Your Total Knee Replacement Kit

Journey to Recovery

Your Healing Journey

About Total Knee Replacement

Your doctor will explain to you how the surgery will be performed, its risks and benefits, and all the things you need to know before your surgery.

You will be asked to complete some questionnaires so that we can understand your knee condition better. You may also be contacted by our staff.

Preparing For Your Surgery

An education class will be conducted by our healthcare professionals to prepare you for surgery.

Pre-admission Procedures

You will be assessed by an anaesthetist to make sure that you are fit for surgery. You will also be counselled about the cost of surgery.

Surgery

You will be contacted by our staff to prepare you on the day prior to surgery. Do remember to bring the necessary items for your stay!

Recovering After Surgery

After surgery, you will be transferred to the ward for recovery and rehabilitation. The team will assess and ensure your readiness before discharge.

Recovering At Home

Continue to do your daily exercises and come back for your follow-up appointments and rehabilitation sessions at the clinics.

Pre-operation checklist

 I have attended the pre-operation education class

 I have received my pre-admission check within 2 weeks before my surgery

 I have arranged for someone to help me with my meals and housework when I am discharged

 I have arranged for transport for follow-up appointments

 I have organised my home environment

1. Make sure things are easy to reach

2. Keep walkways clear of obstacles

 I have started performing the exercises in this brochure

 Optional: I have a standby walking frame at home. (If you do not have one, our physiotherapists will give you advice prior to discharge)

What to bring to the hospital?

 Identity card

 Medications

 Small amount of cash

 One set of clothing & shoes

 Hearing aid & glasses

 Toiletries

 This booklet

The date of my surgery is

To ensure a smooth recovery and get the most benefit from your new knee, here are some things that you will need to prepare.

About Total Knee Replacement

What is Total Knee Replacement (TKR)?

Total Knee Replacement (TKR) surgery is commonly performed to relieve pain and improve movement for patients with wornout and painful knee joints. This is carried out when patients do not respond adequately to conservative treatment (consisting of medication, physiotherapy and activity modification). It is an elective surgery that involves replacement of the worn-out joint surfaces with implants.

Stages of Knee Osteoarthritis

Minimum disruption. There is already 10% cartilage loss.

Joint-space narrowing. The cartilage to begin breaking down. Occurrence of osteophytes.

How will TKR help?

Moderate joint-space reduction. Gaps in the cartilage can expand until they reach the bone.

Joint-space greatly reduced. 60% of the cartilage is already lost. Large osteophytes.

Going through a knee replacement will:

1. Decrease pain

2. Improve mobility

3. Correct deformities of the lower limb

4. Increase overall quality of life

After full recovery, you can enjoy low impact activities such as walking, swimming or cycling. However, sports that involve contact or jumping, as well as high impact activities like jogging or tennis are discouraged. You may not be able to squat after the operation.

Surgery can help to relieve pain and restore your mobility. Set an achievable goal with continued rehabilitation exercise in your journey of recovery.

What are the different types of knee replacement surgery?

TKR, where the whole knee joint is replaced, is the most common type of knee replacement surgery performed.

A unicompartmental knee replacement, or half knee replacement, is performed in selected patients where only one part of the knee is worn out.

In cases of severe alignment problems, or loose or unstable knees, a stemmed implant (or TKR with rod extensions) may be required to improve the stability of the knee.

TKR implants are made of surgical grade metal alloys and plastic components. They are joined to your bone by acrylic cement. Your surgeon will discuss with you the type of implant that best meets your needs.

How long can the implant last?

Typically, an implant can last up to 15 years, depending on the type chosen. However, this also varies from person to person; depending on many factors, such as your physical condition, activity level, body weight and

the surgical technique. There is no guarantee that a prosthetic joint will last the rest of your life. All prosthetic knees may need to be replaced at some point.

Possible Complications

• Pain: Pain will gradually ease after the first few months. However, some patients may continue to have moderate to severe pain in the long term.

As with any operation, TKR carries certain risks and benefits. Your surgeon and anaesthetist will answer any questions you may have about the surgery or the anaesthesia aspect.

Surgical risks include:

• Surgical scar: The surgical scar will be in the centre of the knee and can vary based on the individual.

Scar numbness and discolouration is common. The scar can sometimes be raised and thickened if you are prone to keloid formation. The scar usually becomes less prominent over a year.

