Pre-Admission Clinic

The purpose of this visit is to ensure you are fit for surgery and have all the necessary information you need to prepare for surgery and therefore assist your recovery.  This visit could take up to three hours and will involve assessment from nursing and medical staff.  You will have your blood pressure, ECG, urine, blood test as well as an x ray.  You may be assessed by other members of the team, such as the occupational therapist.

Your total joint replacement preparation session

Once you are placed on the waiting list for surgery you will be invited to attend a group preparation class which will last about an hour.  During this time you will be provided with in depth information about your forthcoming hospital stay.  Any questions or concerns can be answered at this stage.  You will be given a patient notebook which is yours to keep and read at your leisure. This will reinforce any information given about your care.  During this session you will meet the ward physiotherapist and be provided with simple muscle strengthening exercises.

Your hospital stay

Most patients, except in certain circumstances come into hospital the day of surgery.

You should contact the ward on the eve of your surgery to confirm bed availability. The ward staff will inform you that you should arrive on the ward between 7am-7.30am and advise you from what time you should have nothing to eat or drink (usually midnight).

For patients having a knee replacement it is anticipated you will need to stay in hospital five to seven days.  During this time you will receive a daily patient news letter describing what will be expected of you each day and what is likely to be happening during your stay.  You will need to ensure that you have transport to bring you into hospital and also to take you home when discharged.  It will help if possible to ensure you make any necessary arrangements regarding assistance at home on discharge.

On the day of surgery

• Have a bath or shower using anti bacterial soap
• Do not wear any make-up, deodorant, perfume, lotion, talc, nail varnish or jewellery however a wedding ring is accepted.
• Do not bring any valuables or large amounts of cash, credit cards etc, as we cannot ensure their safety
• Do bring a 28 day supply of your regular prescribed medications with you.  They must be in their original container, i.e. bottle or box and clearly labelled with your name and directions for use.  Please leave any ‘controlled drugs’ for example morphine at home.
• You will also need nightwear, toiletries, and a change of comfortable clothes and suitable footwear.  (Patients wear normal everyday clothing whilst in hospital and recovering from surgery).

On the ward

When you arrive on the ward you will be asked to wait in the day room until one of the nurses can show you to your bed.

You will be asked to change into a gown and the nurse will check that you are correctly prepared for your operation

On return from surgery

It is expected you will return from theatre after a couple of hours.  On return you will be attached to an intravenous drip and patient controlled analgesia (PCA) pain relief along with oxygen. 

You will also have drains inserted at site of surgery which will remain for first 24 hours, your limb may feel numb and heavy if your anaesthetist has chosen to provide you with a nerve block. 

You will also have impulse boots in-situ this is to assist with your circulation and help prevent development of blood clots.

Nurses will carry out regular observations until you have recovered from your operation. After a couple of hours you will be allowed to start drinking small amounts of water. A light diet may be offered if the nursing staff assess you as having recovered sufficiently from your anaesthetic.

You will remain in bed for the rest of the day and you will be helped to change position regularly.

Day one

Today your drains will be removed and a lighter dressing applied.  Your PCA will be discontinued along with your oxygen therapy and suitable oral pain relief prescribed.

If you are tolerating drinks, your intravenous drip will also be taken down. You will be taken to the x - ray department on your bed and you will be assisted out of the bed by either the physiotherapist or a nurse. 

You will be instructed regarding the type of exercises which will be expected from you and provided with regular ice pack to help reduce swelling which is to be expected.  Once up and out of bed you will no longer need pulsation boots and will be fitted with elasticated stockings. 

You will receive intravenous antibiotics as a precautionary measure in all joint replacement surgery. Once completed your cannula (the small plastic tube in your hand) will be removed.

Days two to three

Over the next couple of days your physiotherapy will continue and you will progress from Zimmer frame to elbow crutches and possibly walking sticks .It is hoped that you will achieve a 90 degree flexion in your new knee and be able to straighten your knee and lift your leg. 

You will also be encouraged to start wearing comfortable, loose fitting clothes and your independence will start to be increased.  Your elasticised stockings will be changed every other day and your legs will be washed. You will be supplied with 2 pairs of stockings, which can be washed. 

You will be allowed to have a shower as your wound will be covered with a waterproof dressing and will remain undisturbed as far as possible to prevent contamination. 

The occupational therapist may carry out a dressing and kitchen assessment with you assisting with the preparation for a safe discharge.

Day four

You may well be ready for or approaching discharge. You will be assessed by nursing, physiotherapy staff as to your safety.  You may have to demonstrate safety on stairs and general mobility.

If your wound is clean and dry and you have reached the desired goals and your consultant is happy with your progress you will be allowed home. It is hoped that where possible you have transport home with the necessary support you require at home.

You will be provided with necessary pain relief and your own remaining medication to take home and a district nurse will be contacted to remove your clips 14 days following surgery.  You will also be issued with a joint replacement card. The purpose of this is to remind you that during any dental or other surgery, your new joint must be protected with antibiotic cover to prevent possible infection.

Day of discharge

Everything should now be organised for your safe discharge.  You may be asked to vacate your bed area early morning in order for the bed area to be cleaned for a new patient.  You will be assisted into the dayroom where you will receive your breakfast with other patients going home that day.  It is aimed that everything will be ready for you discharge at about 10-10.30am and providing you have your own transport there should not be any delay.  Your wound will be redressed and final checks from the physiotherapist and occupational therapist will be made to ensure you are prepared.

You will be reviewed in the musculo skeletal outpatients department (MSU) usually six weeks after surgery.  At this visit you will be seen by either your consultant, or member of his team.  At this visit you may ask any questions about your recovery and the care of your new joint replacement or the need for further surgery.

• Physiotherapy would not usually be arranged unless required.  It is important that you continue to take your pain killers and do not stop this too soon.  Please continue to carry out the knee exercises demonstrated by the physiotherapist in hospital and following discharge in order to maintain your rehabilitation.  Failure to do these exercises may significantly delay your rehabilitation.
• If you have had a knee replacement it is normal to have a degree of discomfort and we recommend that you take your analgesia 20-30 minutes before performing your exercises.

Your follow up procedure should be as follows unless there are any special instructions:

• At your six week follow up visit after surgery you would not normally be x rayed unless you have had further surgery to your joint.  Your wound will be checked and your range of movement examined.
• About three months after surgery you will have an x ray taken of your recently replaced joint and an examination of your range of movement.
• After one year and every two years, you will have an x ray of the joint and an examination.

It is very important that you keep your outpatient review appointments and inform the outpatient department if you are unable to attend or you require an alternative date.  Please contact the Musculo Skeletal Outpatients department on 0190 2331109 within office hours regarding any changes in your appointment.

Other useful contacts

Ward 19:  (0191) 213 7019
Ward 20:  (0191) 213 7020
Physiotherapy:  (0191) 244 8219 or 223 1024
Occupational Therapy:  (0191) 213 7677