Enhancing your recovery after joint replacement surgery
RAIGMORE HOSPITALORTHOPAEDIC DEPARTMENTPatient advice and information
Bring this booklet with you each time you come to hospital
www.nhshighland.scot.nhs.uk
“I’ve learned thatpeople will forget whatyou said, people willforget what you did,but people will neverforget how you madethem feel.”
Maya Angelou
Useful telephone contact numbers can be found at theback of the booklet
Introduction 1
Enhanced Recovery Programme and joint replacement surgery 2
Planning for your surgery 3
Pre-operative information and your exercise programme 4 Information about the hospital 5
Coming into hospital for your surgery 6
Going home from hospital and follow up arrangements 7
Managing at home 8
This is your future 9
Potential risks and complications 10
Frequently asked questions with answers 11
Daily exercise programme – hip replacement 12
Daily exercise programme – knee replacement 13
Useful information 14
The information contained within this booklet can be provided indifferent languages, or on audiotape and in large print. We can alsoarrange an interpreter. Please contact us giving us notice of any specialrequirements.
Contents
This booklet explains some of what you can expect before, duringand after your hip or knee joint replacement surgery.
It suggests how you can best prepare for your surgery, andrecommends some things to think about after your surgery.
Whether you are having your hip or your knee replaced theinformation and advice to follow is very similar. The main differenceis the exercise programme and so separate sections have beenprepared.
By following the enhanced recovery programme you may be readyto go home once you have met the discharge criteria this could befrom day 1 onwards.
The information is intended as guidance and we strongly encourageyou to read it before you have your surgery. Some treatment andadvice will vary according to individual needs.
Please ask your GP or any member of the hospital staff if there isanything you are unsure about.
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1“Be who you are and say what you feel,because those who mind don’t matterand those who matter don’t mind.”
Dr. Seuss
Introduction
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What is the Enhanced Recovery Programme?
The term ‘enhanced recovery’ is used to describe an approach toperforming joint replacement surgery and promoting recovery.
The evidence shows that taking a planned and structured approachdelivers better outcomes and a better experience for patientsrequiring surgery.
Aims
To ensure that you know what to expect and are ready for yoursurgeryTo minimise the stress of surgery on the bodyTo ensure a safe and quick recovery after your surgery
Why do people need joint replacement surgery?
Your joint may need to be replaced for a number of reasons, themost common being arthritis. The problems this can cause include:
Difficulty with walking and negotiating stairs Not able to sleep well Stiffness
Enhanced Recovery Programmeand joint replacement surgery
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“Knowledge is of two kinds. Weknow a subject ourselves, or weknow where we can find informationupon it.”
Samuel Johnson, 1709-1784
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The main reason, however, is to help people who are experiencingongoing severe pain.
What happens during joint replacement surgery?
Your surgeon will remove the worn and damaged parts of the jointand replace it with an artificial joint. Theoperation takes around 45-90 minutes
Hip joint
The hip is what we call a ‘ball and socket’ joint.The ‘ball’ is formed by the head of the thighbone (femur), which fits snugly into the socketin the pelvis. The artificial joint is placed andthen secured into the socket.
Knee joint
The knee is the largest joint in the body and isa hinge joint. The worn parts of the joint areremoved and replaced with threecomponents. A metal part on the ends of theupper bone (femur) and lower bone (tibia)and a plastic insert which allows the joint tobend.
Partial knee replacement
Partial knee replacement resurfaces only the inner or outer half ofthe knee (the inner half, nearest your other leg is most common).
This operation can be done through a slightly smaller cut than atotal knee operation. A partial replacement usually means you canmove your knee more easily than after a total replacement.
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Whether you are suitable forthis type of surgery isdependent on your age,medical condition and the x-ray of your knee.
Potential risks andcomplications
Joint replacement surgery isa major operation. Whilemost replacements arecarried out without anyproblems, all operationscarry some risks and thepotential for complications.These include infection, dislocation, blood clots, swollen limbs, delayed wound healing anddifference in leg length.
Further information on the potential risks and complications arefully detailed in section 10. It is really is important that you considereverything before you agree to having your surgery.
If there is anything you are worried about, or do not understand,please speak to your surgeon or any other member of the hospitalteam. They will be very happy to discuss any concerns or questionsyou may have.
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Enhanced Recovery P
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e and joint replacement surgery
Partial knee replacement
Joint replacement surgery requires careful preparation to ensure thebest results.
A big part of the success of the Enhanced Recovery Programme isdown to you taking responsibility before and after your surgery.Your hospital stay is just a small part of the overall programme.
GENERAL HEALTH
Smoking
If you are a smoker your general health is at risk. Smoking alsocauses some additional risks and complications for your surgerysuch as:
Increased risk from having an anaesthetic, in particular,developing a chest infection or pneumonia
Increased time for your wound to heal Increased risk of getting an infection Increased risk of developing a blood clot after your operation,
known as a deep venous thrombosis or pulmonary embolism(section 10)
As a minimum stop smoking for at least four weeks before and afteryour replacement surgery.
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Planning for your surgery 3
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“The beginning is the mostimportant part of the work.”
Plato (BC 427-BC 347), Greek philosopher
Planning for your surgery
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If you would like support to stop smoking speak to your GP orpractice nurse and ask to be referred to our service to help peoplequit smoking. For further information or contact details of anadviser, please visit www.smokefreehighland.co.uk , [email protected], telephone 0845 757 3077, or visityou local community pharmacist.
Eat well
A well nourished body is really important to support the healingprocess. Eating well will reduce your chance of inflammation,infection and help you to recover. Eat regular meals and drink plentyof water. Try and eat a wide variety of foods, and include:
Plenty of fruit and vegetables Plenty of wholegrain bread, wholegrain cereals, pasta, potatoes and rice Beans, lentils and other pulses. Fish, especially oily fish – mackerel, salmon, sardines, pilchards etc Some milk and dairy foods Meat, eggs, chicken and nuts
Some foods are of lower nutritional value; sweet and sugary drinks,cakes, biscuits, sweets, chocolate, crisps and takeaway meals.
Being heavy increases the stress on your joints, so it is even moreimportant to eat a good nourishing diet and do any recommendedexercises.
If you need help with your diet please speak to your GP or practicenurse who will be able to provide advice in the first instance.
Walking
Try and keep as mobile as possible, and walk regularly, as painallows.
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Get organised
Most people will be in hospital for only a short time and will be ableto return direct to their own home. Only a small number will need ashort spell in a local community hospital.
After your surgery, you will need to change the way you carry outsome every-day tasks. To start with you may need some help fromothers.
There are a few simple things you can do which will make your life abit easier when you get home from hospital (see box opposite).
Pets
If you have a pet(s) make sure you have arrangements in place. It isalso important to remember that after your surgery it is not easy tobend down.
