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What can I do to prepare for my knee replacement?

1. Be positive about your operation, and its success

To the average person the words Total Knee Replacement may sound as if their active life and all sports are to end. This is definitely not the case. Once a knee replacement is performed, successful rehabilitation will allow you to walk, swim, dance, bowl, cycle and play golf. Running jumping, jogging, contact sports or other high impact activities are not advisable because these activities will increase wear and possibly loosening of the artificial knee joint implants, resulting in the need for further surgery.

One of the most important things for the average patient to remember about having knee surgery is that you will be making a lifetime commitment to physical fitness.

For a total recovery, which means returning to a functional pain free life, the typical patient will need to go through rehabilitation home-based maintenance physiotherapy for approximately 12 months after surgery. Improvement in the knee replacement continues for over a year following surgery. Working as a team, you and your family must take on a positive attitude toward the success of your surgery. Together, you will gain a clear understanding of the common goals and expectations of the procedure.

2. Eating

If you are overweight you will find it very helpful to lose some weight before the operation. In occasional cases this makes the operation unnecessary. Any weight reduction will make the operation improve your mobility after the operation. If you would like some help with losing weight, please ask the doctor in clinic or ask your own GP to refer you to a Dietitian.

3. Smoking

You will be having either spinal anaesthetic (in combination with sedation) or a general anaesthetic (GA) for the operation. Smokers are very much more at risk of developing breathing problems such as chest infections after an operation. You are advised not to smoke for a week before the operation. The hospital has a no smoking policy - why not take advantage of this and make it your time to give up!

4. Alcohol

There is no reason why social drinking should be stopped before surgery. If you are a woman and drink more than 14 units of alcohol per week or a man and drink more than 21 units per week, problems could arise when it is suddenly stopped on admission to hospital. Please talk to your GP and get some advice on how to safely reduce your alcohol intake before admission to hospital.

1 unit = 1 pub measure of spirit or wine or half a pint of beer

5. Health

If we were to operate on you when you had an infection, e.g. an ulcer or a bad tooth, the infection could enter the joint and cause problems. It is very important that you have such infections treated straight away - make an appointment to see your GP or dentist. Any wound or scratch on your leg could cause your operation to be cancelled, so please take care while you are waiting for your operation.

6. Exercise

You will be recommended a low-impact exercise plan that will strengthen your knee without creating further damage.

Things to consider and/or arrange before your admission

Planning for your needs for after the operation will make life a lot easier for you on your return home. If you live alone, you may find it helpful to think a little about those items you use a lot during the day and where they are kept e.g. clothes/crockery/tea/coffee etc. If they are in low cupboards/drawers it may be a good idea to make them easier to get to. If this is difficult ask family or friends to help you.

At first you will not be able to carry out many of your everyday domestic tasks e.g. shopping, housework, laundry. It is also not advisable to carry items when using walking aids. It is, therefore, very important that you think about and organise any help that you need from family and friends. Home helps are only available in some cases and at the discretion of the medical social worker.

Bring into hospital with you a change of everyday clothing. This needs to be comfortable and to include a pair of good supporting shoes. This will allow your rehabilitation to begin as soon as possible. You may prefer shorts to trousers to allow access to your knee for exercises and the application of ice if needed. If you are unable to make any of the above arrangements please inform the ward staff when you come into hospital - this will enable us to discuss alternatives with you as soon as possible, to help you have a safe discharge home with your new knee. Ice is a natural anaesthetic that relieves pain. You may find it helpful to have a pack of frozen peas/crushed ice available in your freezer before your admission to hospital (do not eat peas afterwards!).

Your home

If your home is empty while you are in hospital, let your local police know when you are being admitted. They will try to keep an eye on it. Do not forget to stop your milk and paper deliveries.

When you are going home

If it is identified that you will need support on discharge to return home safely a referral will be made to the hospital’s Social Work Department. Working within the eligibility criteria, an assessment of your needs will be completed by a Community Care Assessor or Social Worker. Support or care will be based on your needs and can include care from the Discharge Assessment Team, Social Services Home Care, or Agency.

We can also refer you to a frozen meals service and can access support from the voluntary agencies such as Age Concern for hospital discharge service or shopping. Please note that you may be charged for these services.

Pre-operative assessment

Before your admission an appointment will be made for you to attend the pre-operative assessment clinic at Broadgreen Hospital to ensure that you are fit for surgery and anaesthetic. At the clinic a qualified nurse will check for your general medical fitness, measure your blood pressure, pulse, weight and height. In addition you may be sent for blood tests, ECG (heart tracing) and a specimen of urine will be collected to ensure that you do not have a urinary infection. Up to date x-rays of your knee and chest x-rays will also be ordered if necessary.

At this appointment you will also been seen by the physiotherapist who will carry out a physical assessment of your knee to enable the development of an individualised rehabilitation programme.

If, following the assessment, anything is found that would prevent you from having surgery, the nurse who carried out your assessment will contact you and advise you on the next course of action and a referral letter will be faxed to your GP. Try and ensure you are as fit as possible at this stage otherwise your admission date may be postponed. You can expect to be at the pre-operative clinic for about half a day.

Please bring your urine sample in the bottle provided (this will be sent with your appointment), any medication (including any bought from health food shops or Chemists), and your completed NJR consent form when you attend for your pre-admission assessment.

If for any reason you are unable to attend for your pre-operative appointment please contact the pre-operative assessment office on the number provided at the end of this booklet. Failure to do so may result in your operation being cancelled.

Pre-operative education group

You will be scheduled to attend a pre-operative education group where you will meet your therapists who will explain your rehabilitation and answer any queries. You may be shown exercises to strengthen the muscles around your knee before the operation.

On admission to hospital

What to bring in with you

There is very little storage space available, and staff need to move freely around your bed. Please keep your personal possessions to the minimum.