Wrightington-Total Knee Replacement Programme

Wrightington – Total Knee Replacement Programme

Patient Information

Trauma and Orthopaedics Department

• Author ID: DP 
• Leaflet ref: Musc 012
• Leaflet Ref: 13
• Version: Wrightington Total Knee Replacement Programme
• Date Produced: August 2025
• Expiry Date: August 2027

Introduction

On behalf of the Orthopaedic Team, we would like to wish you a warm welcome to Wrightington Specialist Orthopaedic Hospital.

Here at Wrightington Hospital, we have a long history and tradition in joint replacement surgery, having pioneered the first joint replacements in the 1960's. We now perform over 1000 knee replacements every year, using innovative advanced techniques to make your recovery quick and safe; helping you to get better sooner.

This information booklet aims to answer any questions you may have about undergoing total knee replacement surgery at our hospital. The booklet also aims to describe what you can expect from your knee replacement surgery and how specialist techniques can make you recover sooner.

We understand that you may feel nervous about surgery, but our orthopaedic team will answer any questions you may have on your visits before the operation, whilst you are an inpatient. Please do not hesitate to ask any member of the team for queries, concerns, or guidance.

We would estimate your hospital stay to be short; We aim to discharge you on the day of your surgery or the day after. You will meet a lot of the orthopaedic staff. Everyone works together to make your surgical experience as pleasant as possible whilst maintaining the highest quality of standards and care.

The Team

• Consultant Surgeon
• Orthopaedic Fellows, Registrars and Resident Doctors
• Anaesthetists
• Orthopaedic Practitioners
• Specialist Pain Management Nurses
• Ward Nurses
• Physiotherapists
• Occupational Therapists
• Therapy Assistants
• Theatre and Recovery Staff
• Pharmacists
• Radiographers

What is a Knee Replacement?

The operation replaces the worn part of the joint with an artificial one. The end of the shinbone and the upper part of the thigh bone are fixed into position, and a plastic insert is fixed between the two to allow the components to move. The kneecap can also be replaced at the same time, should your surgeon feel it is necessary. The different types of implants will be discussed with you at the time of consultation with your surgeon.

Alternative Treatments

A knee replacement is the best option for you due to the severity of your arthritis. This option will only be offered to you after other options have been tried and have not relieved your symptoms. This would include medication to relieve the pain, weight loss, if necessary, physiotherapy and exercise to reduce stiffness and improve muscle strength and the use of walking aids.

Benefits of Surgery

This type of surgery is normally carried out when the joint is very worn and severe pain restricts mobility. The benefits of surgery include:

Reduced pain

Most patients experience significant pain relief. It is normal to have some discomfort following surgery, but our techniques aim to make the surgery as comfortable as possible, in most cases allowing you to walk on the same day.

Improve stiffness

The new joint will have highly engineered metal or ceramic and plastic surfaces designed to allow the joint to move smoothly and freely. The aim would be for you to have less stiffness than before the surgery.

Increased mobility

With a combination of reduced pain and improvement in stiffness, your overall mobility is likely to be improved. This will help you return to a more active lifestyle.

Risk of Surgery

Knee replacement surgery is generally a very successful operation. 80% of patients are extremely satisfied with their result and gain an improvement in lifestyle. There are, however, risks and complications which can occur, some of which are listed on the following page.

Blood Clots

• Deep vein thrombosis (DVT) (Blood clot in the leg)
• Pulmonary embolism (PE) (Blood clot in the lung)

Blood clots can occur after any operation but are more likely to occur following lower limb orthopaedic operations. When these clots occur a blockage can develop in the veins of the leg causing swelling, pain, and warmth. Swelling in the leg after surgery is very common and can take time to resolve. If there is any doubt, you should seek the advice of your doctor.

A blood clot in the lungs is termed a pulmonary embolus (PE). In rare circumstances (1 in 1000) this can cause death. Symptoms of a PE include shortness of breath, sharp chest pain and blood coughed up in your phlegm.

Nerve Injury

It is common to feel some patchy numbness over the front of the knee after surgery. This is normally permanent but does not cause any serious problems.

There are several large nerves near the operation site, which both supply sensation and power to the leg muscles. Although rare, these can be damaged, but normally recover after a period of months. Occasionally the problems can be permanent, leading to pain, altered sensation and weakness of the limb.

Urinary Incontinence

Depending on your anaesthetic type or if you have individual risk factors, a bladder catheter may be inserted. A small number of people can develop urinary incontinence. This is normally temporary and resolves itself within a few hours of your surgery. If you have had a catheter inserted, this is removed within 24 hours after your operation.