Getting back to work
If you work, you should have an initial discussion with your employerand GP before your surgery and consider anything that will helpyour return to work. It may be necessary to go back on a part-timebasis or have a phased return.
Driving
You may return to driving when you feel comfortable and cancompetently manage an emergency stop.
If you think you might struggle with anything please let staffknow before your surgery to make sure suitable arrangementsare in place.
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Have your home ready for returning home after your operation
Throughout your home, and particularly in your kitchen, put things that you use regularly at a height where you don’t have to bend or stretch too much to reach.
Do not stand on chairs to reach things!
Remove any loose rugs or anything else that you might trip over or slip on. Keep extension cords or cables well away from where you will be walking.
When you go home you will need to use walking aids. Remove anything which will get in your way of moving easily from room-to-room.
Check that you have suitable clothing and foot wear that is comfortable and safe. If you are not sure ask your occupational therapist.
Have good lighting on and make sure it is easy for you to switch a light on at night time.
Some patients have said they found having a small backpack to carry lightweight items around the house (such as up and down stairs) was helpful.
Think about putting a chair in the bathroom.
Have a stool accessible to elevate your legs (knees only)
Make sure you have a stock of food in the house and other things that you will need on a daily basis. Have food that is quick and easy to prepare and that you will want to eat. Remember, you will be tired and less mobile when you first get home.
Ensure any necessary arrangements are in place for when you are in hospital and for returning home.
Please complete the furniture measure form and return it to the OT.
Consider keeping meals in the freezer
Consider getting someone in place to help with shopping
Consider your heating and how you will manage this on discharge.
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“No man is good enough to governanother man without the other’sconsent.”
Abraham Lincoln
Pre-operative information and yourexercise programme
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BEFORE YOUR OPERATION
Consenting for your surgery
A member of the orthopaedic team will go through the process ofconsenting for your surgery with you. This may happen at your out-patient appointment, pre-operative assessment clinic (sometimesreferred to as pre-admission clinic) or on admission to the hospitalward.
You should be informed about all aspects of your replacementsurgery including any potential risks and complications (Section 10).You will then be required to sign a consent form.
Pre-operative assessment clinic
The pre-operative assessment service aims to optimise your medicalcondition before surgery. At the clinic you will seen by a nurse whowill carry out a general assessment which includes:
Routine measurements and tests (e.g your height, weight, blood pressure, pulse etc) Checking what medications you are currently taking and whether you need to stop taking anything Checking to see if you have any medical problems (eg high blood pressure)
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Taking a full set of swabs. This is to ensure that you are not a carrier of, or have, MRSA. You will not come in for your surgery if there is any risk of MRSA being introduced to the ward.
When you attend the clinic let us know if you have any:
Dates when you are not likely to be available for your surgery (planned holidays, work commitments etc) Changes to your health or social circumstances Changes to your medications from when your GP referred you to the hospital Changes in your skin such as cuts, ulcers, abscesses, insect bites or rashes Signs of infection, including dental problems
Infections
All infections must be cleared up before your surgery can take place.This includes tooth abscess, in-growing toe nail, or urine infections.If you have a dental infection, please inform your dentist that you arewaiting for joint replacement surgery.
Even minor cuts or broken areas of skin can cause bacteria tocirculate through your body and cause infection. When you attendthe hospital pre-assessment clinic, please inform staff if you haveany symptoms of infection.
Planning for going home after surgery
It will be explained to you that our aim is to support people to beready for discharge from hospital from day two onwards. Beingaware of this will help you plan your transport and otherarrangements for going home.
You need to make your own transport arrangements to and fromhospital. An ambulance will only be arranged if the doctor lookingafter you confirms that this is a medical requirement.
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If you have any concerns about this speak to a member of staff atthe pre-operative assessment clinic. Please also refer to sections 3and 8.
At the clinic you may also meet your surgeon and an anaesthetist.They will provide you with a bit more detail and answer anyquestions that you might have.
Pre-op exercise programme
It is important to be as fit as possible before undergoing yoursurgery as it will help your recovery.
Your exercise programme should start after you have been to thepre-operative assessment clinic. You need to keep on doing yourexercises up until the day before your surgery.
The Daily Exercise Programme for hip replacement is set out inSection 12 and for knee-replacement in Section 13.
Arthroplasty specialist nurse
This is an ongoing service which will provide you with information,advice and support post operatively regarding your jointreplacement.
We are constantly evolving the service and hope in the future tocontact all patients prior to admission to discuss your pathway; thiswill give you an opportunity to discuss any questions or concerns.
You will receive a call around 10 days after your surgery to check onyour progress, the Arthroplasty service is your first point of contactshould there be any concerns in relation to your joint replacement.If you have had to consult your GP or any other health professionalplease contact the service.
Telephone helpline number is 07979245856.
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Hospital appointment letter
A few weeks before your operation, you will receive a letter from thehospital confirming the date and time of your operation. Pleasekeep your letter in a safe place but also make a note of thearrangements in your diary and/or in this booklet.
If there is a problem with the date, or anything comes up making itnot possible for you to come in for your surgery, please let thehospital know as soon as possible. The number to contact will beprovided in your letter or contact the hospital switchboard (section14).
Medications
You should continue to take any regular medication unless advisedotherwise by your GP, surgeon or nursing staff.
Please bring all your regular medication into hospital in the originalpackaging, your discharge prescription will not include regularmedication therefore it is important you have arranged a supply forwhen you get home.
Your anaesthetist and anaesthetic options
Your anaesthetist is responsible for your well-being before, duringand immediately after your operation.
They will review any information needed to assess your generalhealth. This will include your medical history, test results, allergiesand current medications.
There are two main types of anaesthetic:
Spinal anaesthetic
This involves an injection of local anaesthetic in your lower back. It isnot painful but will make your legs and hips completely numb.
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Some patients feel a little nervous about the idea of not being ‘putto sleep’ for their surgery. It is very common to feel like this but youcan be given some sedation to help keep you relaxed. If you haveany concerns ask your anaesthetist.
Most people have a spinal anaesthetic because they are associatedwith a lower bloodloss, reduced risk of DVT, much less sickafterwards and overall have a better recovery. This is not suitablefor everyone, however, in which case you may need a generalanaesthetic.
General anaesthetic
A general anaesthetic is where you will be ‘put to sleep’ for youroperation. You will get anaesthetic (sedative drugs) by injection,and will receive strong painkillers, such as morphine, to make youmore comfortable when you wake up.
A general anaesthetic may have some unpleasant side effects suchas nausea and vomiting, drowsiness, disorientation and sore throats.
Count-down to your surgery
Three weeks before your surgery No shaving or waxing legs, under arms or bikini lines for three weeks prior to your surgery. Continue with your exercise programme.
