After the operation

Before going back to the ward you’ll spend some time in the recovery room, where you may be given fluids and painkillers through a tube in your arm. This may include:

• patient-controlled analgesia (PCA) – a system where you can control your own supply of painkiller going into a vein by pressing a button
• painkilling injections or tablets.

Oxygen therapy is likely to be given through a mask or through tubes into your nose.

There’s often no need to have a blood transfusion because your body can replace any blood lost during or after surgery. If the operation is more extensive you may need blood from a donor. An alternative is to recycle the blood which drains from your knee – returning it into your body through a tube in a vein (auto-transfusion).

After the first day or so, the tubes giving you painkillers, fluids or oxygen therapy will be removed. You may have a tube (catheter) inserted for a few days to drain urine from your bladder, especially if both knees have been replaced at the same time.

Pain will usually be worse on the second or third day after surgery when the anaesthetic and strong medication wears off, and you’ll probably need painkillers to control this. Without them it’ll be difficult to do the exercises needed to strengthen your muscles and restore mobility.

How quickly you get back to normal depends on many factors, including:

• your age
• your general health
• the strength of your muscles
• the condition of your other joints.

Enhanced recovery programme

Most people are able to start moving about soon after surgery, which is good for lung function and the circulation.

The hospital team encourage most people to follow the enhanced recovery programme (ERP). This aims to get you walking and moving within 12–18 hours and home within four days. If you’re suitable, the ERP will start when you go for your pre-admission clinic to make sure you’re fully prepared for the surgery and understand the programme.

After the operation the programme aims to get you moving and eating normally as soon as possible, and when you’re discharged from hospital you’ll be given supporting therapy and follow-up checks. The programme focuses on making sure that you take an active role in your own recovery process.

Getting mobile

Nursing staff and physiotherapists will help you to start walking. If you’ve had minimally invasive surgery or are on the ERP, this may be on the same day as your operation. At first you’ll need crutches or a walking frame. If you’ve had a spinal anaesthetic or nerve block you’ll have very little feeling in your leg for the first day or two, and it’s important to be aware of your state of recovery to avoid falling over.

You may have a temporary brace called a cricket pad splint on your leg if there’s a risk of weak ligaments, deformity or poor wound healing. This is designed to support your knee until your muscles are working effectively.

Your physiotherapist will be able to advise you on getting about and will explain the exercises you need to do to keep improving your mobility.

Arthritis Research UK have recently awarded a grant to the TRIO study, which will look at the effect of targeting specific physiotherapy at patients who are having problems six weeks after having a knee replacement. The aim of the study is to see whether early treatment gives a better outcome one year after the operation.

Going home

It’s usually possible to go home as soon as your wound is healing well and you can safely manage to get about at home with the help of crutches or a frame. Most people can leave hospital between one and four days after having knee replacement surgery. Before you leave hospital an occupational therapist or physiotherapist will explain the best ways to get dressed, take a shower and move about, and they’ll assess what equipment you might need to help you.

You should also make arrangements for wound care. If you have stitches or clips that need removing, this can be done on a return visit to hospital, at home by a visiting nurse or at your GP’s surgery.

You’ll usually have a follow-up hospital appointment about six weeks after your operation to check on your recovery. Further follow-up appointments are also usually recommended.

If you stopped taking any of your regular drugs before the operation, it’s very important to talk to your rheumatologist for advice on when you should restart your medication.

Returning to work

Usually you can return to work when you feel comfortable that you can continue with your normal role. If you sit down most of the day at work, this may be in six to eight weeks, but if your job involves standing for long periods of time or manual work you may need 10–12 weeks. If your job involves heavy manual work, you should discuss with your employer whether a lighter alternative can be found when you return to work as heavy lifting may damage the replacement joint.