Your Knee Surgery
What you need to know before your surgery
When should I arrive in hospital? Typically, you should arrive on the morning of the surgery at a time and ward designated by the hospital. I will meet you on the ward prior to the surgery to mark the operative leg, to confirm consent for the operation with you, and to answer any further questions you might have regarding the surgery. Please remember to bring your specific consent form with you if this has been provided.
Should I take my normal medications? In general, you should take all of your usual medications with a small sip of water on the morning of surgery unless specifically instructed otherwise. If you take regular anticoagulants other than Aspirin you will usually have been instructed to stop these prior to surgery. If you are not sure please contact our team.
Cuts, Scratches and Bites: Open wounds or infected areas of skin on your legs do pose a significant risk of infection and can cause your surgery to be delayed or cancelled. If you have any areas of concern please contact the team well in advance of your surgery date.
“Nil by mouth”: Leading up to an anaesthetic it is important not to eat or drink anything for at least 6 hours before surgery. This helps prevent potentially life-threatening problems caused by regurgitation and inhalation of stomach contents during the anaesthetic. You will therefore be asked to be “nil by mouth” from midnight on the day of surgery. Clear fluids such as water and black tea may be allowed up until 2 hours before the anaesthetic but this needs to be clarified with the treating anaesthetist when you meet them on the morning of surgery.
List order: Occasionally, the order of an operating list may need to be changed on the day of surgery for a number of reasons that are usually not foreseeable – it is best to clarify this with me when we meet on the morning of surgery.
Arthroscopic procedures – The majority of patients having day case arthroscopy procedures under my care will be offered a combination of a nerve block with a light general anaesthetic. This ensures a rapid recovery after surgery and you will usually be able to go home on the same day.
Joint Replacement – It is common to have a spinal anaesthetic (local anaesthetic in to the spinal canal through your back) as well as sedation. The anaesthetist will discuss this in more depth with you on the day of surgery.
Nerve blocks: Nerve blocks provide excellent pain relief for the first 24 hours after surgery, which is usually the most painful time. They are given by the anaesthetist, who usually does this just after you go under the anaesthetic. The nerve block involves an injection of local anaesthetic into your thigh on the side of the surgery, usually guided by ultrasound, aiming to “block” the nerves that supply pain fibres to the knee. A good “block” will result in total or near total numbness of the knee.
What happens after the surgery?
At hospital: You will wake up in the theatre recovery room with your recovery nurse specialist. Once awake, which commonly takes about 15 mins, you will be escorted back to the ward. You may eat and drink as you feel able once back on the ward. I will visit you on the ward shortly after the surgery to explain my findings and any changes to the aftercare plan based on the procedure that was actually carried out (sometimes decisions on the type of surgery carried out have to be made during the operation itself, although I will endeavour to discuss the possible options with you prior to surgery as part of the consent process). Our physiotherapy team will also see you on the ward before you go home to ensure you are safe and have a suitable exercise plan in place.
Dressings (keyhole/arthroscopic surgery): Initially you will have a heavy bandage around your knee. This can be removed the day following the surgery. Under this are smaller splash-proof dressings. I would advise you to keep your knee dressings dry for the first two weeks after surgery whilst the wounds are healing. It is also best to avoid changing these dressings unnecessarily. If, however, one of the dressings has become soaked or poorly adherent then spare dressings are provided by the ward before your discharge. I use steristrips in the skin rather than stitches and these can be removed 12-14 days after surgery, either by your GP or at the time of your follow-up clinic appointment.
Dressings (open surgery): After open surgeries such as a total knee replacement there will be a splash proof dressing covering the wound. This should ideally be left intact until the wound is checked at 14 days. Unnecessary changes of the dressing risks introducing infection and should be avoided. Care must be taken to avoid getting the wound wet as much as possible by keeping the wound out of bath water or by directing the shower stream away from the wound. I prefer to use absorbable sutures under the skin rather than skin clips.
