Preparing for a total or uni-lateral knee replacement

Why have your knee replaced?

Your knee joint can be prone to osteoarthritis, which can result in reduced cartilage at the end of your bones, and changes in the bone at joint level.

People affected by these changes often complain of pain and stiffness resulting in the inability to participate in their active hobbies or even mobilise normally. Initially a course of physiotherapy will have been recommended, but if this doesn’t enable return to normal life you will be advised to have a uni-lateral or total knee replacement.

How to prepare for your knee replacement?

It is definitely worth preparing yourself and your home for after the operation, since the range of movement in your knee and ability to walk may be be slightly limited after the operation.

Useful items to get before the operation include:

  1. Long shoe horn
  2. Long handled grabber
  3. Crutches
  4. Sock aid

It might be worthwhile having an appointment with the physiotherapist you will see after the oper- ation, to ensure these aids are fitted properly, and to practice using them.

Do have a look at our videos on walking with crutches and using stairs and step with crutches:

How to use your crutches non, partial and full weight bearing

How to do stairs with crutches

How to perform steps with crutches

Your physiotherapist will ensure that you are performing the right exercises prior to the surgery and it is important to continue these exercises to ensure, as far as possible, that you maintain range of movement and strength around the knee.

What happens during an uni-lateral or total knee replacement?

When you have an uni-lateral or total knee replacement either part of or the whole surface of the end of the femur and top of the tibia are replaced with plastic and metal components.

What to expect after the surgery?

Depending whether you have a total or uni-lateral knee replacement, you will either have a scar through the middle of your knee, or towards the side of the knee that has been replaced.

Depending on your surgeon, they will close the wound with either clips or stitches, insert a drain into the knee, and wrap bandage around the knee. The bandage and drain will be removed 24 hours after the surgery by a nurse on the ward.

Your surgeon will ask you to avoid bending your knee more than 90 degrees until 2 weeks post operation, in order to allow the wound to heal.

At 2 weeks post surgery, you will have an appointment with the nurse at the hospital or clinic to remove your stitches or clips, unless you have dissolvable stitches, in which case you will not need this appointment.

You can also at this point, start gently massaging the scar with a non-perfumed moisturiser such as Bio oil or E45. Your physiotherapist will be able to show you how to perform this to help with achieve a smooth scar.

You will have follow up appointments with your surgeon at 6 weeks and 3 months post surgery to review your recovery.

Walking

When you first start walking after the operation, the physiotherapist in the hospital will use a zim- mer frame so you can get use to putting weight through your new knee Most people are able to fully weight bear through their leg.

Once you are able to do this with good balance and confidence they will move you onto your crutches. They will initially start with a 2 point gait pattern, as demonstrated in the video (see link above) and then slowly move towards a normal gait pattern with crutches.

As you progress through your rehabilitation, your physiotherapist will help you to practice walking with less support until you are walking unaided. Your physiotherapist will also ensure that you are not limping as you progress.

Stairs

You will practice stairs in the hospital with the physiotherapist as demonstrated in our video, ini- tially performing one step at a time.

As you progress through your rehabilitation, your physiotherapist will instruct you how to perform the stairs with a reciprocal pattern (opposite foot on each step). At this point, you will be walking with one or no crutches.

Exercises

The physiotherapists in the hospital will demonstrate and get you to practice exercises in the bed and in sitting. This will help with circulation, strengthening and regaining your range of movement in your knee.

Here are a few exercises that you will begin with:

Depending on the hospital, you may also have a course of hydrotherapy during your stay which is exercises in water to help with walking and movement of the knee. Many patients find this bene- ficial as the buoyancy of the water assists and supports them. You may want to continue this af- ter being discharged either at the hospital or at your physiotherapist’s clinic.

Here are exercises that you can perform in the water:

On discharge you will be advised to continue with the exercises you have been performing in hospital, and to arrange a follow up appointment with a physiotherapist either at home or in a clin- ic within a week of being discharged.

The physiotherapy at home or in a clinic will help you regain full range of movement in your knee; walk unaided with a normal gait pattern; and return to all your normal activities.

Here are a few exercises that you will progress onto:

Kneeling

This may be uncomfortable to begin with, but you can kneel down whenever you are happy to try. You may find it more comfortable to place a small cushion or pad underneath to provide support. Some people may never return to kneeling comfortably due to restricted movement or discomfort.

Sleeping

After a knee replacement it can be difficult to find a good position to sleep. You may feel more comfortable on your back or lying on your side with a pillow between your knees to relieve the pressure. Please do not put a pillow underneath your knee as this will cause stiffness in the joint and make it more difficult to move.

Helpful tips for when you get home

Car

While your knee has reduced range of movement, you will need to slightly change the way you get in and out of a car.

It will be easier to get in and out of the front passenger seat, but ensure that the seat is pushed back as far as possible and slightly reclined.

When you are getting into the car, face away from the seat and sit down first onto the seat. Then lift your legs into the car. You will perform the reverse to get out of the car.

Washing and dressing

Due to the wound healing, for the first 2 weeks you will need to keep the wound dry either by washing at the sink or showering with a waterproof dressing.

We advise people to avoid bathing for 6-8 weeks after the operation as you may have difficulties getting in and out of the bath as the knee is stiff.

When dressing, the long handled shoe horn, grabber, and sock aid will be helpful until you are able to bend your knee enough to reach your feet. We advise wearing loose fitted clothing such as skirt, shorts, etc, as it will make it easier for you to dress and undress.

We also recommend dressing the operated leg first and undressing it last.

Driving

Before being able to drive again, here are a few things you need to be able to do:

  • Mobilise nearly pain free and without a walking aid
  • Bend your knee at least 90 degrees
  • Perform an emergency stop with confidence

Your physiotherapist will be able to advise you when you might be able to drive again, but they will also encourage you to have a test drive with an experienced driver on a quiet road.

Sports and hobbies

Depending on your hobbies, you can return to them at different times as you are able, and your physiotherapist will be able to help assess when you are ready.

It is normally possible to return to activities such as walking, swimming and cycling within around 6 weeks.

More rigorous activities such as tennis and downhill skiing may be resumed after 3 months post surgery. It is recommended that sporting activities that have a high risk of falling should be avoid- ed after a total knee replacement if you haven’t participated in them previously.