Sometimes, reinsertion of the bladder catheter is necessary if you cannot pass urine. If this continues to be a problem, we will make you a referral to see a specialist urology doctor.

Persistent Pain

Knee replacement surgery is an excellent operation for arthritis.

However, 10% of patients are left with some minor discomfort, but this does not usually interfere with day-to-day activities. A much smaller proportion of patients remain very dissatisfied and have ongoing pain and discomfort. Some patients can develop complex regional pain syndrome, which while uncommon, may cause pain, swelling, stiffness and skin changes.

Revision (Repeat) Surgery

Sometimes, an operation may need to be done again for different reasons.  This is usually many years after surgery but can happen soon after the initial operation. If this is necessary, your surgeon will discuss the issues with you.

Medical Problems

There is a small risk of developing a medical problem following surgery.

These problems include heart attacks, strokes, and pneumonia. There is also a small risk of dying associated with this type of operation. These risks will be discussed with you at the time of your consultation with the surgeon and Anaesthetist. If there are any concerns your doctors may transfer your care to another team for ongoing treatment.

Information Resource

The National Joint Registry (NJR) for England, Wales and Northern Ireland collects information on joint replacement surgery and monitors the performance of joint replacement implants. The Registry helps to monitor the performance of implants and the effectiveness of different types of surgery, improving clinical standards and benefiting patients, clinicians, and the orthopaedic industry. Please see their website for further information www.njrcentre.org.uk

Summary

Knee replacement surgery is usually a very successful operation, but as with any other surgery there are risks of complications, which may affect a small number of patients.

Outpatient Clinic

When you attend the outpatients clinic, your name will be added to the waiting list for your procedure. Your Consultant will work closely with the Admissions Team and Preoperative Assessment Team, to agree a suitable date for your surgery. Once this date has been agreed, you will be notified in writing.

You will be encouraged to reduce weight if appropriate and stop smoking. These two measures have been proven to lower complications following surgery. If there is availability and you have time, your surgeon will send you for pre-operative assessment on the same day as your outpatient clinic appointment. If you have complex medical problems, you may be required to see the Anaesthetist prior to surgery.

Preoperative Assessment

It is essential that you attend this appointment.

During this visit, you will undergo assessment to ensure you are fit for surgery. You will undergo simple checks on your heart and lungs and have blood tests taken. Skin swabs will be taken to test for MRSA.

You may require an X-ray and be asked questions about your medical history. It is important that you bring any relevant documentation and list of medications to this visit. If you are on blood thinning tablets e.g. aspirin, warfarin, clopidogrel or dipyridamole, please inform the nursing staff, as you may have to stop these before surgery. This would only be under the direction of a doctor.

If you have a long-term illness of the heart or lungs, or a metabolic condition (e.g.diabetes, thyroid), an Anaesthetist will examine you to ensure you are fit for surgery. It may be necessary for you to be seen by a specialist if you have a more serious health problem. If you are not considered fit for surgery, the operation will be cancelled. 

You will receive an outpatient appointment with your Consultant, who will discuss alternative treatment options.

Please tell the doctor or preoperative assessment nurse if you are already taking the above medications for other reasons, or if you are taking another medication called pregabalin.

Therapy Preoperative Education

It is important that you attend the therapy preoperative education session or telephone consultation when invited. You will receive a letter about therapy preoperative education. If you have any concerns regarding equipment or managing after your operation, please call us. You will be provided information on:

How to prepare for having your knee replaced

What to expect during your hospital stay

How to carry out daily living tasks immediately after your knee replacement and

What to do once you are at home

A member of the therapy team will also be available to assess your social circumstances, discuss your home environment and how you manage with daily living tasks. This way, we can pre-empt any problems prior to your surgery, to enable your discharge from hospital to run smoothly.

It is important to practice the exercises shown or discussed with you during your education 

session. This will strengthen your muscles and aid recovery.

You will normally be admitted on the morning of your surgery to either Ward D or to the Orthopaedic Admissions Unit (OAU) at Wrightington Hospital. Following your operation, you will be transferred to one of the orthopaedic wards. Please do not bring too many possessions into hospital with you, as storage space is limited. Bring well-fitting comfortable flat shoes and slippers to walk in. There may be some swelling in your foot after your surgery, therefore consider this when selecting suitable footwear; shoes without backs are not recommended. If your knee replacement is undertaken in the morning, we would hope that you are up, walking and dressed in normal clothes the same day.