Knee Brace: If you have had a knee reconstruction or repair (ligament, meniscus or cartilage) you will wake up in a fixed brace set in slight flexion. This is designed to allow the repaired soft tissues of your knee time to recover in the initial 2 weeks after surgery. When at rest in a safe environment the brace can be undone to allow range of movement exercise and also to allow regular icing of your knee. Ice packs can be applied for ten minutes in every hour for the first 5 days after surgery and give excellent pain relief.
Length of hospital stay:-
- Keyhole operations (incl. ligament reconstruction) are typically day case procedures, meaning you can go home on the day of surgery. You must, however, be accompanied by a responsible adult who is prepared to escort you home and provide support for the first 24 hours after surgery. You will not be able to drive yourself on the day of surgery.
- Osteotomy & Realignment Surgery – commonly 1 night
- Unicompartmental Knee Replacement – commonly 1 night
- Total Knee Replacement – commonly 2 nights
Follow up after surgery: This is dependent on the type of surgery you have had but I will usually see you at 2 and/or 6 weeks following the surgery. We will go through the operative findings and discuss your surgery in as much detail as you wish. We can plan your recovery and ensure that you have access to a tailored and professional physiotherapy programme. Further follow up after this may be necessary and will be determined according to your progress.
Driving: You are not safe to drive until you have full control of your car and the ability to make an emergency stop safely. In essence this means you must be fully weight-bearing without the need for crutches. Guidelines are listed below but these may vary on a case by case basis – please discuss this with me before you drive.
Knee Arthroscopy & Meniscectomy: 2 weeks
Cartilage or Meniscus Repair: 6-8 weeks
ACL Reconstruction in isolation: 3-4 weeks
ACL + Cartilage/Meniscal Repair: 6-8 weeks
Knee Osteotomy/Realignment Surgery: 6-8 weeks
Unicompartmental Knee Replacement: 4-6 weeks
Total Knee Replacement: 6-8 weeks
Time off work: Typical times before return to work for the following procedures are advised, although may be altered according to individual circumstance. Return to work also depends on whether you have a manual or desk based job, and also whether you would be allowed back on light duties/phased return (if manual).
Knee Arthroscopy & Meniscectomy: 1 weeks (desk job); 2 weeks (manual job)
Cartilage or Meniscus Repair: 2-3 weeks (desk job); 8-12 weeks (manual job)
ACL Reconstruction in isolation: 2-3 weeks (desk job); 6-8 weeks (manual job)
ACL + Cartilage/Meniscal Repair: 2-3 weeks (desk job); 3+ months (manual job)
Osteotomy/Realignment Surgery: 2-3 weeks (desk job); 3+ months (manual job)
Unicompartmental Knee Replacement: 4-6 weeks (desk job); 3+ months (manual job)
Total Knee Replacement: 6-8 weeks (desk job); 3-6 months (manual job)
What happens after discharge?
You should ice your knee regularly (up to 6 times a day for 10 minutes on each occasion) and remember to take regular simple analgesia as prescribed.
You will receive the date for your post-op follow-up appointment along with your pre-surgery package. This will usually be at 2 weeks after surgery – anywhere between 12 and 17 days is fine. We will check your wounds in clinic – there will usually be no stitches or clips to remove as I prefer to use absorbable stitches under the skin. Sometimes the stitch ends will need to be trimmed but this is simple and painless. Having had major shoulder surgery as a 20 year old I know how much I hated having skin clips removed from my surgical site 2 weeks after the operation! I won’t put you through that.
I am very proud, as are all of the team at Invicta Orthopaedics & Sports Medicine, to bring you our professional services. We strive to make your journey simple, Should you have any questions or concerns then please contact The Invicta Clinic on 01892 552 908 during working hours. In the unlikely event of an emergency then you should contact the hospital where your surgery took place, your GP or your local Accident & Emergency department.