Home Page

Date issued: November 2023

Review date: November 2025

Ref: A-603/TS/Orthopaedic/Preparing for your Knee replacement operation

PDF:   Preparing for your Knee replacement operation final November 2023.pdf [pdf] 734KB

A joint replacement operation is undertaken to improve your quality of life and hopefully allow you to do some of the things you want to in life that have become difficult with your joint arthritis.

This booklet has been written by the teams who will look after you during surgery. It aims to help you understand the surgery, and how you can best prepare and recover afterwards.

Welcome to University Hospitals Plymouth

You are having your surgery within UHP and you will visit one of our orthopaedic wards. The orthopaedic wards are Meavy, Bantham, Shaugh and Sharp.

These wards offer elective care, meaning that we are able to treat  patients who have planned surgery.

Our hospital offers treatment to people across the South West of England.

For more information about the hospital, please visit our website:  www.plymouthhospitals.nhs.uk

Getting to the hospital: Plan for traffic delays

We are aware of multiple roadworks taking place around Plymouth and especially in the Derriford and Crownhill areas. For more information on road closures and diversions, visit Plymouth City Council’s website. Please bear in mind that these roadworkses are also affecting bus services in the area. If you have an appointment, please expect delays in your journey and plan in advance.

Update to parking arrangements

Due to some significant development works it has been necessary to change some of the parking arrangements at the rear of the hospital. The disabled spaces that were in the Oncology car park have now been relocated to the NBS Blood Donor car park. The NHS Blood fleet vehicles have been relocated to the estates car park. Parking spaces for blood donors continue to be provided in the NHS Blood Donor car park. All parking for disabled badge holders and blood donors in this car park is free.   

Some patients are entitled to free parking, please visit our website for further information www.plymouthhospitals.nhs.uk

Preparing for your operation

Care agency support

Very few people require professional care support at home. If your personal choice is to have this help, you must arrange this privately, you may find your local council helpful for further information. The NHS can only provide professional care based on specifically assessed need and cannot arrange convalescent care.

You can contact a charity such as the British Red Cross or your local Age UK to see whether they can offer home help to support domestic duties and shopping (they may not be free).

Plymouth Plymouth City Council: 01752 668000 or visit www.plymouth.gov.uk Age Uk: 01752 256020 or visit www.ageukplymouth.org.uk

Devon Devon County Council: 03451 551007 or visit www.devon.gov.uk Age Uk: 0333 2412340 or visit www.ageuk.org.uk/devon

Cornwall Cornwall County Council:01736 756655 or visit www.cornwall.gov.uk Age Uk:01872 266388 or visit www.ageuk.org.uk/cornwall

Prepare your home

Preparing your home environment in advance is really helpful for when you get discharged.

For example, you can

• Freeze some simple-to-cook meals or have some ‘ready meals’ on hand

• Move any regularly used items that are heavy, or out of reach, to more accessible places eg: move the saucepans you use frequently up from any low shelves or cupboards.

• Avoid potential trip hazards by removing any loose rugs or obstacles from the floor such as excess furniture or things that would be easy to trip over

• Make arrangements for someone to care for any pets including walking dogs after your surgery.

Keep fit and healthy

The fitter you are before your operation, the less likely you are to have complications during and after your surgery.

You should seek to make some lifestyle improvements, such as

• Reducing alcohol intake

• Stopping smoking

• Keeping as mobile as possible and exercising

• Losing weight

If you have long term health conditions you should aim to control these as well as possible before your operation to help prevent any complications and to avoid your operation being postponed.  It would be really helpful for you to check your own blood pressure if you are able to do so or get it checked at your GP.  If it is above 160/90 you are likely to require medication and the sooner this is started the sooner, we will be able to go ahead with your surgery.

Similarly, if you suffer from Diabetes and your HbA1c has not been checked for 6 months or was over 69mmol/mol the last time it was checked, please arrange to have this checked again and work with your diabetic adviser to improve it.  It is very unlikely that your surgery will be undertaken if your diabetes is not well controlled and your HbA1c is above this value. 

Pre-operative assessment

The pre-operative assessment process is important as it helps the hospital plan your care.

You will be asked by the hospital to provide some information about your general health and current medications. You may need to provide this information via

• A computer or mobile app

• A telephone consultation

• A video consultation, or

• A face-to-face appointment

This allows us to inform and advise you about your procedure, for example, we can provide you with instructions about medications and fasting times before your operation.

What details will be checked?

At your pre-operative assessment appointments, we will check various medical details, such as

• Your general health status

• Your blood pressure

• Your blood count to see if you are anaemic

• Your kidney function

• How well you are controlling your diabetes

Medicines

We will also review your medicines. It is fine to continue taking most medicines, and to take them on the day of your surgery. However, there are certain medications we may need you to stop taking for a few days before your operation, such as

• Blood thinning/ anti-clotting medication, or

• Some blood pressure medications

We will give you clear instructions if this is needed and tell you when you should start these medications again after your surgery.

