Posted , 9 users are following.
I've just gone onto the waiting list (UK, NHS) for a partial knee replacement (medial compartment). Most likely timing seems around 2 months from now.
I live alone, don't have many friends or family in this area and want to do all I can to prepare in advance.
I'd be grateful for any advice that people who have been through this (or TKR I guess) can offer. Thanks very much.
0 likes, 42 replies
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John5006 robin93893
Posted
Hi Robin,
Can only endorse what everyone else has said, one way or another.
?I had exactly the same done (right knee, medial compartment) on 6 Nov 2015 (down here in Cornwall). I was admitted to and had surgery done in a private hospital as an NHS patient. One thing I did which the NHS never ever recommended but which became crucial was to build up the general strength and condition of the whole leg, particularly the quads. I did this by going for treatment to a sports injury/massage therapist for about 6 weeks pre op. The aim is to get the leg/knee in as top condition as possible (all nice and ready for the surgeon to butcher !). Then but for a different reason post op return for more treatment, this time the massage treatment will need to supplement all your regular exercises but focus on restoring all your muscles etc to good nick - BUT it will also focus on scar tissue prevention. I got my therapist, once it was confirmed no infection and once the dressing was removed , to massage the scar/incision line and all around it. Dare I say it - you must not let scar tissue form, it will impede your progress with recovery exercises.
?Also - DO NOT RUSH your exercises, DO NOT RUSH recovery, DO NOT RUSH A DAMN THING. If you have crutches use them, make every step you take a winner, gently but surely does it.
?One of the biggest issues is the emotional side. In the first few weeks the lack of sleep and the pain will drive you crazy - I screamed often that I hated myself for doing this to my body. BUT - nowadays I can say it was the best thing I ever did. I made the mistake of taking pain relief (Co-Codomol 30/500) as a pill in the pocket soon learned that didn't work. I ended up taking the pain relief exactly as prescribed on the packet. If you don't control the pain you'll be unable to fulfill your exercise requirements. (8 tablets in 24 hours as prescribed I think it was from memory.)
?Go onto Youtube and search for something like pre op partial or total knee replacement exercises. Also search for post op tkr exercises. A video is worth a thousand words so to speak. you'll find these vids explain why you are doing the exercises, not just the 'how to do the exercises'.
Get a money belt or similar and buckle it around your waist and put in it your mobile phone (for emergencies), spoons, knives and forks or whatever - its always an issue trying to walk on crutches and carry a beer at the same time or a hot coffee !! Ha! Ha!
?Try and balance your life YET dedicate your life to nothing but your exercises - yeah sure you'll go ballistic but for a few weeks its worth it. Try and establish an exercise pattern/schedule regularly throughout the day, and don't forget rest and elevate and ice, after exercises or any other time for that matter.
?You will be frustrated by not having a means or methodology of measuring your own progress. In this regard we all heal differently but as a guide only I was operated on 6 Nov 2015, dressing removed on 19 Nov, returned to hospital for PT assessment on 24 Nov, returned to surgeon on 29 Dec at which point I was given the OK to come off crutches and drive my car again, then back to work driving buses on 26 January 2016. I was 71 at the date of surgery.
?My stitches were the disolving staples type, so as the incison line healed they disolved.
?Hope that helps .... and don't forget you don't have to be alone .... come on here anytime and kick around whats bothering you.
?Good luck.
John
robin93893 John5006
Posted
Thanks a lot John, I really appreciate you taking the trouble to pass all this great info on. One minor point, you say the NHS did not recommend pre-op exercises, but I got a 70 page booklet "Before, during and after knee replacement surgery" which includes exercises and much other info. In fact thinking about it now I'm feeling a bit of a fraud for asking for advice in here! But the more the merrier, I think, and you and others have mentioned things it doesn't cover. Plus it's always good to get personal stories. Most impressed by your recovery rate! And still working at that age! I've had to pack in my business, and fast approaching 65, but maybe I have a few years work left in me yet. Thanks again.
