Orthopaedics
The Covid pandemic has had a significant impact on the ability of the NHS to provide some routine services. We recognise that patients are waiting longer than we would all like and it is not always possible to identify when treatment will take place. This document provides you with information on how you can support yourself while waiting to attend the hospital.
You don’t need to ring your GP, or the hospital caring for you for an update on waiting times because all the information is available on the My Planned Care website.
This guidance has been supported by clinicians who are responsible for your care to support and to help keep you well whilst waiting for your procedure.
Knee replacement surgery
Knee replacement surgery is an operation that involves replacing a damaged, worn, or diseased knee with an artificial joint, with the aim of reducing pain. It will only be offered after other options have been tried but proven not to have relieved your symptoms, such as 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:
- Total knee replacement – where both sides of the knee joint are replaced.
- Partial knee replacement – where the main part of the knee is replaced along with sometimes the knee cap.
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 if you are a candidate this will have been discussed with you by your consultant.
Guidance for patients
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.
Here are some exercises you can try at home:
Exercise 1: Passive knee extension
- Sit upright on a chair, with another chair facing you
- Place your leg on the chair opposite, keeping the knee as straight as possible
- Keep the leg straight and extended for a few minutes with your toes relaxed
- Slowly take your leg out of position
Exercise 2: Assisted knee flexion stretch
- Sit in a chair and bend your affected knee back as far as you can
- Place the ankle of your good leg over the front of your affected leg and use it to bend your knee back further
- Hold the position
Exercise 3: Static quads or straight leg raise
- Lie on your back or sit with your legs out straight in front of you
- Straighten your affected knee by pressing the knee down and tensing your thigh muscle
- Hold this position
- If possible, keep the muscle tense and lift the whole leg just a few centimetres
- Slowly lower back down
- Repeat
How you can support yourself while you wait for your procedure
There are things you can do whilst you wait for your procedure to make you sure you are as healthy and strong as you can be. This will increase your chances of a better recovery. In the time leading up to your procedure, be sure to take good care of yourself by taking a few smart steps. This can help you avoid complications.
Smoking
If you are coming into hospital for a procedure, and you are a smoker, we strongly advise you to stop smoking as soon as possible because this will help to improve wound healing, lung function and you will make the best possible recovery.
Now is a better time than ever to stop smoking. Smoking before procedure puts you at a higher risk for post-operative heart attacks, stroke, blood clots, pneumonia and even death.
With help, you’re much more likely to quit smoking than if you use willpower alone. Visit Make Smoking History to get free access to the latest quitting aids, one-to-one advice and support in your local area
Alcohol
Alcohol can have many effects on your body but importantly it can reduce your body’s ability to heal. Make sure you are drinking within the recommended limits or lower to improve your ability to heal after your procedure.
Keep Moving
Exercise regularly. Among other benefits, better fitness levels reduce complications when having any procedure. This allows you to leave hospital and return to your normal quality of life more quickly.
Keeping an active lifestyle is good for your health and if you are normally an active person it is important to keep that up before your procedure. People with low activity levels can improve their fitness levels within as little as 4 weeks. This gives you an opportunity to get fitter before your procedure and improve your chances of a better and quicker recovery.
Use this tool to find out your BMI If it’s too high, you may need to consider trying to lose some weight in order to optimise your surgery.
You can download a free NHS weight loss planning app to help you start healthier eating habits, be more active and start losing weight.
Good mental health
It is normal to be anxious about having a procedure, relaxation, mindfulness, and breathing exercises can all help. It’s important that you ask for help if you feel you need it, and your GP practice can advise you on support in your local area.
Please keep in touch with your GP or mental health professional if you are already under their care for depression or anxiety.
Here you will find some general information on mental health issues and some top tips to improve your mental wellbeing.
There are also Apps available to help support your health, mental health and wellbeing:
You can find tested and approved mental health apps here.
If you do experience any of these issues, we 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 recommend getting in touch with your hospital team. The number and email for this should be on the hospital appointment letter.
General information
Please watch this useful video from the Royal College of Anaesthetists which offers advice on preparing for a procedure.
There is also some useful information available on North East & North Cumbria Integrated Care System for information about Who we are | North East and North Cumbria ICS
What should I do if my health is deteriorating?
This information 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:
- If your pain get 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
- If If your mobility gets worse to the point you are off your feet or unable to work
- If your knee suddenly deteriorates
If you experience any of these issues, 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 recommend getting in touch with your hospital team. The number and email for this should be on the hospital appointment letter.
If you feel that there is a change in your condition, please contact your clinical team through the hospital switchboard. If your condition suddenly worsens whilst you are waiting you should seek advice.
Pain management
You can take pain relief such as Paracetamol, Anti-inflammatory creams, Codeine, Non-steroidal anti- inflammatory drugs. If you need any advice, your local pharmacy will be able to help.
There are several resources to help you manage your pain:
- 10 ways to ease pain
- The Chartered Institute of Physiotherapy has produced helpful guidance for managing pain and improving your quality of life
Urgent health advice
For urgent health advice about physical or mental health, when it’s not an emergency, please call 111 from any landline or mobile phone. You can also visit www.nhs.uk.
The NHS 111 service is available 24 hours a day, seven days a week.
Life threatening emergencies
For something life threatening – severe bleeding, breathing difficulties or chest pains – please dial 999.
For urgent health advice about physical or mental health, when it’s not an emergency, please call 111 from any landline or mobile phone. The NHS 111 service is available 24 hours a day, seven days a week. You can also visit www.nhs.uk
Patient experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.
T: 01642 835964
E: [email protected]