Do your physiotherapy exercises

The exercises in section 5 of this booklet are to be completed both before and after your surgery. Doing these exercises before your operation will strengthen your muscles and will help you to recover more quickly after surgery.

On the day of your operation

You will be given a specific time to arrive. This may be 7.00 in the morning, or later on depending on the time of your operation.

Eating and drinking before your operation

You must follow the instructions about fasting times. It is important that you follow  the fasting instructions correctly or your operation may be at risk of being cancelled on the day. You must not have any food or very milky drinks within 6 hours of your surgery.

We encourage you to continue to drink plain, still water up to the time of your operation.

What to bring with you to the hospital

• All your current medication in original packaging, please do not bring your medication in dosette/pill boxes.

• Wear loose, comfortable day clothes to get dressed back into after your operation. Your leg may be swollen after your surgery so make sure this is an appropriate size.

• Flat, study footwear with a back in it, for example no mules

• Small overnight bag in case you are not ready to return home on the same day

• Glasses, hearing aids or walking aids that you might have

• Phone, charger, headphones (+/- music device) if you would like to listen to music during your operation

• It is also a good idea to bring something to read/keep you occupied in case you have to wait. WiFi coverage can be variable.

• Contact details of the person who will be picking you up

• Any letters you receive from the hospital giving you arrival instructions for the day of surgery

Please try to avoid bringing in a large number of items with you and minimize items of high value or cash.

Arriving at the hospital

When you arrive you will be greeted by a member of the reception team. They will book you in and confirm some details with you. You will then be seen by one of the nursing team who will run through some additional questions.

Confirming your consent form

The surgical team will confirm with you the operation that they are planning to perform and check your consent form with you. They will mark an arrow with a pen on the leg that is going to be operated upon.

They will also be able to answer any last-minute questions that you may have.

Meeting your anaesthetist

Before your operation, you will meet your anaesthetist. They will explain the type of anaesthetic that is going to be used, and answer any questions you may have about the anaesthetic. Your anaesthetist will also give you some pain relief tablets to help manage your pain after the operation.

Getting ready for your operation

When it is time for your operation, you will be asked to change into a theatre gown. You will then walk to the operating theatre with one of the team. There, you will be greeted by your anaesthetist and you will also meet the operating department practitioner, who works with the anaesthetist, helping to look after you.

Routine checks

Some routine checks will be carried out to confirm your identity and to check if you have any allergies. We will also once again confirm your operation with you, and the side on which you are having the operation.

Attaching monitoring equipment and a drip

One of the team will attach some standard equipment to monitor your heart, blood pressure and oxygen levels while you are having your anaesthetic and operation.

Your anaesthetist will also be giving you various medicines through a drip in the back of one of your hands. These include antibiotics, anti- sickness medicines and fluids.

Spinal anaesthetic

In most cases, your anaesthetist will give you a spinal anaesthetic. This is very safe, and avoids the need for having a general anaesthetic, which may cause unpleasant side effects.

Spinal anaesthetic also helps you to recover quickly and receive the best post-operative pain relief.

Local anaesthetic is placed around some of the nerves in your lower back. This numbs your pain nerves so that you do not feel pain during the operation. Once it is confirmed that the anaesthetic is working well, you will be taken into the operating theatre.

Nerve Blocks 

You will also have some special nerve injections performed which help control your pain after the operation. These injections are done around the knee after your spinal anaesthetic so they will not be uncomfortable to have performed. Local anaesthetic is placed directly around some of the nerves that supply the knee and work for several hours alongside the other pain relief we give you.

Your anaesthetist will be able to explain more and answer any questions you have. If you would like more information on this before the day of your operation then please visit: www.rcoa.ac.uk/patient-information/patient-information-resources/ patient-information-leaflets-video-resources

The operation 

Once you are in the operating theatre, your leg will be painted with some cleaning fluid and then covered with drapes. You will not be able to see the surgery and the spinal block will prevent you from feeling any of the operation. 

Some people find listening to music through their headphones to be a good distraction. It helps them to relax and this will be offered to you. You may wish to bring your own music on your phone or portable music device, and your own headphones. Some people prefer to have a small amount of sedation so that they have a light sleep through their surgery. Your anaesthetist will discuss and agree with you a plan depending on your medical history, and also your wishes.

The operation typically takes about 1½ hours. During this time, your observations will be continually monitored by your anaesthetist.

Collecting blood 

We usually collect any blood you lose during the operation via a machine called “cell salvage”. Should you lose a sufficient amount of blood, this allows us to return your blood to you.  This will help improve your wellbeing and recovery after the operation. It also reduces your chances of needing a blood transfusion with donated blood.

