Knee Replacement, Oxford
Most knee replacements attempt to emulate the normal motion of the knee, which can bend and straighten many times a minute while walking. Though something as common as the act of walking is easy for most, for those with advanced arthritis, such repetitive motion on an already weakened joint can be quite painful and require tireless effort. Often, knee replacement is the only option to alleviate the pain.
The ability to walk easily depends upon the intricate working of the knee joint. The knee is formed by the junction of three bones: the femur (the thigh bone), the tibia (the shin bone), and the patella (the kneecap). These bones are connected to each other by strong ligaments. The powerful muscles of the thigh and calf attach to the bones around the knee by means of inelastic ligaments.
What can I expect if I have a knee replacement?
The Weeks and Days Before Your Surgery
When planning your procedure Mr Whitwell, make sure you obtain an estimate of how long you will be in the hospital (usually two to fourdays). Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans.
The day before surgery, the preoperative nurse will call you to tell you what time to come in, what medications to take, and by what time you should no longer have anything to eat or drink (usually after midnight). This does not apply to the medications that you have been instructed to take the morning of surgery with a small sip of water. Make sure you follow our recommendations strictly! Otherwise, we may have to reschedule your surgery, which may take a number of weeks.
The Morning of Surgery
The Ward
As you come to the preoperative Ward on the second floor, the preoperative nurse will meet and welcome you. You will be asked to change into a hospital gown, be assigned a bed in the ward and store away your personal belongings; please leave any valuables at home, as you will be asked to remove them before entering the operating theatre. Your family can be with you during this time.
Preoperative Exam
One of our resident medical officers will introduce themselves to you and proceed to perform a focused history and physical examination. The main purpose of this is to see if anything has changed since you last saw your medical or surgical team. They will explain the risks of the procedure and present to you the consent forms for the surgery, blood transfusions, and any other unique procedures. Mr Whitwell or one of his team will come to speak to you and sign your surgical site. This is simply a safeguard to confirm where on your body the surgery will be performed.
Next, you will meet your anaesthetist. He or she will discuss the anaesthetic plan with you and then ask for your consent to proceed.
Anaesthesia
The usual anesthetic for a total knee replacement at the Manor Hospital consists of sedation, followed by a spinal or epidural anaesthetic, and possibly an arterial line. Often we will perform a nerve block in order to reduce your pain after surgery. The femoral nerve block provides some relief of knee pain after surgery. It numbs the top 75% of the knee for approximately 18 hours and significantly reduces the pain you experience after surgery. The sciatic nerve block can help reduce the pain in the remaining part of the knee. The arterial line allows the anaesthetist and the postoperative staff to monitor your blood pressure closely while allowing them to take blood samples without having to use any additional needles.
Operating Theatre
Sedation / Anaesthesia / Surgery
Next, you will be taken by a nurse to the operating theatre, have standard monitors placed (such as a blood pressure cuff and ECG leads), and you will be sedated. Your anaesthesia will then be administered. The level of sedation is variable, but most people remember waking up in the recovery room after the operation is completed. Occasionally, some patients recall music or perhaps some tools being used. Be assured, however, that you won’t feel any of the surgery. Your anaesthetist will be with you the entire time. When it is complete, you will be taken to the recovery room and Mr Whitwell will speak with your family.
Recovery
In the recovery room, you will fully awaken from the sedation and be placed back on the monitors.
At this point, your legs will begin to regain some sensation. This is the point when a machine is attached to the epidural catheter to provide more pain medicine. This machine is called a PCA (patient-controlled analgesia) and has a button which is under your control to give yourself more pain medicine as needed. The pain pump is calibrated so that you won’t be able to overdose yourself, no matter how many times you push the button.
Once the recovery room clinicians feel you are stable, they will prepare a regular hospital room for you. They will inform the receiving nurse on the ward of your history, and you will be taken upstairs to your room.
Recovering in the Hospital
Medication
The first full day after your knee replacement is an important one for pain management. This is the day when you will be started on pills for pain control. There is some cross over with the epidural medicine and the pills. It is important to evaluate your pain control on solely oral medications in order to predict how you will feel when the epidural comes out, which is usually within a day or so. If your surgeon requests consultation from our Acute Pain Service, then an anaesthetist and nurse from our department will visit you to evaluate and treat your pain.
Physical Therapy
The recovery process will be an active one. You will likely begin working with a physical therapist the day after your surgery. This is an important part of your recovery that will allow you to get back to your normal activities as soon as possible. Your therapist will evaluate you and progress your therapy over the next few days through dangling your legs, standing, walking to the bathroom, and eventually, walking down the hall.
After two to four days of recovery, you will be discharged home with a prescription for pain medication, a prescription for physical therapy, and a follow-up appointment with your surgeon.
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Mr. Whitwell is the chair and convenor of the Oxford Musculoskeletal Oncology Review 2012.>> read more
