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Total Knee Replacement

Procedure Guide and Patient Instructions

Pre-Admission Clinic

You will be required to attend a pre admission clinic. Everything you need to know about what to do before, during and after your stay in hospital will be discussed at length at this clinic. Your doctor will also examine you and ask you questions, and you should let them know if you have any abrasions or pimples around the knee.

At this clinic the following will be attended to:

Blood tests
You will have simple blood tests to make sure your blood count is normal and you have no other major medical problems. Because knee replacement is such a major operation with drilling and cutting involved there is a higher risks than in most operations of the health care team catching diseases transmitted by blood. For this reason, a sample of your blood will also be tested for AIDS and hepatitis. The results of this test can take up to two weeks.

ECG
A cardiograph of your heart will be taken to make sure you have no underlying cardiac problems. An ECG is non-invasive - no needles, just some stickers on your body that communicate to a machine through wires.

X-rays
Your doctor may or may not require new X-rays of the knee he is operating on.

Urine sample
This is required to make sure you do not have a urinary tract infection. An infection anywhere before surgery e.g. infected toenail, skin lesion, throat infection, gum or dental infection, can greatly increase your chances of infection of the joint replacement following surgery. If an infection is found, it can be treated with simple antibiotics prior to surgery.

Pre-operative Instructions

Medications

  • Cease aspirin and anti-inflammatory medications (e.g. voltaren, feldene) 10 days prior to surgery as they can cause bleeding
  • Cease any naturopathic or herbal medications 10 days before surgery as these can also cause bleeding
  • Patients taking blood thinners or those with diabetes will have special instructions but in general you should stop taking aspirin, Plavix (clopidogrel) and warfarin 5-10 days prior to surgery.
  • Continue with all other medications unless otherwise specified
Home Preparation
  1. Arrange for someone to help out with everyday tasks like cooking, shopping and laundry
  2. Put items that you use often within easy reach before surgery so you won't have to reach and bend as often
  3. Remove all loose carpets and tape down electrical cords to avoid falls. Make sure you have a stable chair with a firm seat cushion, a firm back and two arms
  4. Make sure your shower or bath is safe and easy to get in and out of. Handrails, non slip mats and suitable stools to sit on are helpful for personal safety and comfort

The Procedure

  • The anaesthetist will see you before the surgery. They will discuss with you then if they are going to do a spinal, epidural or general anaesthetic.
  • After you are taken to the operating theatre, while you are still awake you are placed on the operating table and set up for surgery with a tourniquet placed around your thigh.
  • A urinary catheter will be placed in your bladder to measure your fluid balance during and after surgery.
  • A cut is made in the skin and underlying tissues to expose the knee.
  • Special instruments are used to make very accurate cuts in the bone to fit the prosthesis.
  • Trial components are put in first to make sure everything fits properly. The bone is then cleaned to remove debris.
  • The real components are then inserted with or without cement.
  • Drains are usually inserted.
  • The wound is then carefully closed in layers, the last being the skin.
  • A dressing is applied and you are taken to recovery.

After the Operation

  • Your leg will be bandaged from the groin to the toes.
  • Your fluid input and output is measured carefully. A drip in the arm will be used to give you fluid, replace blood during the operation and for antibiotics.
  • Pain is normal after the operation, but if your pain is not reduced be sure to tell the nurse. Pain medication may be injected into a muscle or delivered by IV into the blood stream.
    Patient Controlled Analgesia (PCA) allows you to control your own pain medication. When you push a button, pain medication is pumped through your drip. PCA pumps can provide a steady level of pain relief and with their built in safety features, you will be assured that you will not get too much medication.
  • The drip, drains and catheter are removed on your surgeon’s advice at approximately 24 hours after surgery.
  • Blood will be taken 24 to 48 hours after the operation to check your haemoglobin and blood chemicals.
  • Your exercise regime will begin as soon as you are capable and this will continue during your stay in hospital and once you are at home. A physiotherapist will supervise this.
  • You will be discharged three to five days post-operatively, depending on your progress. In most cases you will be sent to a rehabilitation centre before you go home to have hydrotherapy and physiotherapy.
  • Sutures are usually dissolvable but if not, are removed at about 10 days.

Recovery

  • You will be in hospital for approximately five days. At Day 2 you will get up on a frame and then you progress to crutches and then a stick usually by four to six weeks.
  • After hospital, you will usually go to rehabilitation for one to two weeks. This will include aggressive physiotherapy and hydrotherapy.
  • When you leave hospital you will probably still require tablets for pain but no injections. Wean your medications down to paracetamol as soon as possible.
  • It is best to avoid anti-inflammatory medications for one week to avoid any possible bleeding.
  • You lose 60 to 80 percent of your pain by six weeks and 95 percent of your pain by twelve weeks. By twelve weeks you can usually walk as far as you want to.
  • Regaining movement early is extremely important, getting the knee straight is as important as bending. Do not put anything under the knee even though it feels comfortable as it prevents it from straightening.
  • People usually can return to work somewhere from eight to twelve weeks. Heavy manual work may take longer. Normally by three months you can play sports like golf, bowls, stationary bike ride, bush walk, doubles tennis and swim.

Ph:
Fax:

02 9735 3637
02 9735 3635

Hip & Knee Clinic
Retail 4/8 Australia Ave
Sydney Olympic Park
Homebush Bay NSW 2127
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