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Knee Replacement

Total knee replacement is a surgical procedure where the worn out surfaces of the knee are resurfaced with metal and plastic components.

Over time, cartilage that cushions the bones can wear away, cause pain and discomfort, and make simple activities like walking difficult or even unbearable.
A knee replacement can reduce or eliminate pain, allow easier movement and restore independence.
Your knee replacement journey at ROH will follow these steps.  Click on a step to find out more.

Step 1 - Deciding to have a knee replacement

How the operation is done
A knee replacement is a major operation and usually takes approximately two hours.

During a total knee replacement operation
  • The worn surfaces at the bottom end of the thigh bone (femur) and the top end of the shin bone (tibia) are removed.
  • The surfaces are covered with metal implants fixed in place with bone cement.
  • A smooth plastic insert is fixed to the top of the tibial implant. This ensures that the two surfaces glide smoothly together.
  • Sometimes the underside of the knee cap (patella) is also re-surfaced with plastic.
  • The layers of soft tissue, muscle and skin are repaired and stitched back together.
Who should get a knee replacement?
Knee replacement surgery may be considered for individuals suffering from arthritic knee pain that severely limits daily activities. It is only recommended after careful examination and diagnosis of your particular joint problem, and only after more conservative measures such as exercise and physiotherapy have proven ineffective.
How long will I spend in hospital?
With improvements in surgical techniques and post-operative care, it is now common for patients to be able to go home quite quickly. At The Royal Orthopaedic Hospital, we aim to support the majority of patients to go home within 48 hours (post surgery).
How successful is knee replacement?
Knee replacement is recognised as one of the most successful procedures in all of medicine. In England and Wales over 160,000 people have their knees or hips replaced each year.
How painful is the surgery?
You will experience some discomfort after surgery, but be assured we will do everything we can to keep you as comfortable as possible.
Pain after knee replacement surgery varies from person to person but modern medications and improved anesthetic techniques greatly enhance our ability to control pain and discomfort after surgery.
What are the risks?
Knee replacement is a common surgery and in the majority of cases there are no complications. However, it is a major surgery and like any major surgery there are some risks to consider:
  • Blood clots
  • Infection
  • Implant loosening
  • Fractures
  • Nerve or blood vessel damage
  • Knee stiffness
Your surgeon and healthcare team will take great care to minimise the risk of these and other complications. Keep in mind that complications are rare, but they need to be understood by you and your family. Your surgeon will be happy to answer any questions.
Of course every patient is different, but we aim to help you recover quickly and regain your independence as quickly and efficiently as possible.
JointCare: don’t put up with pain
JointCare at The Royal Orthopaedic Hospital is a modern knee and hip replacement service for NHS patients.
This is modern joint replacement
JointCare brings together a team of experienced and highly skilled surgeons with an amazing care team. Our goal is to provide seamless, efficient care and have you healthy and doing the things you enjoy as quickly as possible.
We have designed a specific and tailored service to care for knee replacement patients. No hospital gowns and long hours in bed; this is all about wellness and recovery.
The benefits
We aim for most routine JointCare patients to go home after their knee replacement within 48 hours (post surgery). You can expect to recover more quickly and experience the amazing care and health outcomes that The Royal Orthopaedic Hospital is known for.  About 90% of people having a knee replacement rate the result themselves as ‘good’ or ‘excellent’.
Find out how we can help
We’re ready to care for you. Speak with your GP about a referral to The Royal Orthopaedic Hospital. You can choose the hospital for your knee replacement; we are an excellent choice.

Call 0121 685 4000 to find out more.

Step 2 - Are you fit for surgery and pre-operative assessment

Pre-operative assessment process
This will provide you with the opportunity to discuss the medical, nursing and therapy requirements needed to help you plan for your admission to hospital and discharge following surgery.
During your appointment you may have some or all of the following:
  • Height, Weight, Blood Pressure,Urine test
  • A detailed nursing assessment
  • An examination of your general health
  • An ECG (tracing of your heart)
  • Blood tests
  • MRSA screening
  • Spirometry (breath tests)
Occasionally other tests are required depending on your state of health
What to bring
  • Reading glasses
  • All your regular medications
If for any reason you cannot attend this appointment it is important to call the clinic on 0121 685 4362 as soon as possible. This assessment helps us to ensure that you are fit enough to have the operation and it cannot go ahead with out it.
Fitness and diet
Before your surgery we advise that you do the following
  • Do moderate exercise dependent on your pain levels and ensure you do pre-surgery exercises you have been given.
  • Eat healthily - see advice on the NHS Choices website
  • Cut down on sugar
  • Stop smoking
  • Moderate your alcohol intake
Your health after your pre-operative assessment
If you become seriously unwell immediately prior to your operation date and are therefore not fit to have your surgery, it is vital that you ring and inform us on 0121 685 4362. You will then be sent a new date for your operation. It is also important that you contact us on this number if your medication changes prior to your admission.
If you develop cold symptoms please contact the nurse in the Pre-Operative Assessment clinic for advice on 0121 685 4362.
It is also vital that you inform us if you have been a patient in another hospital while you are waiting for your operation.