One week before your surgery Think about what you will need to pack for your hospital-stay. We have provided you with a check-list which can be found at the back of the booklet/section 14. Check that you are organised for coming into hospital and for returning home after your surgery. Continue with your exercise programme.
If you have had diarrhoea, nausea and vomiting 48 hours before you are due to come in for your surgery, or if you have a cold or flu-
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like symptoms please contact the ward who will be able to provide you with advice.
One day before your surgery In order to help medical staff to observe your skin and finger nail bed colour during your operation, please don’t wear make-up, nail varnish, acrylic or gel nails on the day of your surgery. It is a good idea to remove anything the day before your surgery. Please also remove all piercings. Continue with your exercise programme.
Day of your surgery Please have a bath/shower/wash on the morning of your surgery. Do not use any talcum powders, body lotions, perfumes or make- up after you have washed.
Eating and drinking before your surgery
On the run up to your surgery it is important that you continue toeat and drink as normal. However, you will need to stop for a periodof time before your surgery. Please follow the instructions on thenext page.
If your surgery is in the morning, have a meal in the evening beforeyour surgery. No fluids should be taken after 07.00 (see box below).
If your surgery is in the afternoon, have a light breakfast before07.30. No fluids should be taken after 11.30 (see box below).
If you are unsure contact the ward staff who will be able to help you(telephone contact details are at the back of this booklet).
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Time of operation
If your operation is in the morning
If your operation is in the afternoon
Allowed food until:
midnight on thenight before yoursurgery
07.30 on the day ofsurgery (lightbreakfast)
Allowed clear fluidsuntil:
07.00
11.30
Clear fluids include:Water, blacktea/coffee, weakdiluting juice andflavoured water (non fizzy)
Instruction to follow about eating and drinking beforeyour surgery
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Information about the hospital
Information about the hospital5“Many, many thanks for yourexpertise, and the care and kindnessyou all extended towards me duringmy hip replacement stay.”
Patient as part of Enhanced Recovery Programme
The orthopaedic unit
Your joint replacement surgery willbe carried out in Raigmore Hospitalin Inverness. When you come in foryour surgery you will be cared for inthe Orthopaedic Unit which issituated on the 3rd floor.
Raigmore has a team of consultant orthopaedic surgeons. They aresupported by a team of anaesthetic consultants who have specialist
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skills in orthopaedic surgery.
Other important members of the teaminclude, nursing staff, nurse practitioners,physiotherapists, occupational therapists,ward domestics, ward receptionist,junior doctors and specialist arthroplastynurse.
Smoking
Raigmore Hospital is a no smoking site.
Reducing the risk of infection
Staff take infection control and prevention very seriously buteveryone has a part to play.
Patients
All patients who come into hospital are at greater risk of acquiringand spreading infection. The following will help to reduce some of therisks:
Do not touch any wounds, dressings or drips that may have been applied as part of your care Bring a container of moist hand wipes to hospital to ensure you can clean your hands, for example, before you eat a meal Always wear something on your feet when you are walking around the ward/hospital Keep the top of your locker and bed table free from clutter. This makes it easier for it to be cleaned Always wash your hands after using the toilet If you visit the bathroom or toilet and are concerned that it does not look clean, report this immediately to the nurse in charge of the ward Your bed area should be cleaned regularly. If you or your visitors see something that has been missed report it to the nurse in charge
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Staff
Members of staff should wash their hands before and afterexamining patients using soap and water or the hand gel that will belocated at the foot of your bed. This is an integral aspect of ourinfection control policy and we would welcome you to ask staff ifthey have washed their hands.
Visitors
Visitors also have an important role to play. They should seek advicefrom the ward staff if they are planning to visit and are sufferingfrom any infections, colds and viruses, vomiting or diarrhoea. Thiswill greatly reduce the risk to vulnerable patients.
Visitors should follow any instructions before and after visiting onthe ward. These can be found at the front entrance to the ward andoutside each room.
Hospital visiting arrangements
Only close relatives or friends are advised to visit you on the day ofyour operation and only for a short period of time. When you comein for your pre-operative assessment, please ask staff about visitinghours and any other arrangements.
If there are particular reasons why your visitors are unable to comeduring set times, please contact the ward staff who will be happy todiscuss alternative arrangements.
Please also be aware that you may have to be seen by thephysiotherapist or occupational therapist during part of thevisiting times. This is an essential part of your rehabilitation.
Help at meal times
If you require or prefer assistance at meal times from a friend,partner or family member, please discuss this with the nursing staff.
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Car parking, Taxis and Bus Service
Free car parking is available at the front of the hospital but at peaktimes, it can be very busy. Whilst security staff will try their best toassist you, please allow additional time to find a car parking space.
In the urgent event that you are unable to get parked, contactSwitchboard on 01463 704000 and ask for a Security Officer.There are a number of bays situated in the first row of the car-parkwhich are reserved for drivers displaying Blue Badges.
In addition there arevarious pick-up and dropoff points at the front ofthe OutpatientsDepartment and mainentrance to the hospitalwhich can be used byprivate cars and taxis.The maximum waitingtime is ten minutes.
Free 24 hour taxi phones are available inside the main hospitalentrance, Outpatient Department and Accident and EmergencyDepartment.
The hospital is well served by a regular bus service every 15 to 20minutes from the centre of Inverness and stops outside the mainhospital entrance.
Kyle Court Patient Lodge
Patients who have a long way to travel may be able to stay inpatient accommodation (Kyle Court) which is on the Raigmore site.Contact the Accommodation staff (01463 705560) to find out more.
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Mobile phones
You may bring your phone into hospital but please respect otherpatients in the room by not disturbing them.
TV, radio and internet
Each bed has a patient line service which supplies TV, radio, internetaccess and telephone service. There is a charge. Cards to operatethis service can be purchased from a machine at the entrance to theward.
Hospital radio
The hospital has a radio station. There are various ways to arrange arequest including email to [email protected],phone 01463 70 4500 or call free from your bedside phone on *800
Other facilities
The hospital has a range of facilities. These include a dining room, acoffee shop situated at the main entrance, a café in outpatients, aRVS shop, and multi-denominational Chapel.
NHS Highland website
Further information about Raigmore Hospital is available on theNHS Highland website under Services and Hospitals
Information about the hospital
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“Courage is the thing;all goes if courage goes.”
J.M. Barrie, 1860-1937
Coming into hospital for your sugery 6
You will be asked to come to hospital either on the day before or themorning of your operation. Please follow any instructions in yourappointment letter.
On the morning of your surgery you will be given an identity bracelet to wear and nursing staff will welcome you to the ward and answer any questions A junior doctor or nurse practitioner will take some blood (in case you need a blood transfusion), mark the leg to be operated on and check your consent form Your anaesthetist (if you have not already met them in the pre- operative assessment clinic) will go over your anaesthetic options
What to expect immediately before your surgery
You will be given pain medication before you go to theatre.
Once in the anaesthetic room monitoring devices will be attached toyour chest, arm and finger. This allows the anaesthetic team tomonitor your heart, blood pressure, pulse and oxygen level duringsurgery.
You will have a small straw like tube (called a cannula) inserted intothe back of one of your hands. This allows the anaesthetist to giveyou fluids if required.
If you are having a spinal anaesthetic, your anaesthetist will ask youto either sit on the trolley or lie on your side. They will check that the
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anaesthetic is working fully before giving you a sedative through yourcannula. The sedative can be used to keep you comfortable andrelaxed during your operation.
If you have brought a personal music player, you may listen to musicduring the operation if you wish.
What to expect after your surgery
Immediately after your surgery
You will be taken from theatre to the nearby recovery unit where youwill stay for a short period of time. You may be given extra oxygenand fluids. You will be looked after by a team of specialist nurses. Theanaesthetist will also be on hand to make sure you have a saferecovery.
In order to reduce risks of forming blood clots, you will have pumpson your legs to help circulation.
When you return to the ward, nursing staff will monitor you closely.Your wound dressing, blood pressure, temperature and pain levels(see overleaf) will all be regularly checked.
A small number of patients find it difficult to pass urine followingtheir surgery. When this happen a catheter may be inserted for ashort period of time to relieve this.
It is important that you start to eat and drink soon after your surgery.Your body needs lots of nourishment to help your wound heal, reducethe risks of infection and to help your general recovery.
You may find you have little memory of the operation taking place.
A few hours after your operation you may get up to walk a few stepswith the nurses or physiotherapists.
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Controlling your pain after your surgery
Prevention or early treatment of pain is far more effective than trying totreat established or severe pain. If you are in pain let any member of staffknow. No matter how busy you think staff might be, helping you tomanage your pain will always be a priority.
You will be given a number of different types of painkillers to keep yourdiscomfort to a minimum. Some medication will be given to youregularly – please take all your medication even if you do not feel anypain. It is really important that your pain is well-controlled so that youare not in discomfort and can start to get mobile and do your exercises.
If you are feeling pain, you may wish to take some extra painkillersbefore a physiotherapy session. This will help you get more out of thesession. There are a number of different ways that can be used to scoreyour pain, including:
Verbal Rating Score (VRS) – you will be asked to describes your pain inwords such as ‘no’ pain, ‘mild’, ‘moderate’ or ‘severe’ pain
Numerical Rating Score (NRS) – scores go from 0 = no pain through to10 = the worst pain you’ve ever had
Visual Analogue Scale (VAS) – this is a line with ‘no pain’ at one endand ‘worse pain ever had’ at the other. You will be asked which scorebest describes the pain you are in (see below).
Please tell the nursing or medical staff if you feel your pain is notwell-controlled.
0 1 2 3 4 5 6 7 8 9 10
Worse pain ever had
Severe pain at all times
Moderate pain at all tim
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Mild pain at all tim
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Hurts on m
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Pain increasing
Dull ache
No pain
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Looking after your new hip
Previously hip precautions were routinely taught following surgery.This has now proved to be no longer necessary. Removingrestrictions has been shown to increase recovery rates and patientsatisfaction.
Some patients may require to have hip precautions relating to theirindividual surgery, if this applies to you it will be clearly identified toyou, all staff involved in your care and on any dischargedocumentation.
The days following your surgery
The doctors and nurses will continue to monitor your progress. Thiswill include you being taken to the x-ray department to have yournew joint x-rayed.
Your cannula will be taken out once your blood pressure and fluidintake are adequate. This is usually after 24 hours.
Occupational therapist or OT (Hip only)
Your occupational therapist will show you how to dress safely usingappropriate aids as necessary. They will also check you are manag-ing to get on and off the toilet, and in and out of bed.
For further information and advice for managing day to day activi-ties after your surgery see section eight.
Physiotherapist or Physio
Your physiotherapist will start you on your post surgery exerciseregime. Each exercise is designed to help improve the strength andrange of movement in your new joint.
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The daily exercise programme for hip replacement surgery can befound in section 12 and for knees section 13.
While you are in hospital the physiotherapist will also teach you towalk with elbow crutches or sticks.
You may also be shown exercises to help reduce the risks of gettinga deep vein thrombosis (DVT) and also some breathing exercises.
Managing steps and stairs
Before you go home, the physiotherapists will check that you areable to safely negotiate steps and stairs. This is important even ifyou do not have steps or stairs at home in case you come acrosssome when you are outdoors or in other buildings.
Going up stairs
Put your hand on the hand rail then step up with your un-operated leg. Then step up with your operated leg, and finally, move your stick up onto the next step.
hand on railun-operated leg operated legstick/crutch
Going down stairsPut your hand on the hand rail, stick on the step below, then your operated leg, and finally bring your un-operated leg down.
hand on railstick/crutch (to check depth of the step and provide you with support)
operated leg un-operated leg
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Going home from hospital and follow up arrangements
Discharge plans should have been discussed fully with you by staffat the Pre-Operative Assessment Clinic. These will be confirmedwith you by staff on the ward.
Occasionally, some people may require further rehabilitation andmay need to go to a community hospital before going home.
You will be safe to go home when you are able to answer yes tothe following discharge criteria questions:
Have you a clean and dry wound? Are you independent and mobile with your walking aid? Can you manage your exercise programme? Are able to wash and dress? Are able to go to the toilet and get in and out of bed on your own? Are safe on stairs and steps? Are you organised at home including with any required equipment? Do your family/carers/friend or neighbours know you are going home and are they able to collect you?
Knee replacement only Are you able to straight leg raise and achieve a good bend?
“One step at a time is goodwalking.”
Chinese proverb
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Day of discharge
On the day you are due to be discharged, a nurse on the ward willgive you a letter for your GP and your prescription for any drugs (egpainkillers). Please ask for a sick note for your employer if required.
Follow up arrangements
Your discharge letter will be sent electronically to your GP so theyare aware that your surgery has taken place.
When you leave hospital you will only be given a supply of painkillersto last for a few days. You will need to contact your GP surgery toget a follow on prescription. Make sure you do this before you runout of any supplies.
You will have dissolvable sutures or clips in your wound. If you haveclips, arrangements will be made for your practice nurse or districtnurse to remove these. They are usually removed 10-12 days aftersurgery.
Outpatient physiotherapy is not usually required, but will bearranged by the hospital physiotherapist if necessary.
Outpatient appointments
Your outpatient follow up appointment with either a member of theconsultant team or the Arthroplasty nurse specialist is usually 6 – 8weeks after surgery. This will be sent out by post.
This appointment is an opportunity to ask any new questions youmay have. It’s a good idea to write down your questions as theycrop up so you don’t forget them. There is space for you to do this atthe back of this booklet and remember to take the booklet in withyou to your appointment.
Further follow up arrangement may be a virtual appointment –where a telephone call is made by the Arthroplasty nurse specialistto discuss your progress.
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Now you are home what next?
The following pages aim to provide you with some generalinformation and advice to help you manage at home and safeguardyour new joint.
Whatever you are doing, remember to take your time and don’t takerisks.
Getting on and off furniture
A chair with strong arms will make it easier for you to sit down andget up.
Remember (see also page 25) Avoid sitting with your legs crossed, even at the ankles Avoid sitting for prolonged periods
Going to the toilet
Your occupational therapists should have advised if a raised toiletseat is necessary.
Use the same method for getting on and off furniture to get on andoff the toilet. Be careful not to twist round to reach toilet paper orto flush the toilet.
Managing at home
“Start by doing what’s necessary;then do what’s possible; andsuddenly you are doing theimpossible.”
Francis of Assisi
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Washing/bathing/showering
You must keep your wound dry until it has healed. This will normallybe within a few days of your surgery.
You may use a shower board over a bath. This will be supplied byyour occupational therapist. ALWAYS use a rubber mat or non-skidadhesive on the bottom of the bath or shower
Remember
Avoid twisting and overstraining to reach your clothes Always dress your operated leg first and undress it last To put your pants or trousers over your feet, hold the waistband and lower the garment to your feet. Then put in your foot from your operated leg. And repeat with your other leg before pulling right up Always use the shoehorn on the inside of your operated leg
If you are struggling with personal activities the occupationaltherapist may be able to help with equipment.
Be organised: collect all the clothes you are going to wear and putthem close to you before you start to dress.
It is a good idea to sit on a chair or on the side of your bed to getdressed. Loose comfortable clothing, easy to fasten isrecommended. Wear comfortable flat slip-on shoes with plenty ofroom as your foot may swell up during the day.
Shopping
You may want to think about having your shopping delivered whenyou first return home (if that is an option), or ask family, friends orneighbours to help out.
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Cooking
If you were able to prepare your own meals before your operation thenyou should be able to manage when you return home. You may findthat you are more tired than normal, so think about ways you canmake your life a little easier and less tiring.
If you are cooking, don’t stand for longer than ten minutes at a time.Ideally, sit down to prepare your meals and remember to collectanything you need before you start to cook.
Place frequently used cooking supplies and utensils where they can beeasily reached so that you don’t have to bend, stretch or walk abouttoo much.
Do not attempt to lift hot dishes out of the oven as this will require you to use both hands. If it is an option use the top of your cooker, grill or microwave for the first three months or so.
Do not go down on your knees to clean floors or pick things up.
Housework
Avoid any heavy housework or laundry in the first weeks followingyour operation.
Preparing to get into the front of the car as a passenger
By the time you leave hospital, you should be able to travel as apassenger in the front of an ordinary saloon car. However somepatients have told us that they found getting into car when they lefthospital difficult. Please discuss with your occupational therapist andask for any help if this is concerning you.
Before attempting to get into the front passenger seat ask someoneto:
Push the front seat all the way back and recline it slightly if possible Place a plastic bag on the front seat which will help you move across the seat If necessary put a small cushion or rolled up towel onto the back of the seat to make it level
Getting into the front of the car
Back up to the car until you feel it touches the back of your legs Reach back for the car seat and lower yourself down keeping your operated leg straight out in front of you Slide across towards the driver’s seat to give yourself more room to get your leg into the car Turn towards the dashboard, leaning back as you lift your operated leg into the car Remove the plastic bag and make yourself comfortable
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Sleeping
It is very common to have unsettled nights after your operation andthis may last for a few months. The discomfort that wakes you isdue to stiffness.
You may find it easier to get in and out of bed leading with theoperated leg.
It is recommended if you sleep on your side to place a pillowbetween your legs.
This is your future
“Nothing is impossible,the word itself says ‘I’m possible.”
Audrey Hepburn
A total joint replacement is performed to give you a better quality oflife, but you must take responsibility for looking after your new joint.
Most people are keen to return to normal as soon as possible,however, it is important that you DO NOT do too much too soon.You should plan to gradually build up your strength.
It is normal to feel tired after surgery. Taking regular short rests onyour bed will help you gain strength and allow you to complete yourexercise programme. Remember to eat well.
Some ideas for goals are summarised (Section 14). These are justindicators. Everyone is different and will recover at different rates.
Your daily home exercise programme
It is really important that you continue to follow your exerciseprogramme for at least three months (section 12 for hips and 13 forknees). Once completed you should continue to exercise regularly.This will help to maintain your fitness and strengthen the musclesthat support your joints.
Becoming mobile again
It is essential that you use your walking aid (s) to support you tostart getting more mobile. This will stop your new joint frombecoming stiff and also make it stronger.
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You should aim to increase how far you walk each day. You can moveonto one crutch/stick when you feel confident. This is often aroundthree to six weeks. Use your crutch/stick in the hand OPPOSITE toyour operated leg. You may discard your walking aid when you feelcomfortable and are no longer limping. It is usually around 6 weeksthat people discard aids.
Some people also prefer to continue to use two crutches/sticks forwalking outdoors, over rough ground or longer distances.
It is normal to have good days and bad days. So even when you feelyou don’t need to use any aids we recommend you keep them for amonth or so before handing them back to the hospital. But when youare finished with them please return them.
Stairs
You should continue to negotiate stairs as taught to you by thephysiotherapist until you are no longer using an aid. After this, youcan start to climb stairs normally. Typically this might be after threemonths or so but everyone is different.
Gardening/heavy work
Avoid any heavy work for the first three months then check with yoursurgeon.
Public transport
You can make some journeys by train, coach and bus but werecommend that you check that you have lots of leg-room forcomfort.
Remember, travel arrangements do not always go to plan, so thinkabout how you would manage if there were delays. Always plan somecontingencies.
Long journeys of any sort are not recommended in the first six weeks.
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Due to the risk of blood clots, long-haul flights (over four hours)should be avoided until after three months from your surgery. Thisshould be discussed with your surgeon.
Returning to work
You are advised not to return to work before your orthopaedicfollow up outpatient appointment.
You will need to provide your employer with a ‘fit note’ from your GPafter seven days of absence. A fit note must be signed by your GP.
Sports and activities
High impact activities such as running, tennis, squash etc may puttoo much pressure on your new joint and are not recommended.
High risk activities such as skiing are also discouraged because ofthe risk of dislocation and fractures.
Potential risks and complications
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Potential risks and complications
“If you tell the truth, you don’t haveto remember anything.”
Mark Twain
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As with all major surgery there is a risk of dying, however, it is highlyunlikely with joint replacements. There are, however, a number ofpotential risks and complications.
Infections
Many precautions are taken to try and minimise the incidence ofinfection. This includes thorough washing prior to surgery,antibiotics given during and after surgery as well as using adedicated theatre for joint replacement surgery.
The incidence of infection is also very low-less than 1%- but it isimportant to contact us directly if you have any concerns about yourwound.
Common signs and symptoms of infection soon after your surgeryare:
Redness around the site of your wound with increased swelling Wound discharge or leakage Increase in pain in your hip or wound Increased body temperature (above 38oc).
Infection can also occur in later years and if so further surgerymaybe required
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Dislocation
Incidence of dislocation is also very low – less than 1%- but canhappen. Signs of dislocation include:
Sudden severe pain Rotation/shortening of your leg Unable to weight-bear or move your leg
Blood clots/ pulmonary embolism
A blood clot in the veins of the leg or pelvis is called a thrombosis. Itis relatively common to develop a thrombosis of the leg after replacement surgery. Notably blood clots can form in either leg notjust the leg where you have had your surgery. Common signsinclude:
Swelling in your thigh, calf or ankle that does not go down when you raise your leg up Pain, tenderness and heat in your calf muscle
In a very small percentage of cases, the clot may leave the legveins and travel to the lungs. This is called a ‘pulmonaryembolism’. This is an emergency situation and if suspected youshould call 999 immediatelySigns which might indicate pulmonary embolism include:
Sudden chest pain Shortness of breath Sweating Confusion Feeling faint or unwell
Blood loss
Sometimes patients may lose a large amount of blood during theiroperation. If this happens you may require a blood transfusion. Likeall medical interventions, a transfusion will only be used if reallynecessary.
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Limb swelling
Swelling of the foot and ankle is very common following jointreplacement surgery and may persist for many months. You mayhave little or no swelling when you get up in the morning but findthat the swelling increases as the day passes.
Some warmth around the joint is often noted. This is due toincreased blood flow through the tissues during healing.
Nerve damage
This is rare but can give rise to pain in the leg or weakness of somemuscles. This can cause your foot to drop, making walking difficult.This is often temporary and will improve over weeks or months butcan also be permanent.
Numbness and scarring
Occasionally, slight numbness around the scar or part of the leg canhappen, but is not anything to worry about.
Difference in leg length
Your surgeon will try to ensure your legs are the same length afteryour surgery. However, if the damage to your bone is too extensivethis may not be possible. If this is the case, a small heel raise foryour shoe can be provided.
Loosening of the new joint
Most joint replacements last between 10-20 years. After 15 yearsaround one in four (25%) will appear loose on x-ray and 5-10% willbecome painful and require to be re-done.
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Frequently asked questions with answers
“There are no foolish questions andno one becomes a fool until theyhave stopped asking questions.”
Unknown source
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How long will my new joint last?Most replacements will last for 10 to 20 years.
Will I recover and feel better?Yes-but remember it can take up to a year to fully recover. You mayfind that you have to adapt the way you do some things for a while.
I don’t feel like eating. Is this common?After surgery you may lose your appetite. This is normal and smallmeals taken regularly will help.
I have got some swelling after my operation. Is this normal?Yes, and it may last for several months. Healing tissue tends to bemore swollen than normal tissue. You may find that you have little orno swelling when you get up in the morning but it increases as the daypasses.
What can I do about any swelling?Hips - When sitting/lying do your circulatory exercises (ankle pumps and knee push-downs, as per pages 47 & 48). This will also help to reduce the risk of clots. You should try and rest on your bed after lunch for an hour. Your leg should be slightly raised by putting pillows lengthwise under your leg. Knees - When sitting/lying do your circulatory exercises (ankle pumps and knee push-downs, as per page 58). This will also help to reduce the risk of clots. When you are sitting your operated
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leg should be elevated on a stool. Your foot must be higher than your hip in order to help the swelling drain. You can use an ice-pack (packet of frozen peas) to help reduce the swelling. Wrap them in a damp cloth and apply to the swollen area. You should only leave this on for a maximum of 20 minutes and no more than every two hours as ice can burn your skin.
Do I need to follow my exercise programme?Yes! This is a really important part of your recovery. If you have anyconcerns, ask your physiotherapist for advice.
What should I do if I think there is a problem with my wound?If there is any wound discharge or leakage, or increasing redness beyondthe suture line, contact your local specialist nurse advice line (section14, page 65). If in any doubt, go to your local A&E Department andprovide them with the details of when you had your surgery.
Why is my scar warm?While your wound may have healed on the outside, recovery on theinside can take up to up six months. This can cause heat on the surface.
Why do I stiffen up?Your new joint will stiffen if you have been sitting for a period of time.This is due to the swelling of the tissues but should ease off once youget moving. Try not to sit for long periods (eg more than one hour atime).
My bowel movements have become irregular. Is this normal?This is quite common and should resolve itself in a few days. Forinstance painkillers can often cause constipation.
I have a numb patch. Is this common?Yes. This is due to small superficial nerves being disrupted duringsurgery. This may or may not be permanent.
My joint clicks. Is this normal?This is normal and should improve as healing continues.
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How far should I walk?Everyone is different and it will depend on how much you used to walkbefore your surgery. After you have walked, you should feel tired butnot exhausted. If you are suffering from pain for a long time after youhave walked then you have done too much. Our advice is to graduallybuild up the distance and remember wherever you go, you have to getback.
When should I stop using my crutches or sticks?If you are still limping, continue to use an aid as it means your musclesare not strong enough yet. Most people use a walking aid for six weeksbut again, everyone is different.
Will I set the security alarms off at the airport?This can happen. If it does, explain to the security staff about yourjoint replacement. If you have metal walking sticks or crutches, theywill need to be x-rayed.
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Daily exercises programme - hip replacement
“A journey of a thousand miles mustbegin with a single step.”
Chinese Proverb
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It is important that you are as fit and strong as possible beforehaving your hip replacement surgery. The exercises described aredesigned to strengthen your overall body including your arms. Youwill rely on your arms to get you in and out of chairs, and also whenyou are walking with sticks.
Before your hip replacement surgeryYou should start your exercise programme on the day after you havebeen for your pre-operative assessment. And continue until the daybefore your surgery.
You should do each exercise 10 times and then move onto the nextone. Aim to complete the programme four times each day. It shouldtake you around 20 minutes. Stop any exercise if it gets too painfuland build up to the suggested numbers more gradually.
Exercise No.1 -Ankle pumpsMove your ankle upand down briskly
Repeat 10 times
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Exercise No.2 -Knee push-downsPress the back of yourknee down into thebed, tightening themuscle on the front ofyour thigh.
Repeat 10 times
Exercise No.3 -Buttock squeezesSqueeze your buttocks together.
Repeat 10 times
Exercise No. 4 -Inner range quadsLie on a couch or bed with a rolled towel under your affected leg.
Press the back of your knee into the towel and straighten your leg.Your heel should lift upoff the bed. Hold for 5seconds. Make sureyou keep the back ofyour knee in contactwith the rolled towel atall times.
Repeat 10 times
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Exercise No.5 -Hip and kneebendsLie on a couchor bed and slideyour heel uptowards yourbottom.
Repeat 10 times
Exercise No.6 -Hip abductionLie on a couchor bed, slideyour heel out tothe side andthen back to themiddle. Try tokeep your footup right.
Repeat 10 times
Exercise No. 7 -Arm chair push upsSit in an armchair and placeyour hands on the armrests.Then push through your arms,lifting your bottom off thechair keeping your feet on thefloor.
Repeat 10 times
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After your hip replacement surgeryPart 1 – up until week 6
The following exercises will help you to fully recover from your hipreplacement surgery. They will support you to get your range ofmovement and strength back.
You should do each exercise 10 times and then move onto the nextone. Aim to complete the programme four times each day. It shouldtake you around 20 minutes. Stop any exercise if it gets too painfuland build up to the suggested numbers more gradually.
Exercise No.1 -Ankle pumpsMove your ankle upand down briskly.
Repeat 10 times
Exercise No.2 -Knee push-downsPress the back ofyour knee down intothe bed, tighteningthe muscle on thefront of your thigh.
Repeat 10 times
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Exercise No.3 -Buttock squeezesSqueeze your buttocks together.
Repeat 10 times
Exercise No.4 -Inner range quadsLie on a couch or bed with arolled towel under youroperated leg.
Press the back of your kneeinto the towel and straightenyour leg. Your heel should lift
up off the bed. Hold for 5 seconds. Make sure you keep the back ofyour knee in contact with the rolled towel at all times.
Repeat 10 times
Exercise No.5 -Hip and knee bendsLie on a couch or bed, with aboard under your leg and a‘donut’ under your heel.Slide your heel toward yourbottom.
Repeat 10 times
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Exercise No.6 -Hip abductionLie on a couch or bed,with a board underyour leg and a ‘donut’under you heel. Slideyour leg out to theside then back to themiddle. Keep yourtoes pointed up andyour knee straight.
Repeat 10 times
Exercise No.7 -Knee extension Sit on a chair witharm rests. Sit withback against chair.Straighten your legout.
Repeat 10 times
Exercise No.8 -Heel raisesStand and hold onto a firm surface.Push up onto your tip toes andslowly lower down.
Repeat 10 times
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Exercise No.9 -Hip flexionStand and hold onto a firm surface(kitchen work top, table etc). Bend andlift your knee up. Keep your body uprightand your toe pointing forwards.
Repeat 10 times
Exercise No.10 -Hip abductionStand and hold onto a firm surface. Liftyour leg out to the side then back to themiddle. Keep your body upright and yourtoes pointing forwards.
Repeat 10 times
Exercise No.11 -Hip extensionStand and hold onto a firm surface. Liftyour leg out behind you and back tocentre. Keep your body upright and try topoint your toe forwards.
Repeat 10 times
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After your hip replacement surgeryPart 2 – weeks 7-12
By now you should be finding it easier and able to return to most ofyour daily activities. It is still important that you continue with yourexercise programme. Complete the exercises shown below fourtimes each day.
Exercise No.1 -Step UpsPractice putting your operated leg uponto a step then back down.
Repeat 10 times
Exercise No.2 -Hip abductionLying on your side,straighten your legthen lift it up 8-10inches. Hold for 5seconds then slowlylower down.
Repeat 10 times
Exercise No.3 -Hip extensionLying on yourtummy, keepingyour knee straight,lift your leg up, holdfor 5 seconds thenlower slowly.
Repeat 10 times
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Exercise No.4 -Hip raisesLying on your back,with both kneesbent up, lift yourhips up until yourbody is straight,then lower slowly.
Repeat 10 times
Exercise No.5 -Sitting to standingPractice moving from sittingto standing and back againin a controlled way. Try toput weight evenly throughboth legs.
Repeat 10 times
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Daily exercises programme - knee replacement 13It is important that you are as fit and strong as possible beforehaving your knee replacement surgery. The exercises described aredesigned to strengthen your overall body including your arms. Youwill rely on your arms to get you in and out of chairs, and also whenyou are walking with sticks.
Before your knee replacement surgeryYou should start your exercise programme on the day after you havebeen for your pre-operative assessment. And continue until the daybefore your surgery.
You should do each exercise 10 times and then move onto the nextone. Aim to complete the programme four times each day. It shouldtake you around 20 minutes. Stop any exercise if it gets too painfuland build up to the suggested numbers more gradually.
Exercise No.1 - AnklepumpsMove your ankle upand down briskly
Repeat 10 times
Exercise No.2 -Knee push-downsPress the back ofyour knee down intothe bed, tighteningthe muscle on thefront of your thigh.
Repeat 10 times
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Exercise No. 3 -Inner range quadsLie on a couch or bedwith a rolled towelunder your affectedleg.
Press the back of yourknee into the toweland straighten your leg. Your heel should lift up off the bed. Hold for5 seconds. Make sure you keep the back of your knee in contactwith the rolled towel at all times.
Repeat 10 times
Exercise No.4 -Hip and knee bendsLie on a couch or bedand slide your heelup towards yourbottom.
Repeat 10 times
Exercise No. 5 -Arm chair push upsSit in an armchair and placeyour hands on the armrests.Then push through your arms,lifting your bottom off the chairkeeping your feet on the floor.
Repeat 10 times
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After your knee replacement surgeryPart 1 – up until week 6
The following exercises will help you to fully recover from your kneereplacement surgery. They will support you to get your range ofmovement and strength back.
You should do each exercise 10 times and then move onto the nextone. Aim to complete the programme four times each day. It shouldtake you around 20 minutes. Stop any exercise if it gets too painfuland build up to the suggested numbers more gradually.
Exercise No.1 - AnklepumpsMove your ankle upand down briskly
Repeat 10 times
Exercise No.2 -Knee push-downsPress the back ofyour knee down intothe bed, tighteningthe muscle on thefront of your thigh.
Repeat 10 times
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Exercise No. 3 -Inner range quadsLie on a couch or bedwith a rolled towelunder your affected leg.
Press the back of yourknee into the towel andstraighten your leg.Your heel should lift up off the bed. Hold for 5 seconds. Make sureyou keep the back of your knee in contact with the rolled towel at alltimes.
Repeat 10 times
Exercise No.4 - Straight leg raiseLie on a couch or bed,tighten your thigh muscleby pushing the back ofyour knee into the bed.Keep your leg straight, liftup 6-8 inches and hold for5 seconds. Lower slowly.
Repeat 10 times
Exercise No.5 -Knee bendsLie on a couch or bedand slide your heel uptowards yourbottom.
Repeat 10 times
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Exercise No.6 -Knee extension Sit on a chair witharm rests. Sit withback against chair.Straighten your legout.
Repeat 10 times
Exercise No.7 -Seated kneeassisted flexion Sit on a chair bendyour operated kneeas far as possible.Hook your other leground your operatedleg to bend it backfurther.
Repeat 10 times
Exercise No.8 -Hamstring stretch Sit on a chair, and placethe foot from youroperated knee on astool. Make sure theback of your knee is notsupported. Stay in thisposition for 10 minutesif able.
You can also lie in acouch or bed, and place a rolled up towel under your heel. Allowyour knee to relax. Stay in this position for 10 minutes if able.
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After your knee replacement surgeryPart 2 – weeks 7-12
By now you should be finding it easier and able to return to most ofyour daily activities. It is still important that you continue with yourexercise programme. Complete the exercises shown below fourtimes each day.
Exercise No.1 -Step UpsPractice putting your operated leg uponto a step then back down.
Repeat 10 times
Exercise No.2 -Sitting to standingPractice moving from sitting to standingand back again in a controlled way. Tryto put weight evenly through both legs.
Repeat 10times
Exercise No.3 -Knee bends on stepPlace your foot from your operated leg uponto a step. Lunge forward.
Repeat 10 times
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Useful Information 14Check list of items to bring into hospital
TICK ITEM NOTES
Daywear You will be encouraged to dress after your operation.We recommend loose fitting clothing and underwear such as tracksuit bottoms, loose trousers, shorts, skirts, socks or stockings. Avoid tights. Nightwear You will need to bring in suitable nightwear (and dressing gown if you wish) for your hospital stay which will usually be around 2 to 4 days). Ear-plugs and an eye mask may help you sleep. Footwear Your foot may swell after your operation so comfortable flat walking shoes or slippers with backs on them. No flip flops.. Toiletries Towels will be provided. Please bring in any toiletries that you feel you will need while you are in hospital. Medications Bring in only essential medications in their original containers. This allows staff to check the dosage instruction. Medication such as paracetamol need not be brought in as we will have a supply. Aids Bring in any aids you use - sticks, crutches, wheelchair. Make sure you label them with your name. Hand wipes Bring a container of moist hand wipes to ensure you can keep your hands clean. Music, reading We recommend you take some reading material etc. material, personal radio or music player (with headphones), i-Pod, i-Pad, Kindles etc to keep you entertained. You can listen to your music during your operation if you wish. There is bedside TV and you can purchase cards for this in the hospital. Mobile phone You may bring your mobile phone into hospital but please respect others in the room. This booklet Bring this booklet with you!
Valuables - You should avoid bringing jewellery, valuables or a largequantity of money into hospital. If you do we would strongly recommendthat you give them to the nurse on the ward, who will give you a receiptand put them in a safe.
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Some goals to think about after your surgery
Here are some goals that you might find useful to aim for.Remember you are a unique individual and will recover at your ownpace.
Weeks one to three
1. Continue with your exercise programme four times daily 2. Continue to walk using your aid unless otherwise instructed 3. Aim to increase the distance you walk each day 4. If you have stairs, aim to be using them regularly. See page 27 for a reminder on how to negotiate stairs and steps 5. Gradually resume household activities but remember for hip replacements avoid bending your operated joint beyond 90 degrees
Weeks four to six
1. Continue with your home exercise programme four times daily 2. By this time you should be more independent 3. Continue to use your walking aid as required 4. Continue to increase the distance you are walking each day 5. Resume household activities but still no heavy lifting
Weeks six to twelve
1. Continue with your home exercise programme four times daily 2. You should be walking without an aid indoors 3. You should be able to return to all normal household activities 4. Return to sports such as cycling, swimming 5. Consider going back to work
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Feedback
We aim to provide the best possible care, experience and service.However, sometimes we don’t always get everything right. If thereis an aspect of your care which you have not been satisfied with,please let us know as soon as possible. Ideally speak to the stafflooking after you or ask to speak to a senior member of the hospitalmanagement team.
If you are unhappy about any aspect of your care and it has not beenresolved to your satisfaction then you should make a formalcomplaint.
We are also keen to hear about positive experiences as this alsohelps us to learn and improve.
Making a formal complaint or to feed-back
NHS Highland Feed-Back TeamPO Box 5713, Inverness IV1 9AQTel: 01463 [email protected]
Patient Opinionwww.patientopinion.org.uk
This is an independent, not-for-profit organisation, which runs thePatient Opinion website, where you can share your experience ofNHS Highland.
Patient Advice and Support Service (PASS)www.cas.org.uk/patientadvice
PASS is an independent service which is part of Scottish CitizensAdvice Bureau (CAB). It aims to provide free confidentialinformation, advice about services provided by NHS.
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Specialist nurse follow-up telephone service
This ongoing service aims to provide you with advice and supportduring the days, months and years following your replacementsurgery.
Hopefully you will have met the specialist arthroplasty nurse on theward after your surgery and received a brief explanation of theservice they offer. You can expect a call from this service around 10days following discharge. The helpline is available to discuss anyworries or concerns you may have.
If you have had to consult your GP or any other hospital or healthprofessional, regarding your joint replacement surgery, pleasecontact the specialist nurse. They will be able to record anytreatment you received and update your surgeon.
Should you have any problems, concerns or questions, please get intouch 07979 245 856
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Useful contact details
HOSPITAL DEPARTMENT TELEPHONE
Specialist arthroplasty nurse 07979 245 856
Orthopaedic ward (Ward 3C) 01463 70 4456
Pre-operative assessment clinic 01463 70 6108
Physiotherapy department 01463 70 5580
Occupational therapy department 01463 70 4293
Kyle Court patient accommodation 01463 70 5560
Inverness Hospital Radio 01463 70 4500
Feed-back, including complaints 01463 70 5997
Hospital switchboard 01463 70 4000
If you wish to contact any other department, or are not sure who tospeak to, then get in touch with the Hospital switchboard.
For medical emergencies always call 999.
Please ask your GP or any member of the healthcare team ifthere is anything you are unsure about. This booklet is to supportany conversations you want to have with staff.
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Notes
Many patients have questions and comments they wish to make.You may find it useful to write these down in case you forget to ask.
Notes
Specialist arthroplasty nurse telephone service 07979 245 856
