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Knee Replacement

Patient information leaflet describing knee replacement surgery and the recovery process.

Information:

Information for patients
This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.

Introduction

This leaflet explains why you have been referred for a total knee replacement operation.

The orthopedics team are here to assist you with all of your needs, and we will provide you with advice and guidance.

Please do not hesitate to ask any member of the tea if you have any questions or concerns at any time.

What is a knee replacement?

The knee is a hinge joint. It is at the bottom of your femur (thigh bone) and the top of your tibia (shin bone). During the operation, the worn or damaged joint will be replaced with an artificial joint.

What are the benefits of surgery/

A knee replacement is usually carried out because of severe pain and restricted movement. These can limit activity and lifestyle choices.

A knee replacement may provide benefits such as:

Reduced pain

The majority of patient’s experience pain relief. It is normal to have some degree of soreness and pain immediately after the operation.

Decreased stiffness

The new joint will move freely. The aim is for you to have less joint stiffness than before the operation.

Increased mobility

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

What are the associated risks?

Knee replacements are generally very successful, and patients can gain an improved lifestyle benefit. It lasts for an average of 25 years. There is, however, a risk of complications. These can include:

Leg swelling

It is very common for legs to be swollen after an operation, and this normally settles without any problems.

Occasionally, it can be due to deep vein thrombosis (DVT). DVT can occur after any operation, but it is more likely following operations on the lower limb. DVT occurs when blood in the large veins of the leg forms blood clots within the veins.

This may cause the leg to swell and become warm to touch.

There are several methods that we use to reduce the risk of DVT and PE. We will apply calf pumps to both legs while in recovery as they stimulate circulation. We get patients moving as soon as possible, often on the same day of surgery as this increases the blood flow to the leg.

After assessment by the joint replacement nurses, most patients will be offered blood thinning medication. Aspirin is used for most knee replacement patients. This is assessed on an individual basis. Where this is not suitable, you will be given an alternative such as Tinzaparin/Enoxaparin injections.

If you do have to have injections the nurse on the ward will teach you or a family member how to administer. If you have had any previous thrombosis, you will need to take these for 42 days.

You will be given a sharps box in which to place the used injections after use, when you have finished the course of injections return the sharps box to the hospital for safe disposal.

Joint infection

You will be screened for bacteria before you come in for your operation to try to reduce the chance of infection.

It is very important you do not have any cuts, grazes or wounds on your body when you come in for surgery. You may wish to avoid activities such as gardening for a few weeks before coming in for your knee replacement.

We may encourage you to lose weight, as being overweight increases the risk of complications including infection.

We also may encourage you to stop smoking, as there is evidence that smoking can increase your chance of infection, due to the wound taking longer to heal.

Infection in the wound or around the joint replacement can occur in hospital, or after you have gone home. Deep infection is a very serious complication but is rare. It is more common to have a superficial infection on the surface of the wound.

Occasionally these can lead to a deep infection. For that reason, we always take these infections very seriously.

If you do have a problem like this, you should let the specialist nurse team know immediately. Your GP or district nurse may be treating the infection, but we will need to be aware.

If a deep infection is not treated within the first couple of weeks, then revision of the knee replacement could be required. Early treatment of infection can reduce the need for revision surgery.

Loosening of the joint

Total knee replacements do have a life span. The younger you are the more likely you are to need a revision at some stage. Most patients do not have any problems for up to 13 years after surgery.

Stiffness

Stiffness can sometimes occur and some patients can end up with less movement than before surgery.

Fracture

There are occasions when a bone may break during this procedure. Normally these are seen at the time of surgery and are treated with wires or plates. They may sometimes be found during an X-ray following surgery. A return to theatre may be necessary to repair the fracture.

Nerve injury

There are several nerves located around the knee, and these can be damaged during the operation. These nerves supply sensation and power to the muscles in the leg.

Normally the nerves recover themselves over a period of weeks and months. Occasionally the problems can be permanent and can lead to pain, weakness and loss of sensation. It is common to have some permanent sensation loss on the skin around the knee.

Urinary incontinence

A small amount of people suffer from incontinence after anaesthetic. This is temporary and settles itself within a few hours.

An inability to pass urine can also happen and may require the insertion of a bladder catheter. This is usually a temporary problem and will resolve in a few days.

