Waiting for a knee replacement

Knee replacement surgery is an operation that involves replacing a damaged, worn or diseased knee with an artificial joint. It will only be offered after other options have been tried but not relieved symptoms.  Such treatments may include medication, weight loss if necessary, physiotherapy and exercise to reduce stiffness and improve muscle strength, and the use of walking aids.

There are two main types of surgery:

  1. Total knee replacement – where all the knee joint is replaced along with resurfacing the kneecap in many cases
  2. Partial knee replacement – where only part of the knee is replaced such as the inner side of the knee.

Patients can go home as soon after surgery as they are deemed fit medically and they can cope with mobilising safely. This may be on the day of surgery or any time from the day after surgery.  Some patients will have knee replacement surgery as a day case, meaning they don’t have to stay in hospital overnight. Not every patient having a knee replacement is suitable for day case surgery but this will have been discussed with you by your consultant.

While you wait

LIFESTYLE CHANGES

We would encourage anyone waiting for surgery to lose some weight if necessary and to stop smoking. Both these measures are known to lower risk of complications following surgery. You can find some advice here.

Another thing you can do whilst waiting for your knee replacement surgery is to stay as active as you can. If you can, continue to do gentle exercise, such as walking and swimming, in the weeks and months before your surgery.

 

EXERCISE

For you to get the best outcomes from your treatment, it is advised you practice some basic strengthening and stretching exercises prior to your surgery. You can ask to be referred to a physiotherapist who will give you some helpful exercises. Here are some exercises you can try at home:

Exercise 1
Passive Knee Extension
  1. Sit upright on a chair, with another chair facing you
  2. Place your leg on the chair opposite, keeping the knee as straight as possible
  3. Keep the leg straight and extended for a few minutes with your toes relaxed
  4. Slowly take your leg out of position
Exercise 2
Assisted knee flexion stretch
  1. Sit in a chair and bend your affected knee back as far as you can
  2. Place the ankle of your good leg over the front of your affected leg and use it to bend your knee back further
  3. Hold the position
Exercise 3
Static quads/straight leg raise
  1. Lie on your back or sit with your legs out straight in front of you
  2. Straighten your affected knee by pressing the knee down and tensing your thigh muscle
  3. Hold this position
  4. If possible, keep the muscle tense and lift the whole leg just a few centimetres
  5. Slowly lower back down
  6. Repeat

Waiting for Knee Ligament surgery

The Anterior Cruciate Ligament (ACL) is one of the ligaments which sits deep inside the knee. The ACL helps to keep the knee stable.

This ligament can be torn or ‘ruptured’ by a fall or sports injury. Your knee may then give way or it may feel unstable. It may stop you doing your normal activities or sports. An operation can done to rebuild or reconstruct the torn ligament. This involves replacing the ligament with a tendon from another area of the leg such as the hamstrings or patellar tendon. This surgery is usually undertaken as a day case. In some cases, an overnight stay may be required.

While you wait

LIFESTYLE CHANGES

We would encourage anyone waiting for surgery to lose some weight if necessary and to stop smoking. Both these measures are known to lower risk of complications following surgery. You can find some advice here.

After your procedure you will need to use crutches for a few weeks. This will make it difficult to do some daily tasks. Ahead of your surgery it may be helpful to plan to have some help from family or friends during this time. You could also stock up on food that’s easy to prepare, such as tinned foods and staples like rice and pasta. You could also prepare meals and put them in the freezer.

 

EXERCISE

We would recommend undertaking some exercises to help prepare for your surgery. This will help you to improve your outcome after surgery by strengthening the muscles you will be using and working during your recovery.

After an ACL tear the knee will usually be swollen, painful, weak and have limited movement. All inflamed joints benefit from RICE: rest, ice, compression and elevation. Apply an ice pack (wrapped in a towel to protect your skin), for 20 minutes every 2 hours until your swelling has reduced. Resting with your leg elevated so that gravity can help to reduce the swelling.

As the pain and swelling decreases, gentle exercise and stretching will encourage a return to normal movement. It is very important to regain full range of motion, particularly full extension (straightening) prior to ACL reconstruction surgery.

Here are some exercises you can do at home.