On admission, the final checks prior to surgery will be undertaken. If your temperature is low, you may be warmed using blankets, as this has been shown to minimise the risk of infection. Occasionally, delays in theatre or unexpected changes to the operating list may mean you have to wait longer than anticipated. If this happens, you may be offered a drink, after discussion with your Anaesthetic Team. You may wish to bring reading material with you.

The Anaesthetic

When you are admitted onto the ward, you will be seen by the Anaesthetist, who will discuss your anaesthetic choices and post-operative pain relief with you.

Most patients will be recommended to have a spinal anaesthetic in combination with a light general anaesthetic or sedation.

The spinal anaesthetic involves a small injection of local anaesthetic between the bones of the lower part of the back around the nerves of the spinal cord. This causes temporary numbness and heaviness from the waist down and allows surgery to proceed without the patient feeling any pain. A light general anaesthetic or some sedation can then be used in combination to lower your awareness of theatre activity during the surgery.

This anaesthetic combination is preferred because it is safe, effective, and the full effects usually wear off very quickly following the surgery.

This allows most patients to make a rapid recovery with very few "hangover" side effects such as sickness, which can occur following a general anaesthetic. It also enables you to start moving your knee soon after surgery.

Because of the spinal anaesthetic, your bladder will be temporarily numbed. This can sometimes make it more difficult to pass urine immediately after surgery. A tube (catheter) can be inserted into the bladder to relieve this problem, but this is only performed if absolutely necessary, or if you have risk factors for urinary problems. From the start of the anaesthetic until the end of your operation, your Anaesthetist will stay with you for the whole time watching your condition very closely. Your heart rate, blood pressure and breathing are monitored, and your body temperature is kept normal using a specialist warming blanket.

The Operation

You may have some awareness once in the operating theatre, depending on how much sedation you have decided to have. Some patients decide to remain completely awake. During your operation, the surgeon may inject high volumes of local anaesthetic into the tissues around the knee joint. This complements the spinal anaesthetic, and helps with your pain relief after the operation, allowing you to move the knee immediately. This technique normally provides excellent pain relief; however, you will be asked about your comfort levels regularly and will be offered extra pain relief if necessary.

Recovery

• From the operating theatre you will be transferred into the recovery ward. The staff here will:
• Check your general condition
• Take your observations; pulse, blood pressure and oxygen levels
• Check your wound dressing
• Monitor your spinal anaesthetic
• Assess your pain control

After a short time, you will return to your ward.

The ward staff will continue to monitor you and make sure you are comfortable.

Pain Relief

You will have regular pain relief prescribed. If you feel your pain relief is inadequate at any time, then you must let the ward nurses know, so they can help you to get more comfortable. We also have a dedicated team of pain nurse specialists, who may come to see you after your operation.

Exercises

It is essential that you commence the following exercises as soon as you can after your operation, and whenever you are resting, to help prevent blood clots.

Ankle Exercises

These should be done every hour for approximately 5 minutes or longer if possible. This helps maintain the circulation in your calf muscles. If you experience any pain or tenderness in the calf, please contact the nursing staff immediately. You may not initially be able to do the exercises until the spinal anaesthetic has worn off. This is normal and the movement will return in time.

Deep Breathing Exercises

This helps to keep your chest as clear as possible. Take 3 or 4 deep breaths. Try to breathe as deeply as possible, and after the last breath try to "huff" out the air. This may stimulate a cough. Some people may experience a productive cough after anaesthetic.

Exercise Programme

It is essential that you follow this programme regularly after your surgery.

We also advise that you start doing this programme BEFORE your operation, to help improve the movement and strength in your muscles.

The Physiotherapy Team on the ward after your operation will monitor your exercises and we encourage you to perform the programme independently at least three times per day. It is very important that you continue to do these exercises when you leave hospital to get the very best result possible for you.

Straightening Exercises

1.   With your leg straight out in front of you, tighten the muscles at the front of your thigh, pushing the knee down. Hold the contraction for 3 seconds and repeat 10 times.

2.   Do the same as exercise 1 but put your heel on a block or pillow.

Bending Exercises

3.   With a sliding board / plastic bag under your heel, slide your heel up towards your bottom. Hold on maximum bend for 5 seconds and then release.

4.    Sitting in a chair with your foot on the ground, slide your foot firmly towards you and hold for 3 seconds

Strengthening Exercises

5.    Sit with a rolled-up towel under your knee. Keep your knee down on the towel and raise your heel off the bed. Straighten your knee as far as possible and hold for 3 seconds. Slowly lower your heel back down to the bed.

6.    Squeeze your buttocks firmly together, hold for 3 seconds, then relax. Repeat 10 times, at least 3 times a day.

7.    Sit with your leg out straight. Tighten the thigh muscles; lift your whole leg about 15 cm off the bed. Hold for 3 seconds and slowly lower down.

If you have a problem with your hip, or have had previous hip surgery, this exercise might not be appropriate. Please speak to your physiotherapist for advice.

Mobility

As a rule, you will be allowed to walk either the same day or the day after your operation. Do not worry if this is not the case for you. You will be told as soon as possible when you will be able to get up.

You will be instructed on the use of crutches / walking aid and the correct way to walk. Once assessed by the Therapy Team, you may walk with another member of staff.

The aim is to help you regain independence with the crutches / walking aid as quickly as possible, allowing you to walk with minimum supervision or independently as soon as you are able to do so.

However, it is important to understand that everyone is different and that the appropriate amount of help will be given to you according to your needs.

Cryotherapy (ICE)

We advise that you regularly apply cold therapy to your knee following your operation. Important things to consider:

• Don’t have the cold source in direct contact with your skin
• Don’t ice for longer than 20 minutes and ensure the ice comes off for at least 30 minutes before being re-applied

Stairs

Once you are walking well, you will be taught how to manage stairs or a step (according to your needs).

• Take one step at a time
• Going upstairs: use the banister on one side and the crutch / stick on the other side. Leading with your non- operated leg, first place your foot on the step; then with your operated leg, place your foot on the same step, and lastly your crutch / stick.

• Going downstairs: use the banister on one side and the crutch / stick on the other side. Place your crutch / stick first on to the step, then your operated leg onto the step, and then the non-operated leg onto the same step

• Steps without rails or kerbs: as above, but use both crutches / sticks together

Day of Surgery (day 0) - on the Ward

You may be encouraged to get up a few hours after your return to the ward. This will initially be with the help of the Therapy Team and nursing staff, who will show you how to walk.

The walking sequence should be:

• Move your walking aid
• Step forwards with your operated leg
• Step forwards with your un-operated leg

You will then be encouraged to sit in a chair and wear day clothing.

Easily fitting and comfortable clothes are best. You will also be encouraged to return to normal functioning, including completing your exercises independently throughout the day.

Post-operative Day 1

You will usually get dressed into your normal clothes. Please bring easy-fitting clothes and well-fitting slippers when you are admitted.

Routine pain relief and any other drugs you may take will be given. Assistance with moving round and dressing will also be given.

You will be visited on the ward by the Therapy Team, including weekends.

The Therapy Team will complete all necessary assessments with you including bed / toilet transfers and stairs if needed. The team will aim to discharge you home at this stage. 

Remember: It is important you also exercise independently.

Discharge Criteria

However long your hospital stay, you will need to meet several goals before you are discharged home:

The Aquacel wound dressing must be intact; this should remain on until Day 14 after surgery. You may shower with this dressing in place.

• Walking independently with crutches / walking aid
• Getting in / out of bed and on / off the chair / toilet by yourself
• Being able to get up / downstairs if required at home
• Making satisfactory progress in straightening and bending your new knee
• Making satisfactory progress in strengthening the muscles in your surgery leg
• Having an X-ray of your new joint
• Having all the equipment / help necessary at home

Getting In and Out of a Car

• Ask your driver to push the seat all the way back and recline it slightly
• If needed, use a small cushion to make the seat level
• Putting a plastic bag on the seat, as this can help you slide and turn into position
• Back up to the car until you feel it against the back of your legs
• Carefully lower yourself onto the seat, keeping your operated leg straight out in front of you as you sit down
• Slide across the seat towards the handbrake, to give you sufficient room to get your legs into the car
• Turn towards the dashboard, reclining backwards as you lift your operated leg into the car
• To get out of the car, reverse this procedure

Follow-up

Although you have been discharged from hospital having made satisfactory progress following your operation, we are still here to support your recovery should you need us. If you have any concerns regarding your recovery, or if you think you may be developing a problem, please contact the helpline; they will be able to offer advice, arrange additional support, or organise a review if required. It is particularly important that you contact us if you are concerned about your wound.

Monday to  Friday: 8am until 4pm

Orthopaedic Practitioner Helpline number: 01257 256372 

Therapy Helpline number: 01257 488282 (answerphone)

SSIS Nurse (Wound Surveillance): 01257 488233

Out of these hours please contact the ward where you had your operation:

Orthopaedic Admissions Unit (OAU): 01257 256219 

Ward D: 01257 256269

Ward A: 01257 256276

Ward B: 01257 256277

John Charnley Wing: 01257 256265 / 256267

REMINDER: please seek advice if you notice any excessive bleeding. or any difficulty with breathing. If you become urgently unwell, please call 999.

You will also have a clinic appointment approximately 6 weeks after your surgery. You will often be seen by the Arthroplasty Practitioner at this point. This is to ensure you are progressing well and to answer any questions you may have. If for any reason you do not receive an appointment through the post, or if you have a problem with your Outpatient appointment, please contact us on the telephone numbers above.  

You will routinely have a physiotherapy follow-up appointment, which is arranged in discussion with the ward-based Therapy Team. It is important to continue your exercises at home.

Once at Home

Please remember you have undergone major surgery, and your recovery can take up to 12 months. It is important that you follow these guidelines when you return home:

• Continue to take painkillers as prescribed
• Use your crutches / walking aids as directed. The length of time these are needed may vary. Your healthcare practitioner or surgeon will inform you of how long to remain on both crutches. When it is time to gradually wean yourself off your aids, do so as your leg becomes stronger, and your confidence increases. If you are using two crutches / sticks and you wish to try with one, always use it on the opposite side to your operated leg
• Your operated leg will feel stiff each morning when you wake up. Do not worry about this; the stiffness should wear off in time. Always exercise to achieve the bend that you had the previous day, then add a little more
• Gradually try to increase your walking distance. Walk frequently throughout the day
• Avoid crossing your legs, as this might hinder your circulation
• Avoid sleeping with a cushion or pillow under your knee, as this will cause extra stiffness and make it more difficult for you to the straightening required
• Wear sensible footwear
• Avoid kneeling on your operated knee until after you have seen your surgeon at follow - up clinic
• A healthy diet and not smoking will help promote wound healing and overall recovery

Frequently Asked Questions 

Why have I still got swelling?

It is normal for healing tissues to be swollen. The swelling may last for many months. When you take a step, the calf muscle works to help pump blood back to the heart. If you are not putting full weight on your leg, the pump does not work as well and you may get swelling around the ankle, especially at the end of the day. You may also find that bruising starts to come out in the first few weeks after surgery. This is normal.

Do your circulation exercises often. When resting, keep the leg elevated, ideally above the level of your heart. Using some ice may help reduce the swelling around the knee, but avoid applying directly to the wound. Always avoid direct skin contact.

Why is my scar warm?

When tissues are healing, they produce heat. This can be felt on the surface for many months.

How long will I have pain for?

It is likely that you may continue to experience some discomfort for several weeks. If the pain is not well controlled, please inform your GP or call the helpline.

Why do I get pain lower down my leg?

While the tissues are settling, it is quite common to get referred pain into the shin or behind the knee.

Is it normal to have a disturbed night's sleep?

As with sitting when you are in bed, your knee may stiffen up and the discomfort may wake you. It is not advisable to sleep or lie on either side in the early stages of recovery. When you do lay on your side, place a pillow between your knees for added comfort.

Is it normal to have numbness around my scar?

Small nerves are disrupted during the surgery, which can cause numbness around the incision. This should resolve but may leave a small area of permanent numbness.

Why does my joint click?

Your new knee works in a different way. The clicking should improve as recovery continues. Some patients may always be aware of some minor clicking.

When can I drive?

You should usually wait 6 weeks before driving. Before you consider driving, you must feel confident that you have sufficient movement and strength to perform an emergency stop. You should also inform your insurance company that you have had an operation before you drive again.

Can I go swimming?

You should not swim for the first 6 weeks, and your wound should be fully healed.

When can I return to the gym?

This will depend on your previous level of experience and fitness. Low impact activities such as cycling, treadmill walking, and swimming are recommended when the soft tissues have healed, and the muscles are strong enough to protect the new joint. High impact activities, such as sports and running, should be avoided until after your consultant clinic review.

Will I set off the security scanner alarm at the airport?

Your joint may set off the alarm, depending on the type of metal it is made of. Your metal walking aids will also be x-rayed. It is not normally advisable to fly within 3 months of your surgery, as flying increases the risk of a DVT. If you are considered to be high risk for DVT, you should get advice from your consultant or GP. They may recommend you delay your trip. You should also check that your insurance policy provides adequate cover.

Myrecovery App

We use an app called myrecovery for pre-and-post operative information. If you are provided with log in details, please use the app for all relevant information and useful resources compiled to help you before and after your operation.

Additional telephone numbers

WWL Main Switchboard: 01942 244000 

Admissions: 01257 256211

Preoperative Assessment Clinic: 01257 256340

Physiotherapy: 01257 256307

Occupational Therapy: 01257 256306

Outpatients Department: 01257 256295