Step 3 - Knee workshop and pre-operative exercises

Knee workshop
You will be required to attend an education session called the Knee Workshop. This session is run by the Therapy Team who will teach you about your knee replacement and how to recover as quickly as possible.

The session will provide information about
  • How to prepare for your procedure
  • What to expect
  • Optimal recovery
  • Teach you movements and exercises
You will have the opportunity to ask questions and discuss any concerns.  We encourage you to invite your coach (friend or family member) to come along with you. It is very important that you attend this workshop.  You will be sent an invitation, please inform us if you are unable to attend this date and we will schedule another for you.
Exercising before surgery
It is important to be as fit as possible before your operation. This will make your recovery more rapid.
You should begin to do the exercises listed in your guidebook.

Step 4 - Become an in-patient and have your surgery

Day of arrival
On the day of your surgery, you will check in at the Admissions and Day Case Unit (ADCU) at the time stated on your admission letter.
What to expect - immediately before surgery
  • In ADCU you will have your blood pressure, temperature, pulse and oxygen saturation levels recorded
  • To help reduce the risk of blood clots you will be measured for compression stockings, which you should wear as instructed.
  • The anaesthetist and a member of the surgical team will visit you before surgery. The anaesthetist will explain the anaesthetic and methods of pain control. You will have the opportunity to ask any further questions.  They will also discuss your consent again prior to surgery
  • A member of the surgical team will draw an arrow on your leg to ensure the correct side is operated on. Do not wash off this arrow!
  • You may be given pre-operative pain relief. This will help ensure that they are in your bloodstream before surgery
  • You will be given an indication of the time you will be going to theatre.  Theatres run all day so your surgery could be in the afternoon
  • Before you go to theatre, you will be given a theatre gown to wear
  • When it is time for your operation, one of our team will take you to the changing room. They will then go through a series of safety checks and then one of our theatre team will take over your care
  • There will be a final series of checks before you are connected to monitoring equipment
  • You will then be given an anaesthetic
The operation
When you have been anaesthetised, you will be taken to the operating theatre.  While you are asleep the anaesthetist will remain with you at all times, monitoring to ensure you are safe. If you are awake or under light sedation, you will be aware at times of some noises and vibrations. The anaesthetist will be there at all times to reassure you.
What to expect immediately after surgery
The operation to replace your hip takes approximately 1-2 hours
After surgery you will be taken to recovery and then onto the ward. Here you will be given regular pain relief by the nursing staff and your observations will be checked regularly

Step 5 - After the operation and preparing to go home

Back on the ward
  • The consultant who operated on you will also visit you to review your progress
  • You will be encouraged to wash and dress
  • The physiotherapist will see you and start your exercise regime
  • You will be assessed and may be helped out of the bed to sit in a chair
  • You will be encouraged to eat and drink
  • The dressing on your wound will be checked
  • Your pain levels will be assessed and pain relief will be given as appropriate
Steps towards discharge
  • You will be encouraged to sit in your chair for meals and encouraged to dress in loose fitting, comfortable clothing during the day
  • The physiotherapist will continue with your exercises and progress your mobility with a walking frame or sticks/elbow crutches
  • You will be encouraged to walk to the bathroom for your wash
  • Blood tests will be taken
  • You will have an x-ray of your new joint
  • If you have them, your drain and catheter will be removed
  • Please confirm your transport home with your family/friend
Preparing for home
  • You will be taught how to go up and down stairs
  • You will be encouraged to walk with sticks or elbow crutches independently
  • You will be shown how to use your dressing aids and to get on and off the bed
  • You will be shown how to give the blood thinner injection
  • Your wound will be checked
  • When you have achieved all of your discharge goals you will move to the discharge lounge to enable our discharge nurses to explain all of your medication, your discharge paperwork and wait for your family/friend to pick you up
After your operation you will be encouraged to be as independent as possible. This is achieved by starting your rehabilitation within a few hours of your operation. You will be asked to take part in a group exercise class while on the ward.
Discharge home from the ward
You may go to the discharge lounge to enable a safe and coordinated discharge. This will allow you time to ask any questions.
We will discuss wound care with you and advise you about when you should make an appointment with your GP Practice Nurse to have your clips or stitches removed. This is usually two weeks after surgery.
You will be given painkillers and will be shown how to use your injection at home (if prescribed).
You will be given your regular medications to take home as well as a copy of your discharge letter. An outpatient appointment will be arranged before your discharge, or by letter shortly after discharge. This will be four to six weeks following your surgery.
Patient Goals For Total Hip Replacement
  • Get in and out of bed by yourself
  • Pain is controlled with tablets
  • Get to the bathroom with little or no help
  • Wash and dress yourself with minimal help
  • Walk 100 feet with the use of walking aids
  • Climb and descend stairs
  • Review and finalise arrangements to return home

