Pathway for total knee replacement and unicompartmental knee replacement
The anaesthetist will contact you by phone before the surgery, to discuss the anaesthetic. Sometimes they will arrange to see you if necessary. Occasionally, we will arrange for you to see another specialist in order to optimise your medical conditions before the surgery (such as a cardiologist).
Read more about Anaesthesia here.
Thrombosis (DVT) and pulmonary embolus (PE)
Orthopaedics WA assess all my patients for risk of DVT/PE. Our routine regime for prevention after hip or knee replacement is:
- Spinal/epidural anaesthetic
- Good hydration
- Early mobilisation
- Calf pumps
- Low molecular weight heparin (LMWH) (hospital policy)
- Aspirin on discharge for 28 days
Orthopaedics WA class patients as being very high risk if they have had a previous DVT or PE, are having bilateral surgery, or have a strong family history of DVT/PE. We will usually fully anticoagulate these patients for 6 weeks, or may use high dose LMWH.
Orthopaedics WA believe that this regime reduces the risk of DVT/PE while minimising the risk of complications associated with other treatments.
Tranexamic acid is routinely used peri-operatively, which halves the blood loss. Spinal anaesthetic, and meticulous control of bleeding during surgery further minimises loss. Transfusion is extremely rare after primary joint replacement surgery (<1%).
Furthermore because transfusion is so rare, it is never necessary for patients to pre-donate blood.
Orthopaedics WA may ask patients to see the physiotherapists pre-operatively. This allows them to better prepare them for surgery by teaching the use of crutches, and manoeuvring in and out of bed before the surgery is performed.
Before admission you will need to arrange someone to collect you after your surgery, and to have someone at home with you at least you the first day. If you require special help at home, then this needs to be fully arranged before you come into hospital.
Please ask if you have any questions regarding this.
There are many factors that influence this, and we have worked on optimising these over the last few years. These include: spinal anaesthetics with multimodal pain relief, minimising blood loss, immediate mobilisation, patient and nursing expectations, and education. The benefits are: earlier return to full activity, driving and work; reduced incidence of DVT/PE; reduced chest complications; reduced bowel disturbance; minimal exposure to the hospital environment; better psychological wellbeing and better patient satisfaction.
Orthopaedics WA’s Professor Yates developed this approach in Osborne Park Hospital from 2006, and it has been highly successful.
The day of surgery
You will next be taken through to the operating room and given your anaesthetic. Antibiotics will be given in order to reduce the risk of infection. Routine knee replacement will take approximately 40 minutes to perform. The skin is usually closed with absorbable sutures, with a thick dressing that remains on for up to 72 hours. Orthopaedics WA rarely use drains, but nearly everyone will have a urinary catheter until the next morning.
We will usually fill the knee with local anaesthetic and other medication, to reduce pain, and minimise blood loss. A tiny catheter is usually left in the knee, which can be used to inject local anaesthetic into the knee over the first two days. A pain patch is placed in theatre, and special ice packs on the knee.
We have a rolling program of research and investigation into this subject. The aim is to speed recovery, minimise pain and maximise function. Pain relief is multimodal and multidisciplinary, involving the patient, the surgeon, the anaesthetist, the nurses, the physiotherapists, and the pain team. All patients are individual, but Orthopaedics WA feel that we have made great advances in this area over the last six years.
Ice post operative for TKR
Most of our knee replacement patients will be independently mobile with crutches and able to return home by the third postoperative day. Patients with unicompartmental knee replacements are usually able to be discharged even earlier.
The physiotherapists will see you twice a day, and teach you your exercises, how to move safely and to help you rehabilitate. They may arrange outpatient physiotherapy, depending on your needs and circumstances.
Advice following knee replacement surgery
Your dressings are waterproof so it is safe to shower without covering them.
If you have clips or sutures that need removing, the ward will arrange for a nurse from Health Choices to visit you at home, 14 days post-op, to remove them. If this cannot be done you will be advised to make arrangements with your GP.
Swelling is common but will resolve, use ice therapy up to every 4 hours, 20 minutes at a time and elevate the leg. However, if there is increasing swelling or calf pain please see your doctor or present to an emergency department.
Bruising is common after knee surgery but this will resolve over a few weeks. Occasionally a haematoma can form under the wound, like a soft or hard ball, this will resolve. However, call the office if you are worried.
If there is redness or discharge from the wound please see your GP or call the office for instructions. Attend an emergency department if you cannot get to a GP or contact the office.
You may get some pain as you increase your mobility please use the pain killers given to you from the hospital, and you may need to get a further prescription from your GP or if you need us to arrange this please allow up to 4 days.
Occasionally deep sutures, often dark in colour, can work their way to the surface, these simply need to be cut back by your practice nurse.
Sick note – if a sick certificate is needed please contact the office.
What you can do to optimise yourself
Stopping smoking 6 weeks before the operation will greatly reduce your risks of chest complications, infection, and poor wound healing, as well as benefit your long-term health.
Exercise, weight loss and healthy eating will all improve your outcome.
Problems with your skin, teeth and nails need to be brought to our attention, as they can be a serious infection risk.
What to bring
- Pathway for total hip replacement and resurfacing hip replacement
- Bearings for hip replacement
- Hip replacement in the young
Pain Management after discharge
Advice following Knee replacement surgery
DVT and PE
Knee Replacement Implants
Total Knee Replacement
Unicompartmental Knee Replacement
Activities After a Knee Replacement
Knee Arthroscopy Exercise Guide
Total Knee Replacement Exercise Guide
Surgery and Smoking
Deep Vein Thrombosis