The sequence is the same for both. Walking up and down stairs One step at a time Stand close to the stairs and handrail. Hold handrail with one hand and crutches / sticks in the other hand. Going Up Step up with the un-operated leg Then bring up your operated leg Finally bring up your crutches or sticks Going Down Place crutch or stick down Then step down your operated leg Finally step down the un-operated leg Your therapist may adjust this technique to suit your own needs.
At Home: Once you are home, it is important to continue with your exercises little and often and increase your walking distances. Aim to return to normal levels of activity gradually. Follow up Physiotherapy may be arranged for you to progress your mobility and exercises, but it is your responsibility to do your therapy programme regularly to get the best outcome. Please discuss any hobbies or pastimes you have with your Physiotherapist, who will be able to advise you when to restart them. Pain and Swelling Control Keep taking your medications and using ice packs, as needed. Use the ice for 20 minutes, while elevating your leg as shown. If your knee is still stiff after a few weeks, you may benefit from using heat on your knee before your exercises. This may help you to stretch your knee more easily. Do not put the heat or ice directly on your skin. Infections & Blood Clots There is greatest risk of infection and blood clots in the first 6 weeks after surgery. Things to look out for include: New excessive swelling and pain (pain not from your exercises) Increased redness, heat or leakage from your wound Generally feeling unwell or having a raised temperature Swelling and pain in the thigh or calf, especially if red and hot If concerned contact your GP or practice nurse.
Walking and Steps / Stairs Continue to walk regularly and increase the distance you walk as tolerated. It is important you walk outdoors. Gradually stop using your sticks or crutches as able or as advised by your Physiotherapist. When using one stick or crutch, use it in the opposite hand to your knee replacement. In addition to walking normally, try walking sideways and backwards to help your balance. Using a mirror to look at how you are walking will help you see if you are using your knee bend properly and allow you to correct it. After 6 weeks, progress to walking on uneven ground such as walking in the park or on the beach. Don t be surprised if you cannot climb stairs normally until 6-10 weeks after the surgery. You may need to practice stepping up and down with your operated leg to improve confidence in using it. The following exercises will help with your walking, balance and stairs. You can try any of them you feel capable of doing, but your Physiotherapist may ask you to work on specific ones. Additional Straightening Exercises Hold the stretches for 30 seconds to a minute and increase the time as you are able. Try to stretch a few times during the day. Passive Knee Stretches Place a soft weight on the front of the knee while resting with the leg on a stool or roll. Lay on your tummy with your foot and lower leg hanging off the edge of the bed. Put a weight on your ankle, or press the other leg on top of your operated leg to increase the stretch.
Additional Bending Exercises Hold these stretches 10 to 30 seconds and do at least 5 repetitions 2-3 times a day increasing as you are able. Stairs Stretch Stand at the bottom of the stairs and lift your operated leg on to the second step. Keep your back straight, your hip down and your good foot on the floor, lean forward into the stairs. This will stretch your knee bend. Towel Stretch Use a towel to help stretch your knee bend as the picture shows. Slide Forward in Chair Knee Bend Start sat in the chair with your feet flat on the floor. Slide your bottom forward in the chair without moving your feet. Block your foot against something solid to help if required.
Additional Strengthening Exercises Start with 10 repetitions 2-3 times a day increasing the repetitions as you are able. Bridging Lift your bottom up as shown by pushing down on your feet. Hold 10 seconds. Sit To Stand Stand up without using your hands. Slowly sit back down again, but try just to touch your bottom to the chair or bed before standing up again. Use a lower surface to progress the exercise. Squats Stand with support. Bend your knees to squat. Hold for 10 seconds. Try to reduce the amount of support you have and increase the depth of the squat.
New Balance and Control Exercises Start these after a few weeks or when you feel you can fully weight bear without a stick for support. Balance With support, stand on your operated leg by itself. Hold for as long as possible (aim for 30 seconds) and repeat 5 times. Progress this by using less support. Step Ups and Downs Practice stepping up and down using your operated leg. Control the movement and don t jump up and down on the step. Increase the repetitions you can do aiming for 20, if possible. Toe and Heel Walking Try walking on your toes and heels as shown. Use support if needed initially. Even try changing directions on your toes and heels. This works your balance control and leg muscles harder.
Heel to Toe Walking or Walking On A Line Practice walking in a straight line placing one foot directly in front of the other, heel to toe. Again this will help with your balance. Exercise Bike An Exercise bike can be very good for both increasing your knee bend and for general fitness. The seat height may need to be higher than you would normally have it until your knee bend improves. If you are using it to increase your knee bend, make sure the operated leg is secured to the pedal. Then by doing half circles forwards and backwards, you can stretch the knee bend in both directions. Eventually you should be able to do a full circle and pedal normally. Gradually lower the seat if you want to improve your knee bend or until it is at a comfortable height for pedalling. Start with up to 5 minutes on the bike and increase as you wish. Pool Exercises / Swimming Once your stitches are out and your wound is healed and dry, there is no reason why you cannot go to a pool to swim or do exercises in the water. Please speak with the Physiotherapist if you need specific advice about exercises. Initially you will need to swim using the flutter or scissor kick leg action, but gradually you can start doing breast stroke leg action as long as it is comfortable. Massage Once your wound is healed, if your scar is tight or bumpy gentle massage down and around the scar for 5 minutes 2-3 times per day, may help. Speak to the Physiotherapist for instruction on the specific techniques and make sure you wash your hands well before massaging.
