SHOULD I HAVE A KNEE REPLACEMENT OR NOT?

This is a question you may well be asking yourself.  There are many websites offering information about knee operations, for example, about the surgery itself, and the aftercare during your stay in hospital.  Links to some of these are given at the foot of the page.

For myself, there was no choice.   I had damaged both my knees when I was a child as explained in "My Story".  However, if you have any doubts then ask to speak to someone who is qualified to answer all your questions.  Don't make up your mind until you are in possession of all the relevant facts.  This is your right.

ON ADMISSION

Once you have taken the plunge, waited for however many weeks and have finally obtained that elusive thing - an NHS hospital bed, you will face yet another round of choices.  However, you are where you choose to be, about to have a procedure which will immeasurably improve your quality of life and give you freedom of mobility again.  Keep remembering this and think positively about the whole episode.  Everyone in the hospital is there for your benefit, from Surgeons through to cleaners and everyone in between.  With their help your stay in hospital can be meaningful and as short as possible.  At the end of the day you all want the same thing, a pain-free, mobile patient!  I will not go into specific details of ward routine and pre-op checks and balances as these may vary from region to region.

At Kettering General Hospital (KGH from here on) all knee patients were given the choice of an epidural versus a general  anaesthetic, if it is appropriate for them..  The pros and cons of each are explained in full so the patient can make the correct decision. The epidural can be anything from fully awake to constant dozing.  I opted for the epidural as I wanted the benefits of not being knocked out fully plus the shorter recovery time. Some of the group also had epidurals and some had general anaesthetics, so we were a mixed bunch. 

The operation itself took between 4 and 5 hours - I don't think it was much longer for two knees than it was for one and there was no pain involved once the epidural took effect.

PAIN RELIEF 

This  is initially delivered via a self-control drip, with additional tablets at regular intervals.  This is well administered & maintained and affords as much comfort as possible.

GETTING OUT OF BED

This will be at the top of the list of things to achieve and you will be encouraged to do this as quickly as you can.  Physiotherapy should start within a day or two of your operation, when you should be able to sit up on your bed and move your knee. You will have physiotherapy every day until you leave hospital, or even longer if required. After three or four days you should be able to walk with a  frame (Zimmer) or crutches.  Ice-packs are brought round at regular intervals to help reduce swelling around the knee joint and they are WONDERFUL!  Some patients will also be given time on a CPM  (Continuous Passive Mobilisation) machine which bends the knee for you if you are having difficulty. Once you are out of bed and sitting in your chair while your bed is being changed, the staff will provide a basin of hot, soapy water for you to dangle your feet in - this is also wonderful and after drying they moisturise your feet thoroughly.  These little touches make quite a difference.  These days you are expected to stay as an inpatient for only 4 days before being released but obviously this can differ from patient to patient.

DEEP VEIN THROMBOSIS (DVT)

This is an area where surgeons have differences of opinion.  Some prefer patients to wear long, highly elasticised white stockings after the operation and for the next six weeks.  My surgeon was one of those who did not think they were necessary and so I avoided this.  Medicine is given in the form of an injection into the abdomen nightly to prevent a DVT happening.

DISCHARGE SHEET TICK BOXES

There are a number of people who have a say in whether or not you are released.  These include:  the surgeon; the physiotherapy team; the haematology department; the ward sister; and the occupational health team, among others.

When you finally get near to having all the ticks on your sheet, Occupation Health/Physiotherapists will visit you to ensure you can do certain things for yourself, viz: 

• Can you wash and dress?

• Can you get up and down stairs?

• Can you get on and off the toilet?

• Do you need walking aids?

• Can you manage in the kitchen?

• Will there be someone there to help you in the early stages?

If you need equipment to help with any of these things then they will provide it on loan.  They will need access to your home to fit it.   If for example,  your toilet seats are too low,  or if your furniture is too low, you may be provided with risers.  In certain circumstances they will install a hand rail in the shower or bath.  Aids for dressing and for lifting light articles from the floor can also be supplied.  These requirements will be fully assessed and discussed with you before you are allowed home. You will also be provided with any walking aids you require, i.e., a frame, crutches or sticks.

WHAT HAPPENS WHEN I AM DISCHARGED FROM HOSPITAL

You will be sent home with a letter for your GP and an adequate supply of your normal medication as well as any additional painkillers you should need. You will be told to see your GP as soon as possible.  Your wound will have a clean dressing and you will be given a spare . The hospital will give you a discharge booklet with some useful advice and a few exercises.  If you are to continue having physiotherapy the first appointment will have been made for you by the hospital.  If there is a choice of venue you will be asked where you would prefer to attend .  Before your discharge, arrangements will also be made for you either to return to the hospital to have your staples removed or for a district nurse to call at your home to deal with this.  Staples are normally removed 14 days after the operation.  Shortly after your discharge your will receive an appointment to return to the orthopaedic clinic to have x-rays and a consultation with your surgeon, normally about 6 weeks later.

You will be asked to join the National Joint Register.  They keep a record of all prosthetic knees  (which have individual serial numbers), to help patients by:

• Improving patient awareness of the outcomes of  knee replacements

• finding out how long knee replacements last

• identifying patients who have received an implant if there is a need for urgent treatment.

As well as trying to be as mobile as possible, you will need to keep doing your exercises but remember you will have been told that you must rest on the bed with your legs elevated for roughly an hour morning and afternoon.  Don't skimp on this - we all found our periods of rest as beneficial as the periods of activity.  When we missed out the bed rest, we paid for it the following day.  It also helps to reduce swelling, particularly in the lower legs and feet. Each day try to walk a little further, at first indoors, then in the garden, if you have one, and eventually in the great outdoors.  One thing we all found very helpful was moisturizing the scar once the staples were removed.  This allowed us to bend more freely and helped the scar to fade.  Any moisturizing cream will do but olive oil is one of the best.

When you are brave enough to venture out to the supermarket or the shopping centre in the first couple of weeks, do not be afraid to make use of the free wheelchairs.  This allows you to get out and at the same time stops you being jostled or becoming overtired.  Similarly when you have enough confidence to go out on your own two legs, make the same use of your sticks, walking frame or crutches.  It sends out a signal that you are of limited mobility and generally other pedestrians are more considerate (although there are always exceptions).  

If you are not a member of the blue badge scheme, you should consider applying before you have your operation.  Even if you are not a driver it is possible to obtain a blue badge which can be used in any car in which you are a passenger.  It only costs a couple of pounds, a couple of photographs and is well worth it.  Being able to park close to where you want to go can make the difference between going out or staying home in the early stages before your legs begin to regain their mobility and strength.  A blue badge is easily obtained from your local council and you can apply in writing by contacting the council who will send a form, or by going to the website and downloading the form yourself.  Full instructions accompany the form. (see link below)