John5006 robin93893
Posted
Hi Robin,
?I did get a booklet entitled Knee Replacement Surgery but it was only 19 pages. However, I have to say it was a hospital publication originally published in June 2014 and due for a review in June 2017. Maybe you have the latest and published by NHS. Certainly, if it weren't for my therapist (paid for by myself not NHS) I don't think I'd have recovered so well. In fact of the whole procedure I rate the PT side of things as provided by the hospital as barely adequate ! Left a lot to be desired. Hence my venturing onto Youtube.
Don't feel a fraud for being on here .... its a great support forum .... but do bear in mind each of our bodies responds differently to both surgery and recovery.
?There are two types of anesethetics that can be used - general and epidural. I had a general anesthetic, don't know why, maybe the surgical team felt I'd be better out of it as I also have a heart arrythmia. My sister about a year later had a TKR but she only had an epidural.
?I should also add I was in hospital 3 days. The surgeon told me I do not go home until I had at least a 90 degree bend in my new knee. I did it but pushing through the pain was something else. I was operated on about 11 am and back in my room by 2 pm - ish and up and walking around on crutches by 4 pm - its all a bloody challenge -BUT - the rewards are worth it.
John
marilyn10235 robin93893
Posted
Hi Robin
I think everyone has covered everything for pre op.
I would like to go over what John touched on re scar tissue. A good point he made! My (NHS) Physio told me to massage the scar (once staples were out & healing) with either E45 cream or Nivea Creme. She demonstrated how & not to be too soft on it. I do this every day, a couple of times a day at first, still do but use Bio Oil! I can't stress enough how you need to keep the scar & underlying tissue from building up & causing trouble. My scar is flat, no puckering, apart from the bit where the internal stitch end popped out, although that's flattening now!
Good luck for your op, I wish you all the best & good recovery.
Marilyn
marilyn10235 robin93893
Posted
Hi Robin
It's interesting to see how this op is dealt with in other areas of the country. I am in Hertfordshire, all of us going for TKR or PKR HAD to have a Physio session 2 weeks before the op. It was a group session followed by one on one with the physiotherapists. Run by the physios in the ward & treatment room.
We all had to bring in a completed questionnaire, given us at the pre op assessment, measurements of height of bed, sofa, toilet etc & during the 1on1 the Physio went through this & ordered any equipment you may need for the home, i.e. shower chair, perching chair, rails etc.
It seems that it's different on other areas of the country. Why???
Did anyone else have the same?
Marilyn
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chris00938 marilyn10235
Posted
Marilyn that was so interesting! I was given a booklet AND DVD for exercises before and after surgery but no physio anywhere - it's all down to the patient. I was asked about home environment - stairs etc. but nothing was mentioned re shower chair. I wonder if there is no physio because people go to the hospital I'm going to from many miles around - it's about an hour and a half each way. But my lot only have a waiting time of between five and eight weeks for knee replacements, which is quite something in the Midlands.
marilyn10235 chris00938
Posted
Hi Chris,
Just read your reply. WOW!! 5 to 8 weeks!! That's really something to the rest of the U.K. I didn't wait too long, but it was over 5 months.
It's amazing how different things are in different health authorities, even in England.
Thanks for replying
All the best
Marilyn
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chris00938 marilyn10235
Posted
It's Barlborough NHS Treatment Centre and they really are proud of the hospital there. Also there is one nurse to every four patients, whereas many others are one nurse to every eight patients. I've been so impressed with them so far!
marilyn10235 chris00938
Posted
Hi Chris
When I went into the local treatment centre there were 19 of us had this op & 3 nurses on duty that 1st night!! They must have had a really stressful night duty!
In our healthy authority area there used to be 5 proper hospitals with a&e etc now there are 2!! The rest are just glorified out patient clinics really! Go figure!!! In south east England not good! I'm glad they have it right in other areas.
