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Issue No: 1

Date of issue: 24/04/2019

Review date: 24/04/2020

If you require any further information or have specific questions about any aspects of your care, before or after your operation, contact:

Ward 10 (Elective Orthopaedics) - 01592 648010

Patient Guide

'NHS

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Fife

Physiotherapy- 01592 643355 ext 21105

Occupational Therapy- 01592 643355 ext 21186

If you have any problems with your wound contact Ward 10 on 01592 648010

Total Knee Replacement Daycase

NHS Fife provides accessible communication in a variety of formats including for people who are speakers of community languages, who require Easy Read versions, who speak BSL, read Braille or use Audio formats.

NHS Fife SMS text service number 07805800005 is available for people who have a hearing or speech impairment. .

To find out more about accessible formats contact: Fife.egualityandhumanrights@nhs.scot

issue No. Date of Issue:

Review-Date:

or phone 01592 729130

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24/04/2019 24/04/2020

Devised by_

Physiotherapy Orthopaedic Department

Victoria Hos ital Kirkcald

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What is Enhanced Recov�ry After Surgery (ERAS)?

The Fife Orthopaedic Unit (Ward 10) is now operating a "short stay admission" in keeping with ERAS and discharge home as soon as possible.

The aim of ERAS is to get you back to your full health as quickly as possible after your surgery, the quicker you are up out of bed and resuming normal activities the better. This will lead to less complications and get you back home s_ooner.

Prior to Hospital Admission

Healthy steps to improve your recovery before your operation:

Food & Drink

• Eat a healthy diet and have frequent You should aim to drink 1 - 1.� litres of water a day on the weeks leading up to your surgery.

'Stay Active

• · Stay physically active prior to your admission to hospital. This will help you get back on your feet quicker after your surgery.
• Begin your exercises as soon as possible, this will help improve your muscle strength and joint range of movement before your surgery

Smoking & Alcohol

• If you do drink or smoke, use this as an opportunity to stop or cut This will help your recovery and reduce the risk of

.complications.

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Lying on your back place a rolled up �owe!

under your operated leg.

Push the back of your knee onto the towel and lift your heel off the bed.

Hold for 5 seconds Repeat 10 times

Lying on your back with your operated leg straight and your leg bent.

Exercise your operated leg by pulling your toes up, push your knee down onto the bed and lift the leg tip off the bed.

Hold for 5 seconds Repeat 10 times

Sit or lie with your operated leg out in front of you. Put your heel on a rolled up towel so you are stretching the back of your knee.

Hold for 30 seconds Repeat 10 times

Sitting in your chair.

Pull your toes up, lift your leg off the floor to straighten your knee.

Hold for 5 seconds Repeat 10 times

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Exercise Programme

We strongly encourage you to begin these exercises prior to admission for your surgery, as pain allows. After your surgery, you should complete these exercises frequently throughout the day - three or four times daily

Please contact ward 10 on telephone no. 01592 648010:

• Evening prior to admission (between 6pm .and 8pm) for fasting instructions
• Morning of admission for bed availapility

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Lying on your back or in sitting.

Bend and straighten your ankles briskly.

Do this exercise for 30 seconds every half hour when you are resting in bed. This will improve the circulation of blood in your lower lei:is.

Lying on your back with legs straight. Pull your feet up towards you. Push your knees firmly against the bed until you feel your thigh muscles tighten.

Hold for 5-10 seconds Repeat 10 times

Lying on your back with sliding board under your leg.

Bend and straighten your hip and knee by sliding your foot up and down the board.

Repeat 10 times

*It is important to keep drinking fluids on the lead up to your surgery - the nursing staff will advise you when to stop this. It is beneficial to have a bottle .of water with you to drink on the way to hospital.

Medication

Please bring all your regular medication into hospital with you in the containers provided by the chemist (including tablets, inhalers, creams, lotions and sprays) - this is so we can use your own medication during your stay, with your permission. Please note that Nomads and Dosette boxes cannot be used. On discharge from hospital you will be given a 7-day supply of medication that you will require for home.

Clothing

You will be able to dress in day clothes after your surgery, so please bring in comfortable, loose-fitting clothes and comfortable shoes (preferably with a closed back).