• Infection of the wound: Superficial skin infections are common and can usually be treated with antibiotics. However, deep infections (bacteria going into the joint and growing on the implant) can also occur. Though these occasions are rare, they require multiple surgeries to clean the joint, and may sometimes involve removal of the implants.

• Blood clots or deep vein thrombosis (DVT): Blood clots may form in the leg veins in the first few weeks after surgery due to reduced movement in the leg. This can be prevented by using special support stockings, walking or exercising soon after surgery, or by using blood thinning medications.

• Unexpected bleeding: This can happen inside or around the joint. Some bruising around the knee after surgery is expected. On rare occasions, the bleeding can become excessive and cause pain.

• Excessive scar tissue forming within the knee and restricting movement: Physiotherapy and exercise after surgery is crucial to recovery and ensuring improved range of movement of the knee. In rare cases, further surgery may be required to remove the scarring and restore movement.

• Damage to surrounding structures (ligaments, arteries or nerves) during surgery: Artery and nerve damage during surgery is an extremely rare but severe complication that can result in loss of the limb if repair cannot be adequately achieved. Ligament damage may result in a knee that feels loose after surgery and may require further corrective surgery.

Anaesthesia risks include:

With any anaesthesia choice - full or half body anaesthesiathere are risks involved. Serious complications include heart attack, stroke, lung infection, blood clots and allergic reactions during surgery. More common side effects include vomiting, giddiness and sore throat.

How much will it cost?

Surgery at Khoo Teck Puat Hospital (KTPH)

The cost will depend on the type of knee replacement chosen, the subsidies you are eligible for, as well as your personal insurance. Financial counselling will be provided prior to surgery.

Post-discharge Care

1. Going Home with Rehabilitation Appointments

After knee surgery, most patients stay at the hospital for 1-3 days to recover, before being discharged.

You will be given appointments to attend rehabilitation sessions to ensure the best outcomes after surgery. You may also be eligible to attend rehabilitation therapy at a Community Rehabilitation Centre near your home. Speak to your Case Manager or Physiotherapist for more information.

2. Intermediate Care

Some patients may be advised to transfer to a community hospital if they require more time to recuperate. At Yishun Health, Yishun Community Hospital (YCH) provides continual care such as rehabilitation services after discharge from an acute hospital. The cost will depend on the ward class and the subsidies you are eligible for.

Visit our website or scan the QR code above https://www.

yishuncommunityhospital.com.

sg/patients-and-visitors/hospitalcharges-schemes-subsidies

The community hospital’s charges include ward charges, daily treatment fees, therapy treatments and ancillary charges such as laboratory, specialised investigations, non-standard medication and consumables. The dietitian service and caregiver training programme are optional, and are in addition to the daily charges. Please inform the nurse if these services are not required.

Patients discharged after 1pm will incur one day’s ward charges and treatment fees.

For subsidised wards, the amount of government subsidy given will be dependent on your Household Means Test Assessment. Please complete the declaration form and submit it to your financial care officer prior to your financial counselling appointment.

Yishun Health reserves the right to change the allocated bed within the requested bed class as and when deemed fit.

You may discuss with your case manager if you wish to transfer to other community hospitals.

Preparing for your Surgery

How should I prepare?

After the surgery, pain and weakness may limit your ability to care for yourself or manage your home for a while. It is important to arrange for help so that you can rest and concentrate on exercise and recovery.

Here are some activities that you may need help with:

You can expect to be discharged within 1-3 days after surgery. Preparing your home and arranging for assistance from family and friends will enable you to have an early and smooth transition home. If it is not possible to arrange such assistance, our team will work with you to assess your needs and make suitable recommendations. Should you require help in this area, speak to your doctor or case manager prior to admission for advance discharge planning.

Pre-surgery exercises

Performing the following exercises before surgery will prepare your muscles and soft tissues for the knee replacement by strengthening and stretching them.

You may continue with the exercises post-surgery. This will help you regain strength and movement quicker. Where necessary, consult your physiotherapist regarding the exercises.

Isometric quads

Sit upright with your back supported. Place a towel under the ankle, tighten your thigh muscles and straighten your affected knee.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

• Repeat on the other side

Straight leg raise Lie down and bend one knee for support. Lift your other leg off the bed, keeping the knee straight. Slowly lower it down.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

• Repeat on the other side

Hamstring stretch

Sit upright with your back supported. Straighten your knee and lean forward till you feel a stretch at the back of your thigh.