After the operation 

At the end of your operation, you will be transferred to the recovery area where the nurses will monitor your observations. You will also be given a post-operative drink and food.

When your spinal anaesthetic has sufficiently worn off, you will be assessed by the therapy team. Our nursing and therapy teams will help you get up off the trolley, stand, and practice walking with suitable walking aids. The team will practice with you getting on and off the  bed, chair, toilet and give advice on how to dress. If you require any equipment to assist you this will be assessed and provided prior to your discharge. You will also be taught how to safely complete the stairs.

In order for you to return home, the team needs to be happy that you can manage these activities at home with walking aids. You will also be encouraged to get dressed in home “day clothes” with supportive footwear.

Going home after your operation

Returning home

Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or, if you need to spend a little longer with us at the hospital.

Arrange for someone to collect you

When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital.

Arrange for support at home

If you live alone you may find it helpful to arrange for a friend  or relative to stay with you for a few days after you return home. You  should arrange this before you come in to have your surgery.  

Wound dressing

Your wound is covered by a shower proof dressing so you can shower as soon as you feel able but do not aim water directly at the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound dressing removed. Please leave it in place until this appointment.

It is your responsibility to book your practice nurse appointment, the nurses on the ward will advise of this.

Keep active after your operation

The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle. 

Pain control 

Joint replacement surgery is painful - just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild- to-moderate pain on movement. It is not going to be 100% pain-free.

The pain relief package you receive has been specially designed to try and control your pain as well as possible. It starts from the day of your surgery, and continues after your discharge home. We will give you the same pain relief tablets whether you stay in hospital overnight, or return home on the same day as your operation.

The pain relief package requires you to take your medicines at specific times.

Additional medications 

We will be asking you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses.

Digital support 

Numerous recovery programmes after surgery are supported by the use of digital technology. Many centres now have a web or app-based software resource that can provide you important information. They can also collect key data about how things are going for you; for example: the amount of activity you are able to undertake, questions on pain medication usage, or side effects.

We would encourage you to use one of these resources if you are directed to do so. This information enables your physiotherapy team to track whether you are making the progress we would expect, or whether we should contact you to provide additional support.

What to expect when you get home

Swelling 

It is common to have some generalised swelling of the leg around the knee replacement. Swelling will often get worse if you sit for prolonged periods so we encourage you to remain gently active. Elevating your leg, ensuring you keep the knee straight will help reduce swelling. If you experience increased swelling and pain, please seek medical advice.

Constipation 

Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain- relief package. However, please ensure that you take these as prescribed, along with plenty of water to drink. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP.

Pain 

Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises.

Please make sure that you follow the pain management programme you were discharged with in order to help control your pain.

Sleepless nights 

It is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. Do not sleep or rest with a pillow underneath your knee.

What to look out for 

Deep vein thrombosis (DVT) Blood clots in the leg can occur after joint replacement surgery. If your leg becomes hard, swollen, hot and painful, especially in the calf area, then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms.

Infection is very rare. However, if your joint replacement or scar becomes hot, red and/or increasingly swollen or if you feel unwell, then please do seek medical assistance.

Support after discharge 

The Ward team will let you know what arrangements have been made for your follow-up appointments. 

Even though you may be discharged after your operation, you are not alone. There is always someone available whom you can contact for advice. You will be given information about whom to contact should you require any help.

You will receive a routine follow-up telephone call to check on you the day after you go home, if you are discharged day of surgery.

If you would like more information before your operation or have any questions in the first 7 days after you have been discharged home, please ring the hospital switchboard on 01752 202082 ask to be put through to your discharging ward, the  nursing staff will be able to advise you directly or be able to contact  people from your surgical team for you.

For therapy related queries please contact 01752 432255 or 01752 432220.

If you are unable to contact one of the UHP team, please ring your surgical consultant’s secretary, who will be able to assist you with contacting one of the team.

Therapy advice following your Knee Replacement Surgery

Completing the following exercises will benefit your recovery, improve movement in the knee joint and develop the strength of the muscles around it.

These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery.

Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.

Initially the exercises may feel difficult due to pain and weakness, so it is important that you take your pain medication regularly.

It is normal to feel a stretch around the operation site when exercising. It is important to continue all the exercises once you have left hospital.

Foot exercises

Move your feet up and down from the ankles when you are sitting or lying. Do this up to 10 times regularly throughout the day. This will help with reducing lower limb swelling which can take several months to settle down and it reduces the risk of blood clots.

Static Quadriceps 

Sitting on your bed or on a flat surface with your legs out straight and toes pointing to the ceiling. Press the back of your knee on to the bed as firmly as possible to tense up the thigh muscle. Hold for 5 seconds and then relax.

Repeat up to 10 times.