Although you are planning to go home on the same day as your operation, it is best to pack an overnight bag in case you require an overnight stay.

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If there are any changes to your health or fitness prior to admission to hospital please inform _your Consultant's Secretary as soon as possible. This will include any change in medications or hospital admissions.

Admission to Hospital

On admission, a nurse will check that all your pre-assessment information is correct. If there has been any change to your health or medication since then, please inform your nurse. The nurse will also assess your general heath by monitoring your blood pressure, pulse rate and breathing rate. The staff will also discuss any medicines, inhalers and/or herbal medicines that you use. Any allergies that you have will also be recorded.

You will meet your consultant again who will answer any questions you may have.

You will meet your anaesthetist who will discuss having a general anaesthetic with you. This type of anaesthetic produces a controlled state of unconsciousness during which you sense or feel nothing. It allows for a quicker recovery once returned to the ward.

During The Operation

You will be given a general anaesthetic:

• Anaesthetic drug (an injection and/or gas to breathe)
• Oxygen to breathe
• �ometimes, a drug to relax your muscles

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How long should I continue my exercises for?

• Your exercises·are very important to ensure your knee joint achieves its optimal movement and that strength returns to your muscles after
• They should been completed frequently throughout the day and continued for at least 3 months after surgery.
• If your new joint fails to gain it's full movement, you may require further surgery tc:i improve this (which at times car:i be

available with exercises).

How far should I walk?

• This depends on how fit you are and what your borne situation is. Start by walking no further than the length of two houses in your street and back, then build this up You should feel tired when you get home but not exhausted.

Can I go swimming?

• You can go to a pool with steps as soon as your wound You can do gentle exercises and walking in the water. More serious swimming can· be started after three months. You can do breast stroke if it feels comfortable, but start off gently.

When will I get better?

• It can take up to 12 months to get the full benefit from you knee As you get better it is important to do everyday activities as these help to improve muscle control and movement - it is important to get back to an active lifestyle. Sports such as golf, cycling, swimming and walking are encouraged. Other acceptable activities include bowling and dancing. Avoid activities that cause high impact on your joints such as running, jumping or very heavy jobs.

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Frequently asked questions

Why have I still got swelling and bruising?

• It is normal fpr the knee to be swollen and inflamed for several wee�s to months as it heals.
• Swelling into the rest of the leg can also be normal. If you do

not put full weight onto the leg, your calf muscle will not work as a pump to get rid of the fluid.

What can I do about it?

• Continue your ankle exercises (Exercise 1) to encourage your calf muscle to pump away the fluid.
• Try to put equal weight through each leg and "push off' from your toes when you walk.

Why do I stiffen up?

• Sitting down for a period of time can increase the swelling and stiffness in your To help this it is important to walk short distances every hour and regularly complete your exercises.

I have a numb patch - is that ok?

• Numbness around the incision is due to small, superficial (close to the skin) nerves being affected by the The patch usually gets smaller but a small amount of numbness may remain.

Why dqes my joint click or clunk?

• This can be normal and it is usually a sign that the swollen tissues are moving over each other differently than before your This should not worry you, as it should improve as your knee continues to heal.

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You will have a breathing tube in your throat to make sure oxygen and anaesthetic gases can easily reach your lungs.

Whilst untjer anaesthetic, and before your operation ends, your surgeon will administer a local anaesthetic to your knee joint which will provide pain relief.

When the operation ends, the anaesthetic is stopped and you will regain consciousness.

Following Your Surgery

In the Recovery Room

After your surgery, you will be-transferred to the recovery room.

The recovery nurse will monitor your blood pressure, heart rate and breathing regularly. You will be given fluids via a drip and will be on oxygen via a facemask.

You should expect to feel pain in your knee once recovering from our anaesthetic; therefore you should request pain relief from the nursing staff to keep this under control. Anti-nausea medication will also be given if you require it.

Return to the Ward after Surgery

You will be allowed something light to eat/drink (e.g. tea & toast), and will be encouraged to drink plenty of water.

Physiotherapy and Occupational Therapy staff will see you approximately one hour after you have returned to the ward. They will review:

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• Exercises
• Bed and chair transfers
• Walking with appropriate walking aid
• Stair practice

Prior to this, the nursing staff may give you an additional tablet to ensure your blood pressure is stable for getting up to walk.