Step 6 - Continue your rehabilitation at home. Work hard at your physiotherapy.

You will be assessed prior to discharge to see if you require support from our community service – the ‘ROCS’ team. The team can visit you at home to offer further medical and physical support to aid your recovery.  After discharge, outpatient physiotherapy will be provided by us, or at a hospital closer to your home.
It is very important that you have organised the necessary support for when you return home. After major surgery you may feel that it is a good idea to ask friends or family members to stay with you or to help with simple chores. They will also be on hand to give you moral support.
Return to sport, leisure and work
  • Low impact sports such as golf, bowls, cycling, swimming and walking may normally be resumed after three months. Check with your consultant at your follow up appointment
  • High impact sports, i.e. jogging, singles tennis, squash, jumping activities, football are not recommended therefore are participated in at your own risk
  • Return to work usually takes place between six and 12 weeks post-operatively
  • Heavy manual work may require longer. Your consultant will guide you on this

Step 7 - Attend your follow up appointment. We'll check that you and your new joint are doing well.

Consultant follow-up
Your consultant or a member of his / her team will review your progress at your follow-up appointment approximately four to six weeks after your operation. You will either be given the appointment before you leave the ward or you will be sent a letter informing you of this in the post. We advise that you write down a list of questions prior to this appointment and take them along, as you may not see your consultant again.
At home exercises
It is very important for your continued recovery and successful return to normal activities that you continue to perform your physiotherapy exercises at home, as directed by your physio.
Wound care
If you develop any new redness around the wound or if the wound leaks after leaving hospital, it is important that you telephone the Wound Care Helpline on 0121 685 4354 8am - 2pm.
Recognising & preventing potential complications
You should consult your guidebook to look out for signs of infection, blood clots, Pulmonary Embolus and dislocation.
This is your future - six weeks on
Total knee replacements are performed to give patients a better quality of life, and most people are keen to return to normality as soon as possible. However, it is most important that you do not do too much too soon so as to allow healing to be as complete as possible. Hence the advice you were given on your discharge from the hospital.
Now that six weeks or so have passed, normal activities can be resumed.
You may discard sticks as and when you feel comfortable. You may need some support when walking on rough ground or over longer distances.
By now you should be climbing stairs normally, one foot after the other.
You should be able to return to work between six and twelve weeks after the operation; however, this will depend upon how much physical activity is involved in your job and how you usually travel to work.
Sports and Hobbies
During your recovery short frequent walks are good exercise. Low impact sports such as swimming (breast stroke), cycling, ballroom dancing and long walks can be resumed after 3 months. However, contact and high impact sports such as football, squash and jogging are not recommended and should be avoided. Gardening is fine but heavy work should be left for three months.
Flying too soon after your operation should be avoided owing to the increased risk of deep vein thrombosis (blood clot). If you are planning to travel abroad you should discuss this with your surgeon.

It is difficult to predict whether your knee will set off alarms at security, although a lot of people ask about this. Some do, however it depends largely on how sensitive the machines are set when you walk through. The best advice is to explain the fact that you have a knee replacement before you walk through the machine.
Please be aware that if you go on holiday soon after your surgery and your wound is injured or you acquire an infection, your travel insurance may be affected.
Staff at the Royal Orthopaedic Hospital are here to help and answer any questions you may have, so please do not hesitate to ask at any time.