Exercise 1
Squats
  1. Stand with your legs shoulder width apart
  2. Drop down into a squat position, pushing your hips back and keeping upright
  3. Ensure your knees do not go over your toes
  4. Control the movement back to the start position
  5. Repeat 10 times x 3 sets
Exercise 2
Step Lifts
  1. Step your affected leg onto a step
  2. Ensure you engage your thigh muscles as you straighten your knee to push yourself up onto the step
  3. Bring your unaffected leg onto the step
  4. Step off with your unaffected leg first using your affected leg to lower you down
  5. Repeat 10 times x 3 sets
Exercise 3
Forward Lunge
  1. Stand up straight with your hands on your hips
  2. Take a large step forward with your affected leg
  3. Bend your knees, lowing your hips down between both feet until your knees are bent to 90 degrees
  4. Make sure your front knee is directly above your ankle and pointing forwards
Exercise 4
Single Leg Bridge
  1. Lie on your back with your legs bent and feet flat on the floor
  2. Keep affected leg on the floor and lift unaffected leg off the floor
  3. Engage your core, and then start to lift your hips up into a bridge carefully starting at your tailbone, driving the movement with your buttocks
  4. Carefully lower your back from the top of your spine down to your tailbone
  5. Repeat this 10 times x 3 sets
Exercise 5
Single Leg Squat
  1. Stand on affected leg only with unaffected leg bent behind you
  2. Drop down by bending your affected leg, pushing your hips back and keeping upright
  3. Ensure hips stay level
  4. Ensure hip, knee and ankle on affected side stay in line
  5. Control the movement back to the start position
  6. Repeat 10 times x 3 sets

Waiting for a Knee Arthroscopy

A knee arthroscopy is a day case operation which involves the insertion of a camera into the knee through two or more small incisions (often referred to as a ‘keyhole surgery’). This is usually completed under a general anaesthetic. This allows your surgeon to further examine the cartilage, ligaments and other structures in your knee. During the operation, if a problem is identified, the surgeon will usually treat it at the same time. This will be discussed with you prior to and following your surgery.

While you wait

LIFESTYLE CHANGES

We would encourage anyone waiting for surgery to lose some weight if necessary and to stop smoking. Both these measures are known to lower risk of complications following surgery. You can find some advice here.

 

EXERCISE

We would recommend undertaking some exercises to help prepare for your surgery. Here are some examples:

Exercise 1
Ankle pump
  1. Lie down or sit on a chair with your feet flat on the floor
  2. Lift your toes upwards, keeping your heel on the floor
  3. Repeat 10 times x 3 times a day
Exercise 2
Static Glue Contraction
  1. Start by lying on your back
  2. Squeeze your buttocks together firmly
  3. Hold for 6 seconds and relax
  4. Repeat 10 times x 3 times a day
Exercise 3
Knee Hang
  1. Start sitting up on the floor with your back against a wall
  2. Placed a rolled up towel underneath your ankle on your affected leg
  3. Allow your knee to fully straighten
  4. Rest your leg in this position
  5. Repeat
Exercise 4
Heel Slide
  1. Start sitting up on the floor with your back against a wall and your legs out in front of you
  2. Slide your heel towards your bottom, bending your knees, as far as you are able to
  3. Carefully straighten your leg again
  4. Repeat 10 times x 3 times a day
Exercise 5
Static Quad Contraction
  1. Start by lying down or sat up on a firm mattress
  2. Tighten the muscles on the top of your affected leg
  3. Hold it for 6 seconds and relax
  4. Repeat 10 times x 3 times a day

Managing Pain

You can take pain relief such as Paracetamol, Anti-inflammatory creams, Codeine, or non-steroidal anti-inflammatory drugs such as Ibuprofen or Aspirin. If you need any advice, your local pharmacy will be able to help.

There are a number of resources to help you manage your pain:

Mental Health Support

It’s important during this time to take care of your mind as well as your body. You might be feeling down, worried or anxious while you wait for your appointment. Remember its okay to feel like this, these are normal reactions. There are a range of services available to help you manage during this time.

Take a look at our  mental health support page for more information.

What should you do if your health is deteriorating

The information on this page is designed to help you manage your symptoms and stay in the best possible health while you wait. It is however possible that some of your symptoms may get worse while you are waiting for your surgery. There are some things to look out for that would indicate you should seek medical help:

  1. If your pain gets worse to the point that it is unmanageable with the pain relief suggested by the pharmacist or doctor and you are struggling to cope with it;
  2. If your mobility gets worse to the point you are off your feet or unable to work;
  3. If your knee suddenly deteriorates;

If you experience this we would recommend getting in touch with your hospital team. The number and email should be on your last hospital appointment letter.

Alternatively you can contact your GP practice. Whilst your GP does not have access to the hospital waiting list to get you seen sooner, if your condition is getting worse they can assess you, give advice and can contact the hospital on your behalf if necessary.

If your condition gets worse but you already have your date for surgery, we would recommend getting in touch with your hospital team. The number and email for this should be on the hospital appointment letter.

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