You will be reviewed by the Advanced Nurse Practitioner. Pain in your knee after surgery is normal - we would advise a pain score of 3/10 ("minimal") at rest and 5/1 O ("moderate") on movement is considered acceptable.

Remember you can always ask for more pain relief

You· will attend an X-Ray of your knee joint once you are up and will have blood tests taken.

You will be discharged home on the .evening of your surgery if:

• You are medically well- when medical & nursing staff are happy with your condition
• You have completed your occupational therapy -and physiotherapy goals
• You are tolerating diet and fluids
• You have passed urine
• You are walking without assistance
• Your pain is well

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To comply with infection control policies, we ask visitors to respect the following:

• Use of hand gels on entering & exiting ward
• Avoid sitting on patients beds or chairs
• No flowers permitted on ward

We value your feedback a'3out your . care under elective orthopaedics

Please visit www.careopinion.org.uk

For further advice & videos on:

• Hip and Knee Exercises
  • Getting on/off a bed
• Up from/down to a chair
  • Stair technique

Please visit our YouTube Channel by searching: "NHS Fife Joint School"

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Things to look out for at home:

Routinely your· surgeon will apply a dressing to the wound with instructions to leave it in place for 14 days after your operation. There should be no need to change this dressing. Your wound is likely to be tender for 2.:.3 weeks, but do look for signs of inflammation or leaking - fiery red, painful and hot around the area of the wound. If you are concerned, use the wound care card given at pre-assessment to contact the hospital

Please seek medical advice from your GP if:

• You experience worsening· pain and swelling in the calf muscle of the operated leg, along with redness and heat from the muscle. You would require a home visit as will be unable to travel to the GP surgery if this is the case.
• You experience increasing pain around your hip joint and difficulty bearing weight (however it can be normal to experience increasing hip pain as you begin to progress your mobility).

Ward Information

The hospital has no set visiting times and offers a flexible approach to this.

However, it is important to note that visitors will be excused from the patient area to allow for ward staff to carry out necessary tasks, and for rehabilitation needs.

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Discharge Checklist:

• Arrange your transport for getting you home - hospital transport is only for people who meet specific eligibility
• Make sure you have all your belongings leaving hospital - we strongly encourage that you do not bring valuables to hospital.

• Make sure you have suitable clothing and footwear at home if you are not already using them in hospital.
• Make sure you have access to your house

• Make sure you have a supply of food and drink at home, and if necessary ask someone to turn on your heating..
• Please let us know in advance if you require a medical

Once. at Home

You will receive a telephone call from the nursing staff the day after your surgery to discuss how you are managing at home. They will also contact you again within one week of d_ischarge.

• Follow advice from medical and nursing staff
• Take regular pain relief
• Do something every hour

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• Regular walks
• Regular exercises

• Eat and drink regularly
• Complete your personal goals

Walking

When leaving hospital you will be walking with 2 sticks. Over the following weeks (when you feel able) yo1,1 can begin to walk with 1 stick. This will be used on the opposite side to your operated knee.

Stop using your walking stick when you can walk as well without it as with it. Many people choose to bring a stick outdoors for a few months after surgery as they find their limp gets worse as they get tired.

Sitting

When you sit down, bend your knee. Sit straight fn your chair with· your knees bent. Do not sit with your knees at .an awkward angle which you may have done before your operation.

Exercises

You should continue the exercises given once at home to prevent your operated knee becoming stiff and to improve the muscles at the front of the thigh. In turn this will help you progress off your walking sticks more quickly.

What are you aiming for?

1. A straight knee
2. A strong knee

Stairs

You will be shown the correct technique for using stairs prior to discharge from hospital, if this is relev;:int to you.

As soon as you have gained enough bend and strength in you� knee you will be able to walk up and down stairs normally.

Going Up

Non-operated leg Operated leg Stick

Coming Down

Stick Operated leg

Non-operated leg

Physiotherapy Follow-Up

The physiotherapist will speak to you prior to discharge to discuss if you need referred to receive further treatment once at home.

3. A good knee bend

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