Getting Up and Down from the Floor After 3-4 weeks getting up and down off the floor can be done as shown in the pictures below, if needed. Use the support of a chair to help with the lowering and standing. Your stronger leg should be used in front for the lifting and lowering. Getting up is the reverse of the pictures shown of getting down. Before your 6 week follow up appointment with the Hospital Doctor You may still need to avoid: Kneeling on your operated knee until your wound is healed Twisting or pivoting on the operated knee Resting with a pillow under your knee Driving (unless your doctor or physiotherapist has said you may drive) You may try: House work and domestic activities. Some things may need to be done sitting down or modified, especially if you still need to use your walking aids, or find standing for periods of time difficult Returning to work, if you have a fairly sedentary or desk type job. More physical jobs should be avoided until after the first 6 weeks from surgery. If you require a medical certificate for work, please ask while on the ward and then speak to your GP (family doctor) for additional ones Doing stairs normally. Don t be surprised if you cannot do stairs normally until 6-10 weeks after the surgery Swimming (see the previous page) Low Impact Exercise Machines (Stationary Bikes, Cross-trainers, Elliptical Trainers, Steppers and Rowers) under guidance by your Physiotherapist Golf (starting with pitching and putting and only mid-swing strokes) under guidance by your Physiotherapist
After your 6 week follow up appointment You should continue to avoid: High impact activities such as running and jumping. Activities which will force the bend of your knee too far (although rare, dislocation of a knee replacement can happen in some cases, if you bend your knee too far). You may try: All domestic tasks you would normally do Driving, if you haven t already been told you can Dancing Bowls Exercise classes (let your instructor know you have had a knee replacement) Speed walking, Cycling and Horse Riding Skating Tennis or other court sports (not high impact, but gentle movements using the arms rather than jumping) Other Advice If you need to see your dentist, inform them you have had a knee replacement in the last 6 months. There will continue to be some variance even between the specialists in what activities you can and cannot do following your knee replacement. One medical study found a knee replacement allowed a significant increase of sporting activities at a 5 year follow up of patients, yet some doctors don t encourage this level of activity. The most important thing to remind yourself is you have had the operation to decrease your pain and improve the quality of your life. It is important you make the most of this improved quality of life, balancing it with a current accepted life of joint replacement being up to 20 years.
Concerns and Queries If you have any concerns / queries about any of the services offered by the Trust, in the first instance, please speak to the person providing your care. For Diana, Princess of Wales Hospital Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01472) 875403 or at the PALS office which is situated near the main entrance. For Scunthorpe General Hospital Alternatively you can contact the Patient Advice and Liaison Service (PALS) on (01724) 290132 or at the PALS office which situated on C Floor. Alternatively you can email: nlg-tr.pals@nhs.net Confidentiality Information on NHS patients is collected in a variety of ways and for a variety of reasons (e.g. providing care and treatment, managing and planning the NHS, training and educating staff, research etc.). Everyone working for the NHS has a legal duty to keep information about you confidential. Information will only ever be shared with people who have a genuine need for it (e.g. your GP or other professionals from whom you have been receiving care) or if the law requires it, for example, to notify a birth. Please be assured however that anyone who receives information from us is also under a legal duty to keep it confidential. Zero Tolerance - Violent, Threatening and Abusive Behaviour The Trust and its staff are committed to providing high quality care to patients within the department. However, we wish to advise all patients / visitors that the following inappropriate behaviour will not be tolerated: Swearing Threatening / abusive behaviour Verbal / physical abuse The Trust reserves the right to withdraw from treating patients whom are threatening / abusive / violent and ensuring the removal of those persons from the premises. All acts of criminal violence and aggression will be notified to the Police immediately.
Risk Management Strategy The Trust welcomes comments and suggestions from patients and visitors that could help to reduce risk. Perhaps you have experienced something whilst in hospital, whilst attending as an outpatient or as a visitor and you felt at risk. Please tell a member of staff on the ward or in the department you are attending / visiting. Moving & Handling The Trust operates a Minimal Lifting Policy, which in essence means patients are only ever lifted by nursing staff in an emergency situation. Patients are always encouraged to help themselves as much as possible when mobilising, and if unable to do so, equipment may be used to assist in their safe transfer. If you have any questions regarding moving and handling of patients within the Trust, please speak to a member of staff in the ward or department you are visiting. Northern Lincolnshire and Goole NHS Foundation Trust Diana Princess of Wales Hospital Scartho Road Grimsby 01472 874111 Scunthorpe General Hospital Cliff Gardens Scunthorpe 01724 282282 Goole & District Hospital Woodland Avenue Goole 01405 720720 www.nlg.nhs.uk Date of issue: December, 2015 Review Period: December, 2018 Author: Service Lead for NL/NEL, Goole Acute & NEL C&T's IFP-893 NLGFT 2015