The Joint School is a programme run by the Mater Private to help prepare patients for joint replacement surgery. The aim is to ensure that they are not only as fit as possible for surgery but that they are ready to be an active participant in their own care.

Patients meet with members of the entire team who will explain the roles of surgery, anaesthesia, physiotherapy, recovery and pain relief.

The Joint School has been hugely successful in encouraging and enabling patients to become active participants in their care. This preparation and involvement also removes many of the fears and anxieties which some experience prior to surgery.

The Enhanced Recovery Programme (ERP) is a multidisciplinary and goal based approach which encourages the patient to become an active participant in their recovery process and rehabilitation. The goal is to minimise the physical and mental stress of surgery through a combination of preparation and participation so that patients can return to normal, daily activities as soon as possible.

In practical terms this means that the nursing and physiotherapy teams commence rehabilitation within 24 hours of surgery. The anaesthetic and pain relief protocols have been enhanced – which has the benefit of allowing patients to move earlier and recover faster.

Within one month before the operation, patients may be invited to attend our Pre-operative Assessment Clinic. During this visit they will be asked about their medical history and any medications they are taking. Patients will have blood tests carried out and may have an ECG and x- ray.

A Consultant Anaesthetist will discuss the options for anaesthesia, as well as the risks and benefits associated with each. Pain management plays an important part in recovery and rehabilitation and is often of great concern for patients. The Consultant Anaesthetist and Nurse at the Clinic will talk to patients about pain management after surgery.

The Pre-operative Assessment Clinic is an opportunity for patients to meet with the Physiotherapist and Nurse, ask any questions and plan for their discharge from hospital.

As is the case with a total knee replacement, it is important to be as fit as possible in advance of revision knee replacement surgery.

Patients and their Healthcare team can take several actions before and after surgery to reduce the risks of complications.

It is important to be in the best possible overall health and patients can do a number of things to prepare for surgery, recovery and rehabilitation

Diet - In the weeks before surgery eat a balanced diet as this can help the healing process.

Smoking - For patients who smoke, stop as far in advance of surgery as possible. Smoking may cause complications with the anaesthetic and nicotine can delay or interfere with healing and bone growth.

Blood Clots - To reduce the risk of developing a blood clot in the legs or lungs, a number of recommendations will be given in advance of your surgery.

Infection - If there are any signs or symptoms of an infection, such as a chest or urinary infection in the days prior to surgery, inform the Surgeon. The Surgeon will also need to be advised of rash or flare up of psoriasis or eczema around the hip area or a leg ulcer. Patients who have a history of MRSA/VRE or have been in contact with someone with MRSA/VRE, should inform their Health Care Team.

Exercise - It is important to be as fit as possible before the procedure, as this will make recovery much faster. Patients will be given a personal exercise programme to follow in advance of and for a time after the procedure.

To begin with, the Surgeon will remove the original implant and prepare the bone surfaces for the revision implant. In some cases, there may be significant bone loss around the knee. If this occurs, metal augments and platform blocks can be added to the main components to make up for the bony deficits.

Finally, the Surgeon inserts the specialized revision implant, repairs any surrounding soft tissues that are damaged, and carefully tests the motion of the joint. A drain may be placed in the knee to collect any fluid or blood that may remain after surgery.

Complications

As with any surgical procedure, there are risks associated with revision total knee replacement. As the procedure is longer and more complex than primary total knee replacement, it has a greater risk of complications. Before surgery, the Surgeon will discuss each of the risks with you and will take specific measures to help avoid potential complications.

The possible risks and complications of revision surgery include:

• Poor wound healing
• Reduced range of motion or stiffness in the knee
• Infection in the wound or the new prosthesis
• Bleeding
• Blood clots
• Bone fracture during surgery
• Damage to nerves or blood vessels
• Pulmonary embolism—a blood clot in the lungs
• Medical problems such as heart attack, lung complications, or stroke

• Patients will be moved to the recovery area until stable enough to return to the ward where the team will work closely to aid their recovery.
• A drip for intravenous fluids will be inserted through a vein into the arm or hand which will continue until the patient is able to eat and drink again. Patients may eat and drink when they wish and we advise commencing with sips of water followed by a light meal.
• The leg will be wrapped in a large bandage and there may be a drain in the knee which is normally removed in the days following surgery.

Discharge

The discharge date will be determined by all members of the Healthcare team involved in the patient's care in consultation with the patient and their family.

Discharge from hospital normally occurs when patients have reached specific goals such as the distance they can walk or how much their wound has healed. The Surgeon will discuss the expected length of stay prior to admission.

Patients generally return to their own homes after discharge from hospital as they typically do better in their own familiar environment. They are given a home exercise programme and rarely require further physiotherapy.