Persistent pain

Total knee replacement is a very good treatment for arthritis. However, some patients are left with pain and discomfort around the wound site.

Memory problems

Some patients complain of mild symptoms, which could be related to the operation, the anaesthetic or painkillers. It is important that you tell the specialist nurses if you suffer from memory problems or mental health problems.

Revision (re-do) of the joint

Occasionally, for various reasons, operations need to be redone.

This is normally after many years but sometimes this needs to be done soon after the initial surgery. Your orthopaedic consultant will discuss this with you.

What happens before your surgery?

You will be invited to attend and education class. This is an important part of your journey, to provide you with information you need to make the best of your health before your operation, and to aid your recovery after that.

You will meet the joint replacement specialist nurse and physiotherapist, you will learn about your care, rehabilitation and what is expected of you before and after your surgery.

We will discuss your anaesthetic, talk about medications and pain relief. We will show you a model of a total knee replacement and trach you exercises you need to perform before and after surgery.

You will also have a final appointment with the specialist nurse approximately 2 to 3 weeks before your operation/admission.

During this clinic visit, you will have simple tests on your heart and lungs and may need a repeat blood test taken. Bring a urine sample with you (using the bottle provided at your education class) This will be tested to rule out infection. You may require repeat X-rays.

You will be given body wash and nasal ointment to use 5 days before your operation. This is to help prevent MRSA infection.

You will need to bring with you a list of all medications you take or a repeat prescription. We will discuss with you any medications that you may need to stop before your operation date.

What if I need help at home?

You can discuss this with the occupational therapist, who can arrange for carers to be put in place for your discharge.

You will also be given a form on your final check appointment before surgery that will ask you questions regarding equipment that may be needed for your return home.

This will all be explained to you by the joint replacement specialist nurse. Your equipment will be delivered prior to your operation.

How should I prepare for my admission to hospital?

Please ensure you have a bath or shower before you arrive at the hospital to aid in the prevention of the risk of infection.

It is also important that you do not apply creams or make up after your bath or shower.

Please do not shave your legs for at least 3 weeks prior to your operation. Shaving is known to increase infection rates in joint replacement. It is not know whether hair removal creams increase infection risks so these may be best avoided.

What should I bring to hospital for my admission?

You should bring well fitting, comfortable slippers or flat supportive shoes to walk in. New slippers may not fit if your feet become swollen, and slippers/shoes without a back are not recommended.

You should also bring easy fitting clothes.

You must bring any medication normally prescribed by your own doctor, or any over the counter medications with you on admission. Please bring them in their original packets. Any medication that is not in its original pack cannot be used on the ward.

Please bring in any leaflets, walking aids, and equipment provided to you for the operation. For example, a helping hand, show horn, or sock aid.

Please only bring essentials into hospital as there is only limited space and no suitable storage for valuables.

What happens during my admission to hospital?

You will be admitted to hospital on the day of your procedure. You will be given a time slot, which is designed to make your stay in hospital before the operation as short as possible. You’ll be admitted to the access lounge, where all of the checks will be completed before you go into theatre.

When you are admitted to the access lounge you will be seen by an anaesthetist, who will discuss your anaesthetic choices 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 a temporary numbness and heaviness from the waist down and allows surgery to proceed without you feeling any pain.

Light general anaesthesia or sedation may then be given to reduce your awareness of theatre activity during surgery. This anaesthetic combination is preferred because it is safe, effective and its full effects usually wear off very quickly following surgery.

This allows most patients to make a rapid recovery with few hangover side effects. It will also allow and promote early mobilisation.

Other anaesthetic choices include: General anaesthesia and/or combined with nerve block or epidural anaesthetic. An epidural anaesthetic is similar to a spinal anaesthetic, but it can be continued after surgery in the ward.

Your anaesthetist will discuss the pros and cons of these choices with you.

From the start of the anaesthetic until the end of your operation, your anaesthetist will stay with you, watching your condition very closely.

Your heart rate, blood pressure and breathing are monitored throughout and your body temperature is kept normal using a warming blanket.

As with all anaesthetic techniques, there is the possibility of side-effects or complications with a spinal anaesthetic.

Common side effects include:

Low blood pressure

This can make you feel a little bit sick, the anaesthetist is able to control this with fluids and medication to raise your blood pressure.

