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Welcome to the online prehab clinic. Now you have been listed for your surgery, it is time to look at how you can prepare for it. This will include what is expected from you to ensure you have the best outcome after your operation.
Objectives
The following information will help you to:
Understand how to prepare for your surgery
Give you an overview of the enhanced recovery pathway
Explain what is expected of you
Explain the role of physiotherapy and occupational therapy
Understand the length of hospital stay after your operation
What is an enhanced recovery programme?
The enhanced recovery programme is about improving your outcomes and speeding up your recovery after surgery. The programme focuses on making sure that you are active participant in the process of preparing for your surgery in order to achieve the best possible outcomes. It also aims to ensure that you are in the best physical wellbeing for your surgery. The underlying principle is to enable you to recover from surgery and leave hospital sooner by minimising the stress responses on the body during surgery.
The average length of stay post-surgery is 1 day. Most elective knee replacement procedures are booked as a day case, which means you will be discharged home on the day of surgery, unless there is medical reason to stay overnight.
You will be seen by a physiotherapist and an occupational therapist the day after surgery.
Your return to work will depend on your job, but usually it is around 6-12 weeks after the operation.
Please, note there is noprovision for the care support following surgery.
Health promotion
Please consider:
reducing/stopping alcohol drinking
stopping smoking
losing weight and improving your diet and eating habits.
Did you know that stopping alcohol for just a month…
Improves your sleep
Improves the hydration of your body
Reduces the risk of stroke and heart problems
Improves the kidney and liver function
Improves the blood pressure and heart rate
Reduces the cholesterol levels.
All of the above benefits will positively contribute to the recovery of your surgery and therefore, allow you to achieve better outcomes. You can download a worksheet on The benefits of ditching the booze for a month
Did you know that stopping smoking…
Reduces the risk of coronary heart disease
Improves lung function
Reduces the risk of lung, throat, oesophagus and bladder cancer
Improves breathing, coughing and wheezing.
All of the above benefits will positively contribute to the recovery of your surgery and therefore, allow you to achieve better outcomes. You can download a worksheet about the benefits of quitting smoking
Did you know that losing 5% of your body weight
Improves quality of sleep
Gives you more energy
Can bring your blood pressure down five points
Can lower your cholesterol
Reduces pressure on your joints
Reduces the chance of sudden death related to stroke or heart disease.
All of the above benefits will positively contribute to the recovery of your surgery and therefore, allow you to achieve better outcomes. You can download a worksheet about the benefits of losing 5 percent body weight
Referral details
For further support for stopping smoking, drinking alcohol, or losing weight please visit the One You Lincolnshire website or call 01522 705162. They offer support with:
drinking less
stopping smoking
weight loss
eating well
moving more
Preparation
If you live alone ask family or friends to help with domestic tasks and support on discharge.
If you think you will need care support, please start arranging this now, so thatyour support is available on your discharge home after the surgery.
Start practising your exercises now and continue with them right up to your surgery. The exercises are included below.
Prehab exercises – start them today!
These exercises will:
Improve flexibility of the knee joint and strength of the muscles around your knee
Improve your lower limbs circulation, helping the healing and soft tissue recovery
Facilitate weight bearing and improve your walking and overall function.
Strengthening your muscles and improving your range of movement of your knee may help to reduce post-surgical pain.
Following the exercise programme is essential for your recovery from surgery.
Pre-assessment clinic
You will be asked to attend a pre-assessment clinic before your surgery. The nursing team will discuss your health and wellbeing , including any existing medical conditions and medication.
Anaesthetics
Spinal anaesthetic
General anaesthetic
Other procedures:
Nerve block
Local anaesthetic infiltration
Occasionally, an epidural
Spinal anaesthetic
A dose of local anaesthetic is injected into your lower back near the nerves in your spine.
You go numb from the waist downwards.
You feel no pain during the operation, but you remain conscious.
If you prefer, you can also have drugs that make you feel sleepy and relaxed (sedation).
General anaesthetic
A general anaesthetic produces a state of controlled unconsciousness during which you feel nothing. You will receive:
Anaesthetic drugs (an injection and/or a gas to breathe).
Oxygen to breathe.
Sometimes, a drug to relax your muscles.
You will need a breathing tube in your throat while you are anaesthetised, to make sure that oxygen and anaesthetic gases can move easily into your lungs.
If you have been given drugs that relax your muscles, you will not be able to breathe for yourself and a breathing machine (ventilator) will be used.