Straight Leg Raise

Lying with your legs straight on the bed, pull your foot towards you and tighten your thigh muscle straightening the knee. Lift your leg 15cm which is 6 inches off the bed. Keep your knee straight.

Hold for 3 seconds and slowly lower your leg. Repeat up to 10 times.

Heel lifts 

For this exercise you will need to place a rolled-up blanket under the knee and allow the knee to bend. Keeping the back of the knee on the blanket, tense

the thigh muscle and lift your heel off the bed. Try and straighten the knee as much as possible and hold for 3 seconds. 

Lower your heel slowly and repeat up to 10 times.

Knee flexion

Sitting in a chair with your thigh well supported and your foot on the ground. Slowly slide your foot towards you, bending at the knee. Keep your bottom and thigh still on the chair. Placing something under your heel to make a friction free surface to allow your foot to slide on the ground will make this easier. You should feel a stretch in the thigh and knee.

Repeat up to 10 times.

This exercise can also be done in lying, sliding your knee towards you keeping your heel on the floor or bed.

Passive knee stretch 

It is important to retain full knee extension of your knee. Sitting or lying with your leg out in front of you, put your heel on a block or rolled up blanket so that there is no support beneath the knee. Let the knee stretch in this position. Begin with a short time, working up to 5 minutes as tolerated. The aim is to get your knee as straight as possible which will help you with your walking. Ensure that you do not rest with a pillow under your knee.

Exercise progression 

Following your knee replacement, you may be referred to your local physiotherapy department to continue your rehabilitation. It is important to continue all the exercises once you have left hospital until you have recovered from your knee surgery.

Ice packs 

Using ice packs can help reduce swelling and ease the pain. Use a bag of frozen peas or ice, wrapped in a damp cloth to allow cold through but to protect your skin from an ice burn. Place onto the knee and leave for up to 20 minutes. Allow 1-2 hours between ice applications to allow your skin to return to normal.

Walking 

Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis and to steadily increase the distance as you recover.

As soon as possible try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking continue to use your walking aids.

Stairs

The therapist will practice with you how to safely complete the stairs before going home. To go up and down the stairs, use a banister rail if there is one.

Go up leading with the unoperated leg first, followed by the operated leg and then the crutch.

Going down, put the crutch on the step below, then step down with the operated leg, followed by the unoperated leg.

Activity

Movement is good for your new knee but remember your knee is an artificial joint. Pace your activity, walk and exercise your knee regularly, little and often.

It is safe to kneel on a knee replacement. Some people find initially the nerve endings around the scar may be sensitive, this should improve.

Kneeling on a cushion to start may help.

Rest

It can take time to recover from a total knee replacement. Elevate your leg (ensure you keep your knee straight) to help reduce the swelling.

Do not sleep/ rest with a pillow underneath your knee.

Getting dressed

To put pants or trousers over your feet, hold the waistband and lower garment to your feet, inserting the operated leg first followed by the other leg before pulling right up. 

To undress, complete in reverse. A helping hand, shoehorn and sock aid can make dressing easier and would need to be privately purchased. These are readily available from mobility shops, pharmacies and online.

Relationships

It is normal for your sex life to change initially following a joint replacement. Sexual intercourse may be resumed when you feel comfortable.

Driving

You can travel as a passenger in a car immediately following your operation. It is best to sit in the front seat, with the seat well back and reclined. An extra cushion on the seat can be helpful.

As a passenger gently lower yourself down onto the edge of the car seat keeping your operated leg straight and out in front of you. Slide back into the seat then lift both legs in as your body turns to sit upright in the seat. You may find a plastic bag on the seat helps you to turn smoothly. Remove the bag once you are seated. If possible, get into the car directly from the drive or road rather than the kerb or pavement.

You can usually resume driving around six weeks after your knee operation. Ensure you have adequate flexibility as driving requires good knee movement and stability. Stop regularly on longer journeys so you can get out of the car to change position and move around.

You may wish to inform your insurance company before you start driving.

Returning to full activities 

Most people are ready to return to work at six to eight weeks after their operation. Air travel should be avoided whenever possible for the first six weeks. Depending on the sensitivity of the security scanner it may set off the alarm.

You can resume most physical activities as soon as you feel comfortable and confident, and you can swim once your wound has healed, starting with straight leg kicking and avoid breaststroke initially. Exercise bikes and treadmills can be used once knee movement allows, returning to outside cycling once comfortable. If you play golf, we suggest you can resume gradually after six weeks. For activities such as tennis, badminton, and cricket we suggest resuming from around 3 months.

You can run short distances but longer distances risk wearing the joint and reducing how long it lasts.

Contact sports are not advised following this surgery.

Equipment

The walking aids and any equipment prescribed to you after your surgery are provided by local services. The equipment can be returned to your local Council recycling centres or your local hospital’s equipment return store. Alternatively, please ring the number on the sticker on the equipment to discuss its return.