Patient Information > Patient Matched Knee Replacement Surgery

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Introduction

The knee joint is the largest joint in the body. It is known as the “hinge” joint that allows the knee to flex, extend and rotate. It is formed by the tibia (shin bone), the femur (thigh bone), and the patella (knee cap). It is surrounded and held together by muscles, ligaments and other soft tissues. Each bone end is covered with a layer of joint cartilage that cushions the knee and allows smooth movement of the joint.

Osteoarthritis is the most frequent form of arthritis which is responsible for people undergoing knee replacement surgery. Osteoarthritis is the progressive wearing of the bearing surface of the knee joint. The cartilage becomes soft and frayed and eventually is worn away and leaves the underlying bones exposed. As the disease progresses, pain and stiffness usually occurs, mobility decreases and quality of life becomes affected.

A total knee replacement is where the damaged areas of the knee and cartilage are removed and replaced with metallic and plastic components.

The outcomes following surgery are generally good. You will notice a decrease in your pain, increased mobility and improvement of your general lifestyle.

From 2005 I have successfully performed over 760 knee replacement operations using Patient Specific Instrumentation.

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Contents:


Before Surgery

You will receive a letter from the Clinical Nurse 3-4 weeks prior to your surgery. You must read this letter carefully as it contains vital information.

Before the surgery you will require to have some blood tests which include a complete blood examination, hepatitis screening, HIV screening, urine testing and group and save. The request form for the tests will be with the letter you receive. You will need to go to a collection centre to have these done.

You will be required to make an appointment to be reviewed by the anaesthetist, a specialist physician, a physiotherapist, as well as the pre admission clinic at the hospital. Their names and telephone numbers will be supplied at the time of booking your surgery.

There are a number of important things you can do prior to coming into hospital:

  • Prepare your home and arrange assistance from family and friends to help you cope once you return.
  • Clear all walkways as you will be using a walking frame or walking stick.
  • Remove loose mats inside, and garden hoses outside to prevent tripping.
  • Your bed and chair should be at the height of your knee crease and the mattress should be firm to ensure you can get into and out of bed easily.
  • Move frequently used items from very low or high cupboards for easier access.
  • Use non slip mats in wet areas.
  • Family and friends can assist with transport as you will not be able to drive for 6 weeks.
  • If you smoke, it is important to stop 1 – 2 weeks prior to your surgery. Anti-inflammatory drugs, any medication containing aspirin and natural herbal medications should be ceased 10 days prior to surgery. This includes fish oil, glucosamine and krill oil (You may need to confirm with the specialist who prescribed this medication for you if it is safe to stop this drug for this amount of time).
  • If you are taking Warfarin or any medication to thin the blood, you should discuss with the surgeon before your surgery when to cease this drug.

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Your Surgery

You will be admitted to hospital on the day of surgery (or if indicated the night before your surgery.

You will be fasting. You will be asked to contact the rooms prior to your surgery for your fasting and admission timnes.

You should bring your previous xrays (if not already with Dr Savvoulidis), medications, toiletries, clothing etc.

Surgery is normally performed under spinal block or general anaesthesia. Your Anaesthetist will discuss the preferred option with you when you have your pre-operative appointment. The operation usually takes 1 – 2 hours and you will be away from the ward for 4 hours. If indicated you may spend the first evening in the High Dependency Ward immediately following surgery. The Anaesthetist will discuss this with you at your visit.

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What to Expect After Surgery

Pain relief: You will have a small catheter in your operated site after surgery. This is used to administer pain relief. This will be supplemented by oral medication. It is important to have good pain relief so that you are comfortable and can exercise and move around with minimal discomfort.

Diet: It is recommended that after your operation you will start with ice chips and sips of fluid, gradually increasing to a light diet. You may experience nausea and vomiting after the operation. Medication can be given to relieve these symptoms.

Intravenous therapy: For the first 24 – 48 hours, IV fluids will be administered until your oral fluid intake is adequate and any nausea has settled.

Wound/drain tube: The dressing over the wound will be left alone. It will be inspected regularly by nursing staff and reinforced if necessary. Under the dressing, there may be a drainage tube which drains away any excess fluid from the operated area. It is usually removed within 24—48 hours after your surgery.

Oxygen therapy: You will be given extra oxygen via a small set of prongs inserted into your nose or a face mask. This is usually removed at 36 – 48 hours post operatively.

Physiotherapy: Exercises begin immediately. Feet exercises and deep breathing begin on the day of surgery You will start walking with the physiotherapist within 24 hours of your surgery. As your confidence and leg control improves you will progress to walking with a stick. Your physiotherapist will teach you how to mobilise correctly with walking aids and show you a range of exercises to continue at home.

Toileting: Sometimes a catheter to drain urine from your bladder will be required.

Anti-Coagulant (Blood thinning medication): You will start taking Aspirin daily during your stay in hospital. This helps to thin the blood and helps prevent the formation of clots in your legs. You will continue this for 3 months from date of surgery.

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Length of Stay

Most patients are allowed home after 4 nights in hospital. Occasionally patients need further time at a rehabilitation centre and this will be arranged by the hospital. This is only arranged if medically indicated. The aim when leaving hospital, is to be discharged home and managing independently with showering and toileting. Most patients will be independent with a walking frame or a walking stick on discharge.

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Complications

Total knee replacement is a surgical procedure. Most patients experience no particular problems with the surgery but it is inevitable that with major surgery, there are some risks and you should be aware of them. Dr Savvoulidis would have discussed this with you when you signed your surgical consent. Do however remember that this operation is designed to improve your quality of life and is usually only undertaken when all other avenues of treatment have failed and the benefits outweigh the risks.

