Knee replacement patients are generally in the 'autumn of their days'. It's important to ensure your family is part of the education process when knee replacement surgery is pending.
Their support is critical for a successful rehab which can take months after surgery. Ask that they attend the pre-op clinic with you so any questions they have can be answered. Like you, they will want to know about the risks involved in surgery, the medications you will find it necessary to take, the rehab protocol and in general, how they can assist your recovery.
There is usually a very formal routine when you are just about to go to the operating room (operating theatre) -
- Although the ward nurses already know you, they may still have to formally check your name on a wristband, with which you will be supplied.
- This may be checked again in the operating room, and you may be asked to verify your details.
- You may already have signed a form consenting to surgery, but it is likely that this will again be formally checked in the operating room.
- You may be asked to confirm which leg is being operated upon. The leg ma be marked with a black pen.
- A drip will likely be put in while you are still awake.
- A heart monitor may be attached while you are sill awake.
- If you are having a general anaesthetic, this is about all you will know before an injection is given and you are asleep.
- For a spinal or epidural anaesthetic it is more complicated.
Both of these work by inserting local anaesthetic near the spinal cord, and paralysing the nerves. For this, you will likely be turned on your side and rolled up as far as possible, while the anaesthetist goes behind you. A small prick of local anaesthetic will numb the skin.
Sometimes this is done in a sitting position.
A spinal anaesthetic inserts the anaesthetic fluid in one go into the space around the spinal cord via a fine needle - in skilled hands it is usually quick and easy. As soon as the injection is given, the needle is withdrawn and a sticky-plaster applied.
Epidural anaesthesia is a bit more complicated. The anaesthetist places the anaesthetic agent outside the casing of the spinal cord, and a bigger needle with a plastic cover is used. It may take longer to find the exact position. The needle is withdrawn and the plastic part remains in position, allowing the anaesthetic to be topped up during and even after the procedure.
After your surgery
The post-op week in hospital -
The policy with regard to 'intensive care' (ITU or ICU) will depend on your surgeon and the hospital. The older patient having a knee replacement may be taken to the intensive care unit more or less as a routine after surgery, to make it easier for the ward staff and to be safer for the patient. It will not necessarily mean that there have been complications.
The drip is likely to be continued for at least 24 hours, and blood may be given via the drip.
The knee is likely to be have a drain inserted through the skin (48 hours).
A 'CPM' (continuous passive motion) machine may be immediately applied - this gently and slowly bends and straightens the knee. It is not uncomfortable, but of course it is necessary to lie on your back and makes it hard to wiggle around in the bed.
Pain management will initially probably be via injections into the leg or buttock. Later tablets will be given. If epidural was used, it may be continued for a while in the ward to offer pain relief.
A bedpan will be necessary for at least 24 hours.
Managing back at home
- With regard to getting in and out of the car, hospital staff may wave you goodbye at their station without a thought to how you'll get on with this difficult task. The easiest may be to sit on the back seat with your legs supported on the seat - you can still get the seat belt on OK. Patients just need to sit on the seat first and then slide backwards, bad leg against the back of the seat.
- Household chores are probably already difficult but there are things which will be harder immediately on return from your knee replacement. Your family will need to take over some of the chores - those that require longish periods on your feet - ironing, gardening, cooking.
- In any event the family will need to make arrangements for taking over all your chores while you are in hospital, and be flexible if it turns out that you need more than the expected 7 to 10 days.
- It's sometimes as difficult for the family of a TKR patient as it is for the patient themself! Like you, their sleep may be disrupted if they are your primary care-giver. They may have the same mood swings as you do, feeling helpless when seeing you in pain. Keep the lines of communication open so they know they are an integral part of your recovery. And donâ€™t forget to THANK them!
- It will be helpful for the family to have a grasp of the extent to which you will need car and bathroom to be modified for you once you are back home. It takes time to buy and fit bath grab bars, for example.
- Most people having a knee replacement are likely to be retired, but many will still have work commitments. Inasmuch as arthritic patients have been struggling with their daily lives anyway, they often manage remarkably well getting back to their normal routines.
- Two months is probably the least you can allow, and should allow you to get the benefit of the rehab sessions within your rehab allowance, but it will take six months or longer to really get fully confident with the knee and to take on new activities.
Rehabilitation programme for the first month
- The first month will concentrate on regaining general mobility and then on regaining flexion (bending) of the knee. The greater the effort you made pre-op in building upper body strength, the easier it will be to use crutches, sticks or other walking aids like a Zimmer frame.
After the first month and beyond
- After the first month rehabilitation will concentrate on building general fitness, and balancing the various muscle groups that support the knee.
Dental work around the time of surgery
- There appears to be a conflict between the dentists and the surgeons. Patients are usually told that any dental treatment other than the routine clean requires antibiotic treatment beforehand. Dentists on the other hand may insist they've been instructed to only give this treatment for patients with heart conditions. It's best to ask your surgeon for instructions, and for a note for the dentist.
- It might also be worth adding that any infections in addition to the knee area also need quick intervention with antibiotics.