AFTER SURGERY

HOSPITAL STAY

Before your surgery, Mr. Bentley will advise you on how long your hospital stay will be. Please ensure you have transport arranged as you will not be allowed to drive home. The following is a rough indication of hospital stay:

  • Knee arthroscopy - 0 days

  • Metalware removal - 0 days

  • Simple fractures / tendon repairs (distal biceps / pectoralis major / patella / quadriceps / tendoachilles) - 0 to 1 day

  • Complex fracture surgery - 1 to 2 days

  • Knee Osteotomies - 1 to 2 days

  • Total Hip Replacement - 2 days

  • Navigated Total Knee Replacement - 2 to 3 days

  • MAKO Total Knee Replacement - 1 to 2 days

  • Partial Knee and Patellofemoral Replacement - 0 to 1 day

PAIN RELIEF

For lower limb surgery, the gold standard of pain relief is spinal anaesthesia. We supplement this with an adductor canal block for knee surgery as well as local anaesthetic into the wound. The relief is temporary but will allow you to mobilise sooner and reduce the need for stronger medications which have their own side effects profile. Our goal is to keep you as comfortable as possible while at the same time allow early mobilisation.

You will need to take pain killers after surgery. We recommend analgesia in the following order

  1. Regular Paracetamol

  2. Anti-inflammatories such as Diclofenac and Celecoxib

  3. Opioids

These medications are safe to take together. Anti-inflammatories should be taken with caution as they can cause stomach ulcers and kidney impairment. Opioids like morphine / codeine / oxycodone cause constipation and can be addictive so should be discontinued as soon as possible.

Using an ice pack or bag of peas wrapped in a towel helps to reduce local swelling and therefore pain.

PHYSIOTHERAPY

Physiotherapy is extremely important following surgery to ensure you get the best result. Most of the movement achieved following a joint replacement occurs within the first 6 weeks of surgery. Therefore it is important to initiate rehabilitation as soon as possible. For joint replacements, you will commence walking once your legs recover from the spinal anaesthetic and begin immediate strengthening and range of motion exercises. The physiotherapist will guide you through these exercises and organise ongoing sessions where required.

WOUNDS

Jarome will close most of his wounds with absorbable sutures with the exception of knee wounds. Jarome has concerns about a continuous absorbable suture breaking during knee bending moments and will use clips in this situation.

You will be required to see your family doctor or practice nurse in 10 - 12 days for a wound review and trimming of suture ends or removal of clips. Where clips are used, we will provide you with a staple remover to give to your local practice on discharge.

CONSTIPATION

Please drink plenty of fluids following your surgery. Kiwi crush, prunes and mandarins as well as early mobilisation will help with constipation. We will provide you with regular laxatives during your hospital day and upon discharge.

BLOOD CLOTS

There is a risk of blood clots (DVT) forming in the legs following any lower limb surgery. These clots become concerning when they occur in the deep veins as there is a low chance that the clot can travel to the lungs (PE). Early mobilisation, a calf compression device and heparin initiated as an inpatient followed by a 6 week course of aspirin is Jarome's preferred choice of prophylaxis. Where the patient has an increased risk of DVT (obese, cancer, previous DVT/PE) or is undergoing bilateral joint replacements, Jarome prefers Rivaroxaban for 4 weeks following a hip replacement(s) and 2 weeks for knee replacement(s).

MEDICAL CERTIFICATE

If you require a medical certificate, please remind Jarome prior to your discharge. The amount of time off work is dependant on a number of variables and is therefore decided on a case by case basis.