IN THE OPERATING ROOM
The anaesthetist will choose (with your consent ) either an injection in the back ( called spinal or regional anaesthesia ) or a full ( called General Anesthesia ) for the operation. Monitoring equipment which will measure your vital signs ( pulse rate, Blood pressure and respiration ) will be attached so that a continuous check of these parameters can be kept during the operation. You may choose to be awake during the operation if a spinal anaesthesia is administered or prefer to take a sleeping injection.
After anaesthesia, the leg will again will be thoroughly washed with an anti-septic solution and suitably prepared so that the operation can be performed. You will not get any pain and most people remark that they did not realise when the operation started or when it ended. Generally, the operation takes 1 hour to be completed although the time spent in the operating room is approximately 2 hours.
After the operation, there will be a bandage on the leg and the legs may feel numb for a few hours. You may have a tube inserted for drainage of urine and another tube in the thigh as an adductor catheter ( for pain relief )
After this , you will be shifted back to the ward. In the ward, of the first 4 hours, you will have supplemental oxygen and the knee will be kept in a bent position as shown. Because of the way the surgery is done and the medicines that we use , there will be minimal to no pain. We will ask for special anti-embolism stockings to be applied to the legs.
Once the numbness of the legs is reduced and you would be able t0 move the leg relatively comfortably. You should start the following exercises as soon as possible :
Toe stretch and Ankle pumps
In the lying down position, you should try to move your toes and ankle towards and away from you as shown. This helps in the circulation and reduces the likelihood of a clot formation.
Quadriceps sets
Put a pillow underneath the heel as shown and practise tightening the thigh muscles. After tightening the thigh muscles, hold form a count of 1 to 10 and then relax. This should also be done at least 10 times every hour .
SLR – Straight Leg Raise – You should practice lifting the leg in the air after tightening the thigh muscles and pulling of the ankle and the toes towards you ( as shown ) at least 5 times every hour.
Sitting by edge of the bed and dynamic knee extension
Once you are able to lift the leg in the air comfortably and your vital signs ( pulse, BP ) is ok, you will be asked to sit by the edge of the bed with both your knees dangling. Do not keep the leg tight at this juncture and the knee will be bent to around 90 degrees by its own weight.
Dynamic quadriceps exercise ( Active Knee Extension )
Try to straighten the knee from the bent position by the edge of the bed as shown. ( If you pull the toes up, this becomes easier ) You should try to straighten the knee fully and hold to a count of 1 to 10 .
Do active knee extensions, 5 times every hour
These five exercises, ankle pumps, Quadriceps sets, SLR, sitting by the edge of the bed and Knee Extensions – form the major chunk of the exercises required after the surgery.
We can discharge the patient once we are sure that the patient will be able to manage at home. For this to occur, the patient should be able to sit up from a lying down position in bed, sit by the legs dangling by the side of the bed, get up form the bed, walk a bit and to be able to sit on a chair and to get up with support ( walker ). The pain should be under control and the dressing over the knee should be nice and dry. ( A few blood spots on the dressing are common ) Additionally, the patient should have used the washroom, should have passed urine comfortably, should have eaten and if there are other diseases such as diabetes, blood pressure etc . they should be under reasonable control. There should be enough home help and the patient and the relatives should also be willing to take the patient home.
The aim in the first few days ( 1 to 3 ) is to make sure that the pain is well controlled , the knee keeps moving and to avoid swelling .
The operation also is a form of injury to the knee and our body needs rest to recover.
We need only simple exercise with or without a physiotherapist. Exercise needs to be done for 5 to 10 minutes every waking hour with 2 hours of rest in the afternoon. The exercises in the first few days are the same that you have done in the Hospital.
If one feels out of breath, has pain in the chest area or feels excessive uneasiness, or the level of consciousness drops or feels paralysed or any other major problem – one needs to contact the hospital urgently and may need to be readmitted.
Knee related
If there is excessive bleeding or oozing from the wound or the leg appears misshapen, or you are not able to walk the way you had started walking after the operation, then also one may need to seek medical help.
Kindly note the numbers for urgent medical attention-
Recovery from 2 weeks to 3 months
You would have had a visit at around 2 weeks time from the operation to see us. Hence, any further questions and doubts could be tackled at that time also.
In general , the level of exercises can increase as tolerated , one may start going out of the house for small errands or for work. One should also start ones’ routine now and not wait for “ full recovery “ and postponing things. Here , the underlying principle is to try normal activities gently , slowly , repeatedly as tolerated until happy.Obviously , if there is undue discomfort or pain , you need to stop.
Most people by this time would be at 60 to 80 % of their recovery.
There will be occasional episodes of pain and swelling but they would reduce. If there were ecchymoses around the knee , they would be settling . You may still wear stockings for excessive swelling . You will also feel some areas of numbness around the knee and burning etc from the knee . This is normal and would reduce over 6 to 12 months . If burning is very intense , we can prescribe medicines for it.
Please be very sure that the knee is fully straightening and do not keep a pillow underneath the knee . If it is not happening , you may need special exercises to achieve that.
In general, the level of exercises can increase as tolerated, one may start going out of the house for small errands or for work. One should also start ones’ routine now and not wait for “ full recovery “ and postponing things. Here, the underlying principle is to try normal activities gently, slowly, repeatedly as tolerated until happy. Obviously, if there is undue discomfort or pain, you need to stop.
Most people by this time would be at 60 to 80 % of their recovery.
There will be occasional episodes of pain and swelling but they would reduce. If there were ecchymoses around the knee, they would be settling. You may still wear stockings for excessive swelling. You will also feel some areas of numbness around the knee and burning etc from the knee. This is normal and would reduce over 6 to 12 months. If burning is very intense, we can prescribe medicines for it.
Please be very sure that the knee is fully straightening and do not keep a pillow underneath the knee . If it is not happening, you may need special exercises to achieve that.