Complications include:

  • Blood clots: This is a possible complication following joint replacement surgery. Generally blood clots form in the calf muscle. This risk of this is reduced by early mobilisation, bed exercises and blood thinning medication. You will have a scan of your legs 2 weeks after you operation to see if you have had any clots form. Many clots found, are superficial and as you are discharged on Aspirin no further intervention is usually taken.
  • Embolism: Occasionally clots or fatty material can go to the lungs leading to severe breathing difficulty or even death.
  • Infection: Fortunately, good surgical technique and the use of antibiotics reduce this complication. However, if it does occur, it is serious and may result in the need to remove artificial joint components.
  • Loosening: This could occur after 10 to 15 years. Occasionally, the hip will loosen earlier.
  • Blood loss: It is common to lose blood during the operation.
  • Neurovascular complication: There are many major blood vessels and nerves situated around the joint which in rare cases may be damaged during the operation.
  • Mobilisation: A limp is common for a number of weeks or months following your operation but usually improves with time and exercises.
  • Leg Length: Sometimes this can occur but can be corrected with the use of a heel raise in your shoe.

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Follow up

Your will continue to be reviewed at regular intervals following your joint replacement surgery. You will require xrays prior to all appointments. For your first visit at 6 weeks you would have received your request form with your original letter. The date for your appointment will also be mentioned in the letter. It is important that you keep these appointments. If you need to change the date or time please contact Dr Savvoulidis’ rooms.

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Discharge Instructions

Wound Management: You will have sutures that lie underneath the skin surface. These do not need to be removed and will dissolve in about two weeks. Your wound will be covered with a water proof dressing and on discharge from hospital you will be given a dressing pack which will allow you to change your dressing at home 3 weeks from your surgery. This second dressing can be removed 5-7 days later. Once your wound has healed, massage firmly around the scars to prevent thickening and excess scarring. Vitamin E cream can be useful with this.

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Should you notice any:

  • Tenderness, redness or swelling of your calf
  • Elevated or persistent temperature
  • Increasing pain
  • Redness around your wound
  • Discharge from your wound
  • Chest pain or shortness of breath
  • Shortening or rotation of the leg on the operated side

Please contact Dr Tom Savvoulidis or his clinical nurse at his rooms. If you attend your local doctor, and for any reason he/she thinks your wound is infected—do not take any antibiotics until you or your doctor have contacted Dr Tom Savvoulidis or his clinical nurse at his rooms.

Pain Relief: It is important to take pain relieving medication on a regular basis as this will allow you to exercise more freely. Please ensure that you have adequate pain relief tablets with you on discharge from hospital or that you will have some at home.

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Return to Usual Activities/Work

Mobilisation: Continue with exercises as advised by your physio. Mobilise as tolerated using your appropriate walking aid.

Avoid excessive walking. Frequent short walks are better for the first few weeks rather than long walks to avoid excessive swelling and pain. If you notice any increase in discomfort—this may be a sign you are overdoing it.

Work: Depending on the physical demands of your job, work may be resumed 3-4 weeks following surgery.

Sexual Activity: Gentle sexual activities can be resumed once you are comfortable, provided you are careful.

Sporting Activities: It is generally 3—4 months before you can resume low impact activities such as unrestricted walking, golfing, bowling and swimming. Jogging, high impact aerobics and contact sports are discouraged.

Driving: It is recommended that you do not drive for 6 weeks or more after the operation. As a passenger, always sit in the front seat to use the excess leg room. Discuss this with Dr Savvoulidis.

Dental Care: Defer any non-urgent dental procedures in the first 3 months after surgery. If emergency surgery is required within the first 3 months then recommended for LA extractions or deep curettage, root canal, and implants - Amoxycillin 2-3 grams orally 1 hour prior to precedure. Dental treatment after 3 months in a patient with a normally functioning artificial joint. Routine dental treatment including extraction - No antibiotic prophylaxis required. Dental treatment for patients with significant risk factors ie diabetes, immunocompromised, previous joint infection, cancer or rheumatoid arthritis the need for antibiotics should be discussed with the patient's consulting physician, dentist or orthopaedic surgeon.

Constipation: Your decreased activity level, limited appetite, reduced fluid intake and some medication may lead to bowel irregularity. You will be encouraged to drink fluids, increase the fibre content of your diet and, if necessary, take mild laxatives.

chart

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Specific Instructions Following Joint Replacement Surgery

  • Your knee may be swollen. Most of the knee swelling usually settles by 6-12 weeks after your surgery.
  • Ice packs applied for 15 minutes 2-3 times per day can be used to control the swelling and aching in the knee. Remember to wrap the ice in a towel first. Do not put the ice directly onto the skin.
  • Do not kneel on your new knee. Check with Dr Savvoulidis as to when this is allowed.
  • Spend plenty of time resting with your leg elevated at least with the level of your body. Eg: on a sofa or bed.
  • You may do some hydrotherapy after discussion with Dr Savvoulidis.
  • You may sleep on your side with a pillow between your legs for comfort.

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Appointments

To make an appointment with Dr Tom Savvoulidis, click here and fill out the online form, or call (08) 8331 9177
Have you seen our new mobile website? Simply visit our website using your mobile device and add it to your home screen. www.drsavvoulidis.com.au
PHONE (08) 8331 9177
PRIVATE ROOMS 62 Kensington Road, Rose Park, SA