Pain during injection

If you feel pain in any place other than the needle tip, tell the anaesthetist immediately and they will reposition the needle to prevent any nerve injury.

Headache

This usually settles by itself, but it if persists tell the anaesthetist.

Difficulty passing urine

Due to the effect of the spinal anaesthetic your bladder will also be temporarily numb. This ca sometimes make it more difficult to pass urine immediately after surgery. A tube (catheter) can be inserted into the bladder to relieve this problem.

Rare side effects:

Nerve damage

This is a rare complication. Most nerve injury will resolve over a few days or weeks. The anaesthetic team will monitor you after the spinal to try and prevent any severe complications. Permanent nerve damage is very rare.

What happens during the operation?

you should be aware that in theatre the operating team wear specialist clothing, hoods and masks, this is to further minimise the risk of infection.

At the end of the operation, the surgeon will inject local anaesthetic into the tissues around the new joint which will assist to relieve your pain.

What happens following the operation?

You will go into the recovery unit. The staff will check your general condition, take observations of your pulse, blood pressure, temperature (vital signs), check your wound, monitor the reversals of your spinal anaesthetic, and assess if you need any further pain relief.

Once the anaesthetist is happy with your recovery and vital signs, you will return to the elective care unit where the staff will continue to monitor your vital signs, bladder and bowel functions, the return of feeling in your legs and lower body following the spinal anaesthetic.

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 that they can help you get more comfortable, and provide you with medication required.

You will be encouraged to be as independent as possible. You will be expected to get dressed into your normal clothes. A physiotherapist/occupational therapist will visit you daily on the ward.

It is important that you exercise independently at times through the day when the physiotherapist is not attending you.

You will be escorted to X-ray to have imaging taken of your knee replacement. Blood tests will also be taken on this day.

You will be encouraged to attend your own personal hygiene with minimal assistance. It is important that you continue with your physiotherapist exercises, and learn how to walk with a Zimmer frame before progressing to elbow crutches or walking sticks. You will also practice stair climbing if necessary.

The nursing staff will discuss your discharge plan with you as soon as possible after your operation, to ensure you have all of the necessary equipment and help in place at home before you leave the ward.

You will be discharged home when you are medically fir and have completed all of your physiotherapy and occupational therapy assessments.

Will my medication change following surgery?

You will be prescribed some new medicines. Some are to help to reduce the amount of pain, and some help to reduce the risks of complications following surgery. There may also be some temporary changes to your regular medicine, but if there is it will be explained to you.

The nursing staff will give you your medication prior to you leaving the ward. You will be discharged from hospital with 1 week supply of tablets to relieve the pain, and you will need to contact your GP for any further prescriptions required.

Before you leave the ward you will be given a discharge letter. This contains information about your operation and medication. Your GP will receive a copy of this letter on the day you are discharged.

What happens following discharge home?

A few days after you have been discharged, you will be contacted by a member of the joint replacement specialist nurses team to see how you are getting on.

Your wound review appointment will be carried out approximately 2 weeks after surgery, this will be given yo you at your final pre-op appointment with the joint replacement nurses.

You will have a consultant or a joint replacement specialist nurse review around 6 to 8 weeks after surgery to check your progression.

You will be reviewed again at 5 months in a virtual clinic (phone call appointment), and asked to attend for an X-ray at a convenient time.

There will also be a review at 1 year and you will be asked to attend for an X-ray. If you have met all required milestones you will then be discharged back to the care of your GP.

If you have concerns regarding your recovery, or think you may be developing a problem please contact the helplines (listed in the back of this leaflet). We will be able to offer advice and arrange additional support, or organise a review if required.

How to care for your wound

Your wound may leak slightly into your dressing and dry up. This is normal, if it leaks outside of the dressing you must contact the service straight away (numbers provided in the back of this booklet). Your wound dressing should remain in place for at least 14 days.

You will attend an outpatient appointment for this with the joint replacement specialist nurse, given to you prior to surgery.

Your dressing will only be changed if the dressing will not stay in place of attach to your skin.

Please do not change the dressing yourself.

The dressing on your knee wound has a bacterial barrier to help reduce the risk of infection, it is not advisable to shower for at least 14 days after surgery. Washes only are advised.

An infection at the site of your wound is unusual but may present with discharge from the wound, redness, swelling and heat, increased pain or an offensive smell. You must seek advice from the helpline number or contact the ward where you had your surgery.

If you are concerned about your wound, please call the helpline at any time.

If your GP or district nurse prescribes antibiotics for a possible wound infection, please contact the joint replacement specialist nurses, we may need to arrange an appointment with your surgeon.

Seek advice from your hospital or GP if you notice any excessive bleeding, or any difficulty with breathing. If you become urgently unwell, call an ambulance.

Frequently Asked Questions

Are there any other treatments available?

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 others such as medication or physiotherapy have been tried and have not relieved your symptoms.

Why have I still got swelling?

It is normal for healing tissues to be swollen. The swelling may last for several months. When you take a step the calf muscle works to pump the 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 your ankle, particularly at the end of the day.

What can I do about it?

Do your ankle pump exercises regularly when sitting, if needed rest on the bed after lunch for about an hour.

Why is my scar warm?

When tissues are healing within your knee they produce heat. This can be felt on the surface for several 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 contact the joint replacement nurses. Alternatively contact your GP.

Why do I get pain lower down my leg?

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

Why does my knee stiffen up?

After sitting for a while, your knee may feel stiff when you stand up. You may need to take several steps before your knee loosens and feels mobile again.

Do not discard your walking aids completely unless you are able to walk without a limp. You should be able to balance on your operated leg, without your knee moving out to the side, and the opposite side of the pelvis dropping downwards.

How far should I walk?

This will vary depending on your fitness. Set yourself realistic targets, building up the distance you walk gradually, on a daily basis.

Overall, your exercise tolerance will improve, and the distance you cover will increase.

When can I drive?

You should usually wait 6 weeks before driving. Before you consider driving you must be confident that you have sufficient movement and strength so that you can do an emergency stop.

When can I return to work?

This depends entirely on the nature of your job, but it is usually around 6 to 12 weeks after your operation.

You may be able to negotiate a phased return or return to lighter duties is required.

Can I go swimming?

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

How often should I do my exercises and for how long?

Please do your exercises as instructed by your physiotherapist. You should focus your attention on the weight bearing exercises in standing, unless you were advised otherwise.

Continue your exercises and increase your functional activities until you have reached normal levels and achieved any outstanding goal.

Is it normal to have a disturbed sleep?

As with sitting, when you are in bed your knee may stiffen up and the discomfort may wake you. Your sleep pattern may also be disturbed if you are not used to sleeping on your back.

You can sleep on your side when it feels comfortable to do so.

Do not try to ease the discomfort by sleeping with a pillow under your knee.

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 settle but there may be a small area of permanent numbness.

Why does my joint click?

Your new knee works in a different way. If your joint clicks it should improve as healing continues.

When can I walk with one crutch/walking stick unaided?

Routinely you will be discharged from hospital with 2 crutches or walking sticks. As you strength and confidence improves you will be able to progress your walking onto one stick.

Always use the stick in hand on your un-operated side.

When can I return to the gym?

We advise against returning to the gym for 6 weeks. Low impact activities such as cycling, treadmill, walking and swimming are recommended after 6 weeks.

High impact activities such as sports and running should be avoided until after your consultant clinic review.

What are Patient Reported Outcome Measures (PROMs)?

Patient Reported Outcome Measures (PROMs) involves filling in a questionnaire with your nurse prior to surgery about your knee and then again 6 months after surgery to measure success rates and covers regional and national statistics.

References

NJR (National Joint Registry)

www.njrcentre.org.uk

NIHR (National Institute for Health and Care Research)

www.evidence.nihr.ac.uk

NICE (The National Institute for Health and Care Excellence)

www.nice.org.uk

Contact Numbers

Joint replacement specialist nurses

Monday to Friday: 8.30am to 4.30pm

Hartlepool

Telephone: 01429 522493

Ward 4 Hartlepool

Telephone: 01642 382804

Physiotherapy Ward 4 Hartlepool

Telephone: 01429 522030

Ward 32 North Tees

Telephone: 01642 382732

Ward 33 North Tees

Telephone: 01642 382733

Returning Equipment

Durham and surrounding districts

Telephone: 01325 524531

TCES Equipment Hartlepool, Stockton and Middlesbrough

Telephone: 01642 224205

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Privacy Notices

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Information:

Leaflet reference: PIL1462
Date for Review: September 2026

Page last reviewed: