A knee replacement involves major surgery. It is normally only recommended if other treatments, such as physiotherapy or steroid injections, are unsuccessful at helping to reduce pain or improve mobility.
A Surgeon may recommend knee replacement surgery if:
- A patient experiences severe pain, swelling and stiffness in the knee joint and reduced mobility
- A patient experiences knee pain so severe that it interferes with quality of life and sleep
- Everyday tasks, such as shopping or getting out of the bath, are difficult or impossible to complete
- A patient cannot work or have a normal social life.
- Joint School
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 patients are as fit as possible for surgery and ready to participate actively in their own care.
As part of the programme, patients meet with members of the orthopaedic team who will explain each stage of the patient journey from anaesthesia and surgery to 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 combination of preparation and education helps to remove many of the fears and anxieties which some patients experience prior to surgery.
- Enhanced Recovery Programme
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 main goal of the programme is to minimise the physical and mental stress of surgery. Using a combination of preparation and active participation, the priority is to help patients 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.
- Pre-Operative Assessment Clinic
Within one month before the operation patients will be invited to attend the Pre-operative Assessment Clinic. During this visit they will be asked about their medical history and any medications they are taking. Blood tests will be carried out and patients 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 gives patients the opportunity to see the Physiotherapist and Nurse, ask any questions they may have and plan for their discharge from hospital.
- Preparing for Procedure
It is important for anyone planning to have a total knee replacement to understand that an artificial knee is not the equivalent of a natural knee. There must be a realistic expectation about what the operation can achieve. Whilst over 90% of patients have a dramatic reduction in pain, the operation will not allow for a high level of athletic activities, particularly in some high impact sports.
In addition, many patients find kneeling and crouching difficult after a knee replacement due to some residual stiffness in the knee. It is important to remember that the knee heals slowly after a knee replacement and it takes at least three months for the swelling and skin discolouration to settle. The knee will continue to improve for up to one year after the operation as pain lessens and movement recovers.
The majority of joint replacement surgeries are complication free, however, the risks vary depending upon your age and overall health. The Surgeon will discuss success rates and complications with each patient.
Both 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 there are a number of things patients can do 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.
- The ProcedureDamaged cartilage and bone will be removed and the new metal / plastic implants positioned to restore the alignment and function of the knee. A total knee replacement takes approximately 1 to 2 hours.
- Following the Procedure
- 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.
- Patients will have a drip for intravenous fluids through a vein into the arm or hand which will continue until they are able to eat and drink again. Patients may eat and drink as required 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.
A patient's discharge date will be determined by all members of the Healthcare team involved in their care, who will work in consultation with their family.
Discharge from hospital normally occurs when patients reach 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.