When the operation is finished, the anaesthetic is stopped and you regain consciousness.
Advantages – spinal vs general anaesthetic
You are likely to have less sickness and drowsiness after the operation. You will usually eat and drink sooner. This means you will be ready to get up and start using your new joint sooner.
You do not need so much strong pain relief medicine in the first few hours. This keeps you feeling well, and ready to be active with your new joint.
You remain in full control of your breathing. You breathe better in the first few hours after the operation.
There is some evidence that less bleeding may occur during surgery, which would reduce your risk of needing a blood transfusion.
Your old knee will be shaved and shaped and a new prosthetic knee will be fitted. The surgery usually takes around 60-90 minutes. At the end of the operation, your surgeon will put local anaesthetic around the wound. This will help with pain control.
Pain
You will have post op pain and swelling, this is different to your arthritic pain you have now and will improve with time. Your pain will be managed by taking regular pain relief and use of cold compression therapy and by doing regular exercises. Some level of pain and swelling is expected for a couple of months.
Many people experience moderate to severe swelling in the first few days or weeks after surgery and mild to moderate swelling for 3 to 6 months after surgery. To manage your swelling for the first few weeks after your operation, rest 50% of the time with your leg elevated and the rest of the time with your knees bent. How you experience pain is very individual, depending on your post op recovery, pain threshold and general wellbeing.
Morning of operation
Paracetamol
Morphine based medication
After your operation
Regular Paracetamol
Co-codamol
Anti-inflammatory medication
Oramorph if needed
Cold compression therapy
On the ward, after your surgery, you will be provided with cold compression cuff and all the instructions on how to use it. Please don’t forget to take it home on discharge from the hospital.
Occupational therapy
You will meet occupational therapy staff, they will focus on your daily routines, independence and what is important to you. They will support you throughout the process, starting before your operation through to discharge. Prior to surgery, you will receive a phone call from the Occupational Therapy department and you will be asked about your daily activities such as dressing, washing, toileting, cooking, housework and shopping. You will also be asked how you normally manage getting on and off the furniture and going to the toilet. You will be given advice accordingly.
Please arrange care support if needed as this is not provided after the operation and your surgery may be cancelled if the care is not in place.
Provision of equipment to support discharge
Following your assessment, the occupational therapist will identify and discuss your recommended equipment needs before your surgery. The recommended equipment will be ordered and delivered to you before the surgery. If there is a need for additional equipment whilst on the ward, we’ll be able to provide you with that on discharge.
Physiotherapy – after surgery
Day of surgery: after your operation you will:
Practice exercises (you will be issued a leaflet)
Transfers on and off the bed.
You will mobilise with physiotherapy staff using walking frame and then two walking sticks as appropriate.
If required, you will practice climbing up and down the stairs/step. However, if you are not able to complete that, the downstairs living maybe recommended – please consider this when preparing for your surgery.
Wash yourself and dress in own clothes, ready for going home.
You will be advised about your follow-up outpatient physiotherapy referral. You can choose to have it in Boston, Grantham, Lincoln, Louth, Skegness or Spalding.
On discharge, you will be advised on pain management and medication, when it’s safe to shower, and post-op wound management. We will also make the referral for the follow-up physiotherapy in the Outpatient Physiotherapy department.
Outpatient physiotherapy
All patients will be offered a place on our total knee replacement class. The class is a chance to try different exercises, utilise gym-type equipment and allow staff to review your progress. In addition, it gives you the opportunity to meet others who have had the same surgery and share your stories. You will be contacted by the outpatient physiotherapy admin team to book your first class which will be 2-3 weeks after your surgery. If for any reason, you don’t want to attend a class, this will be discussed with you at the time of booking.
When you come to your first outpatient appointment, please ensure you attend in loose comfortable clothing so we can assess your knee. Please bring your crutches or walking sticks and a list of your current medication.
Ongoing referrals
On discharge from the physiotherapy department, if you would like to become more active and fit, you can also refer yourself to One You Lincolnshire on thier website or by calling 01522 705162.
Let’s summarise
Think about what you can do to help yourself to benefit from the surgery
Be systematic with doing your prehab exercises
Be prepared! Make sure you have all required support that you will need after surgery
Remember that having a proactive and positive attitude will help you to achieve greater outcomes and benefits.
We use some essential cookies to make this website work. We’d like to set additional cookies to understand how you use www.ulh.nhs.uk, remember your settings and improve our services. We also use cookies set by other sites to help us deliver content from their services.