• Hold for 30 secs

• Perform 3 repetitions, once a day

• Repeat on the other side

Calf stretch

Standing supported, place one leg behind. Keep that knee straight, with your heel on the ground. Bend your other knee slightly till you feel a stretch at the calf.

• Hold for 30 secs

• Perform 3 repetitions, once a day

• Repeat on the other side

Quadriceps stretch

Standing supported, wrap a towel around one ankle and pull the towel towards your buttock until you feel a stretch at the front of your thigh.

• Hold for 30 secs

• Perform 3 repetitions, once a day

• Repeat on the other side

• No squatting toilet

• Keep the floor dry

• Prepare a shower chair to sit while showering

• Place items within reach of shower chair

Bedroom

• Avoid sleeping on the floor or low beds/mattresses which can be difficult to get up from

You may need help from family and friends the first few weeks after discharge. Arrange for help so that you can concentrate on exercise and recovery!

• Avoid low stools which can be difficult to get up from

• Choose seats that are higher and preferably with arm rests

• Remove any items placed on the ground or at doorways (such as electrical cords) that put you at risk of tripping or falling

• Ensure walking paths are wide enough for you and your walking aid

Steps, kerbs & stairs

• If your home is multi-level, try to stay on the ground level

• Inform your therapists if you have steps, kerbs or stairs in your home

Pre-admission Procedures

What are the tests that will be done before the surgery? There will be a pre-admission assessment that will take about half a day. You will be asked to make an appointment once you have decided to go for the surgery.

If any of the test results are abnormal, you may be referred to the appropriate specialist for a review of your surgery.

• X-ray

• ECG

• Blood test

• MRSA Screening

• Financial Counsellor

• Anaesthetist

Surgery

What should I do before admission?

What will happen during the surgery?

The surgery will be conducted under full body (general) or half body (regional) anaesthesia.

• Stop smoking immediately. Nicotine is known to slow down the healing process.

• Your doctor or anaesthetist may advise you to stop taking certain medications and dietary supplements before your surgery.

• On the night before surgery, do not eat anything after midnight.

• You may have a small amount of water (approximately 100mL) before 5am on the day of surgery.

• Shower before coming to the hospital.

• Remember to remove all hair pins, nail polish and jewellery before admission.

The worn out area of the joint will be removed through carefully measured bone cuts. Implants will then be inserted onto the cut bone surface. The knee will be balanced, stabilised and a good range of motion ensured. The wound will then be closed and dressings applied.

How long will the surgery take?

Depending on your condition, a typical knee replacement surgery lasts about two to three hours.

What can I expect immediately after the surgery?

You will be transferred to a recovery area for monitoring until you are fully awake. When the anaesthesia drugs are discontinued, you will gradually wake up. You will probably feel groggy and a little confused. Other common side effects include:

• Nausea

• Vomiting

• Dry mouth

• Sore throat

• Headache

An X-ray will be performed before your transfer to the ward.

You will then be moved to the ward, where you will stay before going home. You may feel some pain, but medication prescribed by your doctor will help control it.

Recovery After Surgery

Keeping track of your recovery

Getting up post-surgery

Getting out of bed early after your knee replacement prevents unnecessary deconditioning and speeds up your return to independence. The physiotherapist will review you after surgery and teach you how to get out of bed, stand up from a chair and walk. Most patients require a walking aid to assist in standing and walking in the initial period of recovery.

• Take your prescribed painkillers

• Continue with your daily recommended exercises

• Practise walking with your therapist and nurses to the toilet and showering

• Aim for discharge

Upon discharge, the doctor and physiotherapist will brief you and/or your caregiver on the follow-up treatment, the use of medication/prescriptions given and the important steps for proper care and rest at home.

Your follow-up appointment and medications will also be given.

Try to walk as normally as possible without limping after you are discharged. It will help to train your knee to get used to the motion.

Swelling management

Excessive swelling can worsen pain and cause stiffness. Manage your swelling by icing it regularly and elevating your operated leg with a stool or pillow placed below the ankle, keeping the knee straight.

Do not put a pillow under the operated knee as it can cause the knee to be bent.

Icing: Apply an ice pack to your operated knee for 15-20mins every 2-3 hours (preferably after doing your prescribed exercises)

Pain management

Pain following TKR surgery is expected. You will be prescribed pain relief medication that should be taken regularly.

Poor pain control can cause you to avoid walking or doing exercises that are necessary for your recovery.

Wound care

Dissolvable sutures are usually used. If staples or non-dissolving sutures are used, they will be removed on the 10th to 14th day after surgery.

Expect to feel some tenderness, tightness, itchiness or numbness around the wound site.

You will be discharged with a waterproof dressing. Keep the dressing and wound site dry and clean.

• Do not attempt to peel off the bandage/dressing or change it yourself

• Do not apply cream or lotion to the wound until fully healed

Visit the polyclinic for your scheduled dressing change or if there are excessive blood stains on the bandage.

Are my symptoms normal?

Upon discharge, it is normal to experience:

• Bruising on your leg

• Warmth around your knee

See a doctor if you notice any of the following:

• Wound is smelly

• Too much drainage from the wound

• Unusual redness, swelling and warmth at the wound site

• Fever > 38 degrees Celsius

• Increasing pain that is not relieved with painkillers

• Calf pain and swelling

Do not over exert yourself, take it slow. Your knee needs rest to heal too.

Post-surgery exercises (Day 0-7) Exercises to improve knee range

Heel slides

Sit upright with your back supported. Place a towel/belt under the sole of your foot or your thigh. With both hands holding onto the ends of the towel/belt, gently pull it to bend your knee as much as possible.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

Seated knee flexion

Sit on a stable chair. Cross your ankles as shown, with the operated leg behind. With the top leg, push the operated leg towards the back. To bend your knee further, you may sit on the edge of the chair or table.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

Seated knee extension

Sit on a stable chair with your thighs supported. Tighten your thigh muscles and straighten your operated knee. Use your unaffected leg to assist slightly as needed.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

Exercises to improve knee strength

Isometric quads

Sit upright with your back supported. Place towel under your ankle. Tighten your thigh muscles and straighten your operated knee.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

Inner range quads

Roll a towel and put it below your operated knee. Lie down. Tighten your thigh muscles and keeping your operated knee firmly on the towel, lift your foot off the bed and straighten your operated knee.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

Straight leg raise Lie down. Bend your unaffected knee for support. Lift your operated leg off the bed, keeping the knee straight. Slowly lower it down.

• Hold for 10 secs

• Perform 10 repetitions, 3 sets a day

Add the following exercises:

Knee extension stretch

Sit on a stable chair with your foot of your operated leg propped up on another chair. Allow gravity to stretch your operated knee to a more straightened position. For an increased stretch, you may place a weight such as a small bag of rice (1kg -2kg) on the knee.

• Hold for up to 5 minutes

Sit to stand

Sit on a stable chair and cross your arms over your chest. Stand up from the chair using as little help from your hands as possible.

• Repeat for 10 reps

• Perform 2 sets a day

Knee extension with band

Sit on a stable chair. Secure an elastic band to a stable support behind your operated leg and tie the other end around your ankle.

Straighten your operated knee against the elastic band.

• Repeat for 10 reps

• Perform 2 -3 sets on alternate days

Recovery at Home

Follow-up appointments

Please attend the followup appointments with your surgeon and physiotherapist after discharge. Your wound healing and functional recovery will be reviewed at these appointments.

Post-surgery Exercises

(Week 1 – 6)

Swelling of the knee or leg is common. Continue to ice and elevate your knee to reduce the swelling.

Avoid sitting or standing for long periods of time. This includes staying in bed the whole day. Instead, take frequent, short walks with the use of a walking aid.

You should perform your exercises regularly. These will help to strengthen your knee and help you regain your mobility.

Don’t get discouraged if these feel difficult to complete. Give yourself time to adjust to the activities. You may consult your physiotherapist regarding the exercises.

Post-surgery Exercises

(Week 7 – 3 months)

There should be minimal swelling of your knee or leg. You may continue to ice and elevate your knee to help reduce swelling as needed.

Continue to exercise to increase your leg strength and balance, and to improve your walking. Most patients are able to return to work around 3 months post-surgery.

Contacts

Khoo Teck Puat Hospital

Hotline 6555 8000

Non-emergency Ambulance

1777

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg

Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg

Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg