Preparation for your hospital stay and getting ready for an operation

Do as much moderate exercise as your pain will allow, but in particular make sure that you do the pre-surgery exercises you have been given. Click Video links below to see exercises.

Stop smoking – your chest needs to be clear for your anaesthetic.

Drink alcohol only in moderation.

Good nutrition will improve your recovery and will be part of your treatment whilst in hospital. Eating a varied, healthy and balanced diet will ensure that your nutritional needs are met. This is essential both before and after your operation.

Healthy eating

If you are overweight and your consultant has recommended that you lose weight before your operation it is best to eat a varied healthy diet. This will help maintain your vitamin, mineral and protein levels which is ideal for an operation.

If you want more detailed information please see the NHS Choices website or ask your GP to refer you to a community dietician.

General healthy eating advice

Eat more fruit, vegetables and cereals. Fruit, vegetables and cereals are all rich in vitamins and fibre (roughage). All fruits, vegetables and salads are beneficial and you should try and have five portions a day. Wholemeal/ wholegrain foods like wholemeal bread/pasta/rice, porridge, Weetabix and other high fibre cereals, beans, lentils and oats are also good for you to try and keep healthy.

Eat less fat

Grill, poach, bake or steam food, instead of frying or roasting. Eat more fish and poultry (remove the skin). Choose lean cuts of meat and trim off all the fat you can. Use skimmed or semi-skimmed milk and try low-fat yoghurt and margarine. Avoid high fat ‘take-aways’ for example; burgers, fish and chips, sausages and oily Indian foods. Avoid crisps chocolate, and biscuits as these are also high in fat.

Cut down on sugar

Sugar contains no useful nutrients apart from energy and we can get all the energy we need from other foods. Reduce your intake of sweets and limit adding sugar to foods and drinks. Reduce sugar containing drinks.

Alcohol

Limit the amount of alcohol to 14 Units for women and 21 units for men a week and try and have 2 days free on alcohol in each week. Alcohol contains calories and having too much can cause more health problems.

For information on what a unit is please ask any health care professional.

Build up advice for those not eating well or with a low body weight

During an illness or debilitation you may require additional nutrients. In such an event, a high protein and energy diet is required to maintain weight and muscle mass, rather than a low-fat diet.

If you have lost weight recently, please ask your nurse for a ‘Have you got a small appetite?’ leaflet for help and advice.

Your dietician or doctor may prescribe nutritional drinks for you if you have a low body weight or are not eating well. Please ask for a referral to a dietician if you have any concerns.

Before you come into hospital

You will be seen by a nurse in the Pre-Operative Assessment Clinic, who will check what medication you are prescribed and tell you if and when you need to discontinue any of your drugs before surgery. In most cases you will continue on all the drugs usually prescribed by your GP.

You should bring all your usual medication into hospital with you, which will be locked away in a medicine locker beside your bed. It is better to store and bring them in their original containers rather than to decant them or bring in single strips. This is so that we can check your dosage instructions and positively identify them as belonging to you.

Whilst you are in hospital

The doctor will prescribe on your drug chart your usual medication and any further drugs that you might need whilst in hospital. These usually consist of anti-sickness, painkillers and blood thinning medication. The pharmacist also checks your drug chart.

Discharge from hospital

Before discharge, the pharmacist will dispense an interim box of analgesics and any other medication prescribed by the doctor on your drug chart. If you need to continue with the prescribed treatment you will need to order more from your GP, before you run out.

Blood transfusion

Why might you need a blood transfusion? Most people cope well with losing a moderate amount of blood (e.g. two to three pints from a total of around eight to ten pints). This lost fluid can be replaced with a salt solution. Over the next few weeks your body will make new red blood cells to replace those lost. Medicines such as iron can also help compensate for blood loss. However, if larger amounts are lost, a blood transfusion is the best way of replacing the blood rapidly.

What might I do to reduce my need for blood before an operation?

  • Eat a well-balanced diet in the weeks before your operation.
  • Boost your iron levels – ask your GP or Consultant for advice, especially if you know that you have suffered from low iron levels in the past.
  • If you are on Warfarin or Aspirin, stopping these drugs may reduce the amount of bleeding. You will be advised if you should stop these before your operation.

Are transfusions safe?

Almost always, yes. The main risk from a transfusion is being given blood of the wrong blood group. A smaller risk is catching an infection. To ensure you receive the right blood, the clinical staff make careful identification checks before any transfusion. They will ask you to state your full name and date of birth. They will then check the details on your wristband to ensure that you receive the right blood. They will regularly monitor you during your transfusion and ask how you feel.

Donated blood will be specially selected to match your own blood for the most important blood groups. But, because your red blood cells carry over 100 different blood groups, an exact match is not possible. About one in every 15-20 patients develops an antibody to the donated blood, and will need to have specially matched blood. If you have a card saying that you need to have special blood, please show it to your nurse. Fortunately, severe reactions to blood transfusions are extremely rare. But when they do occur, staff are trained to recognise and deal with them.

Please inform the orthopaedic team if your religion/belief system has an objection to you receiving blood products.

Other information

If you are interested in finding out more about blood transfusions and have access to the internet, you might find the following website useful:

National Blood Services – www.blood.co.uk

Joint School

You will be invited to attend an education session which we call Joint School. This session is based at Yeovil District Hospital and will last for approximately 1 – 2 hours. It is run by the Therapy Team with input from the Nursing Team and aims to teach you about knee Replacement and your recovery.

The session will provide information about your procedure and you will have the opportunity to ask questions and discuss any concerns. You will be taught specific exercises to strengthen the muscles around your knee.

Please make every effort to attend because you will be given vital information about your surgery and how you can help yourself to make a good recovery.

Exercising before surgery

It is important to be as fit as possible before undergoing a total knee replacement. This will make your recovery much faster. Six exercises are shown that you should start doing now and continue until your surgery.

You should be able to do them in 15 – 20 minutes, and it is recommended that you do all of them twice a day. It is not harmful for you to do more.

Consider this a minimum amount of exercise prior to your surgery.

Also, remember that you need to strengthen your entire body, not just your leg. It is very important for you to strengthen your arms (e.g. by doing chair push ups see video link below). You will be relying on your arms to help you get in and out of bed, chairs and to walk with sticks.

Stop any exercise that is too painful.

If you find these exercises difficult, build up to the suggested number gradually.

Activity guidelines pre-op: exercises (Click links below to see videos)

  1. Ankle pumps
  2. Static quads
  3. Inner range quads
  4. Straight leg raises
  5. Knee extension (bend & straighten)
  6. Arm chair push-ups

Arranging some support for when you return home

If you have not already done so, please start thinking about when you go home and start to organise and make the necessary arrangements.

These are the things that you need to consider:

Many patients find it helpful if friends or relatives come to stay, or they go and stay with them following your discharge from hospital.

Convalescence is not funded by the hospital or social services, you may be able to arrange this privately. Home care is limited and the need is assessed on an individual basis. You need to consider how you will manage any caring responsibilities you have (including pets), shopping, laundry and meals.

Preparing your home for your return

It is very important that your home situation is suitable for you to return to following your surgery, especially if you live alone. Here are some things you should do:

  • Clean and do the laundry and put it away.
  • Put clean sheets on the bed.
  • Prepare meals and freeze them or buy ready meals that are easy to prepare.
  • Pick up loose rugs and mats.
  • Make sure there is room to walk from room to room without obstacles getting in your way.

It is your responsibility to ensure you have suitable transport for your admission and discharge home.