Day Case – Partial Knee Replacement 

Patient Information

Trauma & Orthopaedic Department

• Author ID:           MN
• Leaflet Ref:         Musc 074
• Version:              1 
• Leaflet title:         Day Case – Partial Knee Replacement
• Date Produced:   September 2021
• Expiry Date:        September 2023

Introduction 

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

Here at Wrightington we have a long history and tradition in joint replacement surgery, having pioneered modern 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 and therefore helping you to get better sooner. 

This information booklet aims to answer any questions you may have about undergoing partial (unicompartmental) 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 help you recover sooner. 

This booklet is also your guide.  It will give you the information you need to achieve the best outcome from your joint replacement surgery including:

• How to prepare for your upcoming surgery
• What to expect before, during and after surgery
• What to expect during your hospital stay
• What to expect and what to do, to continue your successful recovery at home

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

The Team 

You will encounter a lot of orthopaedic staff. Everyone works together to make your surgical experience as pleasant as possible whilst maintaining the highest quality of standards and care. The staff you will meet are as follows:

• Consultant Surgeon 
• Orthopaedic Fellows, Registrars and Junior Doctors 
• Anaesthetists 
• Specialist Pain Management Nurses 
• Ward Nurses 
• Physiotherapists 
• Occupational Therapists 

• Therapy Assistants 

• Theatre and Recovery Staff 
• Pharmacists 
• Radiographers 
• Bone Bank Team 

Introduction to Partial (Unicompartmental) Knee Replacement and Day Case Surgery

Why Day Case Surgery?

The time patients spend in Hospital after partial knee replacement has reduced a lot over the years. Now, with modern techniques and support, it is possible to have the operation and go home the same day. The advantages are being in your own environment, a reduced risk of medical complications and being in control of your own recovery.

Who is suitable for Day Case Surgery?

Not every patient having a partial knee replacement is suitable for day case surgery. Patients must be quite fit apart from their knee problem, live quite close to the hospital, have someone living at home with them that can help after surgery, have their own transport to and from hospital, but above all must be motivated to succeed.

What is done differently when I have Day Case Surgery?

• Your operation will be one of the first of the day on the operating list. 
• The drugs used for the spinal anaesthetic wear off more quickly, so that you get control of the muscle function more quickly; this allows you to walk sooner after the operation. 
• We also give other medications during the operation to reduce blood loss, control pain after the surgery and reduce any nausea/vomiting.
• When you are back on the ward, you will receive regular pain relief and have access to stronger medication that you can use if you feel it is necessary.
• The Therapy Team will spend time with you on the ward after surgery, to ensure you safely progress through the stages of regaining your independence.

What is a partial knee replacement? 

The knee is a hinge joint between the thigh bone and the shin bone. During the operation, the worn or damaged part of the joint will be replaced with an artificial one. The different types of implant will be discussed with you at the time of consultation with your surgeon. 

Benefits of surgery 

A partial knee replacement is usually carried out when the affected part of the knee joint is worn, and severe pain restricts mobility. The benefits of surgery include: 

1. 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, so that you can walk on the same day. 

1. Reduce stiffness 

The new joint will have highly engineered metal 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. 

1. Increased mobility 

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

Risk of Surgery 

Partial knee replacement surgery is generally a very successful operation. Around 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 below: 

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 additional swelling and pain. 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 called a pulmonary embolus (PE). In rare circumstances (1-2 in 1000 patients who have knee surgery), this can cause death. Symptoms of a PE include shortness of breath, sharp chest pain and blood coughed up in your phlegm.

Preventative measures

• We now get patients moving as soon as possible following partial knee replacement surgery. This has the advantage of increasing blood flow to the leg and maintaining the circulation. 
• We assess all patients’ individual risk of blood clots as recommended by the National Institute of Clinical Excellence (NICE). Following risk assessment, most patients are advised to take blood thinning agents. You will be advised by your doctor or nurse on how to take this medication and for how long; it may be an oral or injectable type of medication called an anticoagulant. 