All the best
Marilyn
XX
chris00938 marilyn10235
Posted
Unfortunately the same is happening here Marilyn. We lost a maternity department first, and now our closest A & E is looking as though it's closing as well. But other hospitals vary hugely in the Midlands - some are exceptional and some truly struggling! When I was told that most ortho wards have one nurse to eight patients it was a bit of a surprise - that sounds as though it could be very difficult!
robin93893
Posted
Thanks again for all the input, particularly the more recent comments from John and Marilyn. I had no idea that scar tissue could be a problem.
Regarding pre-op PT and differences around the country, I think I'm very lucky to be going to the Golden Jubilee National Hospital, Clydebank, which specialises in joint replacement and uses advanced computer-assisted surgery. The 70 page booklet they gave me, which includes a DVD with exercise videos and discusses all the anaesthesia options among other things, is a collaboration between them, NHS Scotland and a company called Stryker. The key terms in this approach seem to be JointPathways and Enhanced Recovery, so if you're interested I'd suggest googling them. I expect to get a spinal anaesthetic (not an epidural) with sedation and a nerve block, which is the standard combination in Enhanced Recovery.
I've already had the pre-op assessment, the same day I went on to the list. All of that stuff re chair height and so forth was covered by an occupational therapist. One issue that arose was not having a separate shower, mine is over the bath, and we're not supposed to be stepping in and out of baths post-op. Dare say I'll survive though!
marilyn10235 robin93893
Posted
Hi Robin, thanks for the info on JointPathways it will be interesting to read about it. Wow you've really got it covered up there it all sounds good.
I also was on the enhanced recovery programme & had spinal block & sedation (or as my anaesthetist said "would you like a gin & tonic"
. I also had local anaesthetic in the joint before going to recovery.
I'm sure you're not worried about the actual op as you have been given lots of info, but I'll reassure you anyway. It is nothing to worry about, my main concern beforehand was hearing what was going on but with sedation I didn't really hear & didn't care!
Good luck
Marilyn
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John5006 robin93893
Posted
Hi Robin,
?Many thanks for the reference material - Joint Pathways etc at Stryker. I've downloaded it - not that I need it now but a good buddy of mine is soon to have a total hip replacement and it could be useful for him. I'll keep it anyway in the event that I ever have to have this surgery again.
Good luck.
John
chris00938 robin93893
Posted
When I went for my appointment at the hospital I was asked if I have someone at home to help and if I hadn't then they would arrange for someone to come in and help me so I hope you'll get the same offer. They also asked if I had pets and made sure my husband would look after those too.
robin93893
Posted
Another quick question for those who've been through it: the pre-op exercises I'm doing are not very painful at the time but there's delayed pain that is definitely due to them. My inclination is to persevere on the basis that they're important, and the knee's going to be fixed soon anyway, but my friend with two artificial knees says she didn't experience that and her view is, if it's painful don't do it. Who would you say is right?
marilyn10235 robin93893
Posted
Hi Robin
Long time no speak!
To answer your question I would say you are both correct but, if you haven't exercised those particular muscles for some while, what with knee problems & such, it could be that it is because you are exercising under used muscles. If it's bone pain don't do it.
They used to say no pain no gain! As long as the pain isn't disabling & rest eases it, you are probably best carrying on. I did the exercises & some my chiropractor gave me before the op. The stronger those muscles are the better for after the operation.
Keep on keeping on!!
Marilyn
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robin93893 marilyn10235
Posted
Thanks Marilyn.
It's definitely arthritis pain, not from the muscles. I think maybe I need to check with my GP. I'd really like to be as well prepared as possible but the score is now 2-0 for not exercising.
robin93893
Posted
Well I've now spoken to the GP but he didn't commit himself to yes or no. Yes he recognises the importance of the pre-op exercises but no, I should cut down or stop if it's too painful. So I suppose moderation must be the way to go...