Joint Infection 

You will be screened for bacteria including MRSA (Methicillin-Resistant Staphylococcus Aureus) before you come in for your operation to reduce the chance of infections. This enables any treatment to go ahead if the patient does not carry the bacteria, and it will reduce the risk of infection to you and to others. It is very important that there are no cuts, grazes, or wounds on your legs when you come for surgery. It may be worthwhile considering avoiding activities such as gardening for a few weeks prior to your surgery. 

We will also encourage you to lose weight, as being overweight increases the chances of infection following surgery. We also encourage smoking cessation, as there is evidence that smoking increases your chances of infection, with the wound taking longer to heal. 

During the operation, you will be given intravenous antibiotics and your surgery will take place in advanced air-flow operating theatres. Both these measures help reduce the chance of infection. 

Deep infection in an artificial joint is a very serious complication. It occurs in about 1% of patients. More commonly, one can develop an infection on the skin surface, which can occasionally this progress deeper. We take any infection seriously. If you think you have a wound problem, you should always let us know immediately via the helpline or by contacting the Surgical Site Infection Surveillance Nurse (SSIS Nurse), using the number from the list at the back of this booklet. If necessary, we will inform your surgeon and arrange for you to be reviewed. 

Wrightington, Wigan and Leigh NHS Foundation Trust currently takes part in Surgical Site Infection Surveillance. This is a structured process developed by Public Health England to monitor post-operative wound infections, with particular attention given to Orthopaedics and joint replacements. 

As a Trust, we monitor all hip and knee surgical procedures, both first-time and revision (re-do) procedures, for a full 12 month period following the date of operation. As an important part of your plan of care, we need to monitor the progress of your wound. By 10-14 days post-operatively, your wound should be healed. If you have sutures or clips, these will be removed by the Community Nursing Team or the GP Practice Nurse. 

At around day 20, we will post a questionnaire to you about your wound progress. This will be accompanied by an information leaflet entitled “Monitoring Surgical Wounds for Infection – Information for Patients”. We would kindly stress the importance of you completing and returning this form to us, as it is an important tool in maintaining our high standards. 

By following the clear instructions you receive with this document, it will provide you with useful information, and help us to maintain our high standards of wound care, by identifying any problems. 

In the unlikely event that you develop a surgical site infection, your GP or nurse may treat the infection, but we would still like to be informed. Any of the contact numbers provided are appropriate; however, to report an infection outside of office hours, please inform the ward you were treated on. 

If a deep infection is not treated within the first few weeks, then revision (re-do) surgery may be needed. Early treatment can help reduce this risk.

Bearing dislocation of the joint 

Occasionally following partial knee replacement, the bearing inserted can dislocate from the joint. This can occur in 1 to 3% of patients. Normally, the bearing is put back in place with a short operation. Occasionally patients need to undergo further operations to make the knee more stable.

Joint loosening 

Partial knee replacements have a limited lifespan. They are mechanical devices which will eventually wear out. The younger and more active you are, the more likely you are to need a revision (re-do) operation in the future at some stage. Your surgeon will discuss these risks with you. Around 90% of partial knee replacements are working and in place 10 years following surgery. 

Fracture 

There are occasions when a bone may break during this procedure. The risk is very low, and most fractures are very minor and require no specific treatment. If treatment is necessary, fractures can be treated with plates and screws, or require more complex knee replacement surgery. Everyone gets a routine check x-ray after the operation. In rare circumstances, a return to theatre may be necessary to fix the fracture.

Nerve or blood vessel injury 

There are several nerves located around the knee and these can be damaged during partial knee replacement surgery. These nerves supply skin sensation, and they power the muscles in the leg. Injury to major motor nerves (those responsible for movement) or sensory nerves (those responsible for feeling lower in the leg) is rare. It is very common, however, to experience some numbness next to the scar on the outer side of the leg, this is because of small branches of skin nerves being cut at the time of the incision. This rarely troubles patients in the long term, except in the unusual cases where the area affected becomes painful rather than numb.

Behind the knee joint, there are large blood vessels carrying blood to and from the lower leg. Injury to these is very rare, but potentially very serious were it to occur.

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 develop urinary incontinence. This is usually 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 refer you to see a specialist urology doctor.

For patients planned as a day case, needing a catheter might also mean needing to stay in hospital overnight.

Persistent pain 

Partial knee replacement surgery is an excellent operation for arthritis. However, there is a group of patients who are left with ongoing pain and discomfort around the knee. Further treatment for this can be discussed with your doctor if necessary. 

Revision (re-do) surgery 

Occasionally for various reasons, operations need to be re-done. 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 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 consultation with your surgeon and anaesthetist. If there are any concerns, your doctors may transfer your care to another speciality for ongoing treatment 

Summary 

Partial 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. 

Out-patient clinic 

When you attend the out-patients clinic, you will be entered onto the waiting list for your procedure. Your consultant will work closely with the admissions team and pre-operative assessment team to agree on 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 necessary 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 to pre-operative assessment on the same day. If you have complex medical problems, you may be required to see the anaesthetist prior to surgery. 

Before You Come into Hospital

Pre-operative 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, lungs and have blood tests taken. Skin swabs will be taken to test for MRSA. You may require an x-ray and will 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 prior to surgery. However, this would only be under the direction of a doctor. 

If you have a long-term illness, heart, lung or metabolic (diabetes, thyroid) condition, 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 out-patient appointment with your consultant, who will discuss alternative treatment options. 

Please tell the doctor or pre-assessment nurse if you are already taking these medications for other reasons, or if you are taking another medication called Pregabalin.

Pre-Surgery Physiotherapy 

It is important to practise the exercises contained in this booklet. This will help you to be familiar with how to perform them, so that after surgery you can complete them to strengthen your muscles and aid recovery.

How long will I be in hospital? 

Discharge will be planned for the same day as your surgery.  However, you will only be discharged home if it is medically safe to do so, you have someone at home with you and you can manage safely.

What is my role?

Once you have been listed for surgery, you become part of the team.  Actively participating in the steps before and after your operation can help you:     

• Leave hospital sooner
• Make you feel better sooner
• Return to normal living sooner.

Healthy steps you can take before your operation

Food and drink:

Eat well; your body needs fuel to repair.

Sleep, rest & play:

Staying physically active before your operation will help you get better, faster. Try to relax.  Try not to worry and get together with family and friends.

Smoking & Alcohol

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

Exercise:

Remain active and complete your exercises regularly to maintain muscles. Start your surgery specific exercises contained in this booklet before surgery if possible.

Practical tips before your admission

Set up your plans for going home before you come into hospital.  Your stay in hospital is not very long.  It will be useful to talk these steps through with your friend, carer, or family to ensure you have all the practical support in place to support your recovery.

Your to do list

If you have any last-minute questions or are unsure about anything, don’t be afraid to ring us and ask.

During Your Stay in Hospital

Admission 

The day you are admitted will be the day you undergo surgery. Please follow the fasting guidelines:            

• Eat until midnight on the day before admission.
• Drink until 6:30am; have a glass of water or your normal hot drink at this time.
• You may be given a carbohydrate drink to take before midnight.

Reminder: Please ensure you have a bath or shower before you arrive at the hospital. We need you to be as clean as possible to reduce the risk of infection. 

It is also important that you do not apply creams or make-up after your bath or shower. If you shave your legs, please do not shave for at least three weeks prior to the operation. Shaving is known to increase infection rates in joint replacement, unless conducted immediately before the operation. It is not known whether hair removal creams increase infection risk, and these may be best avoided. 

You will normally be admitted on the morning of your surgery to 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/trainers to walk in and some comfortable slippers. There may be some swelling in your foot after your surgery: therefore, consider this when selecting suitable footwear; shoes without backs are not recommended. Your partial knee replacement will be undertaken in the morning. We would anticipate that you would be up and walking and dressed in normal clothes soon after surgery. 

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. 

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 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 a temporary numbness and heaviness from the waist down and allows surgery to proceed without feeling any pain. Some sedation can then be used in combination with this 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 allows for you to start moving your knee soon after surgery. 

Due to the effect 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 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. 

The theatre team, including your surgeon, will be wearing specialist theatre clothing and working under a state-of-the-art special airflow system to minimise the risk of infection. 

During your operation, the surgeon will inject 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: 

1. Check your general condition 
2. Take your observations: pulse, blood pressure and oxygen levels 
3. Check your wound dressing 
4. Monitor your spinal anaesthetic 
5. Assess your pain control 
6. Offer you a carbohydrate drink

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

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

Your surgeon may request an x-ray of your new knee. 

The following x-rays demonstrate unicompartmental knee replacement after surgery. 

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 as soon as you can after your operation, and whenever you are resting to help prevent blood clots. 

General exercises - Ankle exercises 

This 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 this until the spinal anaesthetic has worn off. This is normal and the movement will return in time. 

General exercises – 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.

Surgery specific exercises 

The Therapy Team on the ward after your operation will discuss your exercises and we encourage you to perform the programme independently at least three times per day. It will be very useful if you have been able to perform these before your surgery as previously mentioned. Timing your exercises around any pain relief you are taking or ice treatments you are using may help to reduce discomfort.

It is very important you continue to do these exercises when you leave hospital in order to get the very best result possible for you:

Buttock squeezes 

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

Tightening the thigh muscles 

Sit or lie with your leg straight out in front of you. Point your toes towards you and tighten the muscle on the front of your thigh by pushing your knee down. Hold the muscle tense for 5 seconds and then relax. Repeat 10 times, at least 3 times a day.

Knee Extension

• Lie with your legs out straight with a rolled-up towel under your heel
• Tighten your thigh muscle to push your knee as straight as possible
• Hold for 3-5 sec and then relax, repeat 10 times, at least 3 times a day

Inner Range Quads

• 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, repeat 10 times, at least 3 times a day

Straight Leg Raise

• Lie with your legs out straight
• Pull your foot toward you, tighten your thigh muscles, and lift your whole leg 2-3 inches keeping your knee straight
• Hold for 5 sec then slowly lower, repeat 10 times, at least 3 times a day

Back on the ward 

• You will be encouraged to be as independent as possible.
• You will be encouraged to sit in a chair and wear your own clothing

 Mobility/ Walking

You will be instructed on the use of crutches/walking aid and the correct way to walk. 

The walking sequence should be: 

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

Once assessed by the Therapy Team, you will need to practise your walking. The aim is to help you regain independence with the crutches/walking aid as quickly as possible, allowing you to return home the same day.

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.

Steps to improve your recovery whilst still in hospital

• Take an active part in your recovery – follow the advice and instructions of the clinical team
• Be positive.
• Start to eat and drink – your body needs fuel to repair
• Don’t be afraid to ask questions or for information to be repeated.  If you are unsure about anything – say so.

Remember – we are all individuals, don’t worry if you don’t reach your goal straight away, just keep trying!

Discharge criteria

You will need to meet several goals before you are discharged home. The plan is for you to return home on the same day as the operation. However, you may need to stay overnight. Don't worry if this happens - we will have a bed for you just in case, and the chances are you will be able to go home the following day.

• Aquacel dressing should be intact; this should remain on until Day 10-14 post-operatively. You may shower with this dressing in place. 
• Walk independently with crutches / walking aid 
• Get in / out of bed and on / off the chair / toilet by yourself 
• Be able to get up / downstairs if required at home 
• Have all the equipment / help necessary at home 

Handy tips for getting in and out of a car

• Ask your driver to push the seat all the way back 
• Back up to the car seat 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.

When you are 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, to enable you to move effectively and manage your pain and swelling 
• Use ice regularly for swelling control - If you do not have any circulatory disorders, you will benefit from applying ice regularly following surgery. This will help to minimise pain and swelling. Firstly, (before your wound has healed), wrap the leg with cling film. Then place a bag of frozen peas, ice cubes, or an ice pack in a damp tea towel. Raise your affected leg and apply your ice pack for approximately 20 minutes. This should be done regularly throughout the day.
• Approximately 5 days after surgery, you will have an appointment to see one of the Therapy team
• Use your walking aids as instructed when moving. Your physiotherapist will advise you when you no longer need them. 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 
• Gradually try to increase your walking distance. Walk frequently throughout the day 
• Your operated leg may feel stiff each morning when you wake up. Do not worry about this; the stiffness should wear off in time 
• Continue to perform your exercises and continue with your physiotherapy out-patient treatments 
• Wear sensible footwear. 
• A healthy diet and not smoking will help promote wound healing and overall recovery. 

Post-operative wound care 

The dressing should not be changed or disturbed until 10-14 days after your operation; at this point, the district nurse will remove your clips or sutures and perform a wound check.

It is normal to see some blood-stained fluid within the pad of the dressing.  If the fluid leaks outside of the dressing, you will need to contact your district nurse to check the wound and dressing.

Post-discharge Rehabilitation

The Therapy Team will review you within a week of your discharge. This will be to check how you are getting on. They will assess how you are walking, check your exercises and address any queries. Please remember to access the helpline numbers below if your queries are urgent. 

You will then continue with regular outpatient physiotherapy.

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 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. 

Contact Details

Monday to Friday: 8am until 4pm. 

Inpatient Therapy (answer machine available, please leave a message)

Enhanced Recovery Practitioner Helpline number:  01942 778993 or 01257 488282 (answerphone service) 

SIS 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 have a clinic appointment with a member of the surgeons’ team approximately 6 weeks after your surgery. This is to ensure you are progressing well and to answer any questions you may have. 

Frequently Asked Questions 

Do I have to sleep on my back?

No. In the past, patients were told to sleep on their back after joint replacement for 6-12 weeks. There is now research that shows many patients do not do this and that it does not benefit patients. You can sleep on your side. Some patients find it comfortable to use a pillow between the knees.

Can I use a normal toilet?

Yes. Most patients find this comfortable to do without any additional equipment. Practical tips such as putting your surgery leg forward while you sit can help with comfort. If you have a need for equipment, this can be arranged.

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 following surgery. This is normal. 

Do your circulation exercises as advised. When resting keep the leg elevated, ideally above the level of your heart. 

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 ankle. 

Is it normal to have disturbed nights? 

As with sitting, when you are in bed your knee may stiffen up and the discomfort may awaken you.

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 partial knee works in a different way. The clicking should improve as recovery continues. Some patients may always be aware of some minor clicking, as the cartilage has been replaced with metal and plastic bearings. 

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, so that you could 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 in the early stages of recovery.  Please see your physio for further advice. This can also be discussed further at your 6 week clinic review. 

When can I fly?

You should not fly for 4 weeks before your surgery. Following your surgery, you should not fly short haul for 6 weeks, or long haul for 12 weeks.

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.

Additional telephone numbers 

Wrightington Main Switchboard: 01942 244000 

Admissions: 01257 256211 

Pre-operative clinic: 01257 256340 

In-Patient Physiotherapy: 01257 256307

Out-Patient Physiotherapy: 01257 256305 

Outpatients: 01257 256295 

Patient Advice and Liaison Service (PALS): 01942 822376

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; this can help improve clinical standards, and benefit patients, clinicians, and the orthopaedic industry. 

Please see their website for further information www.njrcentre.org.uk