A Patient's Enhanced Recovery Guide to having a Knee Replacement

Enhanced Recovery After Surgery

At Blackpool Teaching Hospitals NHS Foundation Trust (BTH) we aim to provide high standards of care based on current recommendations and protocols. Enhanced Recovery After Surgery (ERAS) is part of this and ensures that all members of the hospital and primary care staff work together to improve the patient experience throughout their stay in hospital.
Research shows that patients who maintain a healthy lifestyle and are well prepared prior to surgery have better outcomes after surgery.
By identifying any problems after surgery early such as pain control or post operative nausea and vomiting we can ensure that patients are able to move around early after surgery, take on the necessary calories needed to recover and therefore ensure a timely discharge from hospital.

What ERAS Means for You

• Taking an active role in your recovery - following the advice of the clinical team and being positive about your recovery.
• Starting normal activities, for example, eating, drinking, toileting, washing and walking (with supervision initially) as soon as possible after surgery.
• Make sure that before you come into hospital for your surgery, you have organised any help that you will need at home after you are discharged home.
• Being aware of your estimated length of stay and discharge date prior to coming in for surgery. In some cases patients will go home the day after their surgery. We expect that patients will go home 1-2 days after surgery.

How Will this Benefit You?

Patients who actively participate in their recovery.
Feel better sooner.            Leave hospital sooner.                      Return to normal living sooner.

Pre Operative Planning

It is important to be in the best physical health you can be prior to elective/planned surgery. Below are some things you should consider prior to your admission.
• Stop Smoking: This helps reduce your risk of breathing problems/chest infections post operatively. Wound healing can also be affected with patients who smoke. Please note that we have a No Smoking Policy at Blackpool Victoria Hospital and cannot take you outside to smoke. For further information please see the Trusts website www.blackpoolteachinghospitalsnhs.uk and search for “Smokefree Blackpool”.
• Reducing alcohol intake: It is important to reduce alcohol intake prior to your surgery as it increases the risks of complications and slows down the recovery process. Do not drink alcohol for at least 48hrs prior to surgery. For further information please see the Trusts website www.blackpoolteachinghospitalsnhs.uk and search for “Drink Less”.
• Improve your diet: Eating a healthy balanced diet can help reduce infection complications. Good nutrition is always important but it becomes even more important before and after surgery. After surgery you will have wounds that will heal better if you have been eating a healthy balanced diet before surgery and help avoid developing surgical site infections after surgery. Pre-operative nutrition focuses on high protein, nutrient-dense foods (lean meat, fish, eggs, beans) to boost immunity, aid wound healing and reduce complications. Try and eat your recommended 5 portions of fruit and vegetables in the days/weeks leading up to your admission and increase your protein intake. Continue to eat and drink as normal the day before surgery. For further information please see the Trusts website www.blackpoolteachinghospitalsnhs.uk and search for “Healthy eating”.
• Hygiene and skin care: Before your surgery, it is important to keep your skin clean to prevent surgical site infections (SSI). Bacteria on you skin can build up and can potentially cause infection. You should wash your skin with regular soap and water the night before and/or the morning of your operation. If you struggle to wash yourself, please let a member of staff in surgical admissions know on the day of your operation so they can help you before you go to surgery. If you have any rashes or breaks in your skin, please tell a member of staff.
• Gentle exercise: Ensure you are doing gentle exercise if your pain allows. You should follow the exercises in this booklet. If you struggle with these exercises, it is important that you keep as active as you can including keeping mobile.

Pre Operative Discharge Planning

Prior to coming into hospital you need to think carefully about any adaptations to your lifestyle or possible assistance that you may require when you return home. These could be such things as;
• Preparing meals in advance or microwaveable meals, to keep ready in the freezer.
• Having plenty of supplies in store including long life milk for emergencies.
• Internet shopping or having shopping delivered.
• Recruiting friends and family to help with shopping/housework/looking after pets.
• Removal of any clutter or loose rugs that may impede you walking with walking aids.
• Plan your transport to and from the hospital.
It is important to eat and drink before surgery. Please make sure you eat a good meal the evening before surgery and have a light supper at 10pm before you go to bed. If you are on the afternoon list you will be able to eat breakfast on the day of surgery. You will be told if you are able to eat breakfast.
You will be able to drink water on the day of surgery up until the time you are admitted. Once at the hospital the preadmission nurses will tell you when you need to stop drinking.

How Long Will I be in Hospital?

It is not unusual that patients will be discharged on the day of their surgery or on the day after their surgery. Before going home, you will have to be:
• Medically fit.
• Independently mobile with an appropriate walking aid.
• Able to transfer on and off the bed, toilet and chair.
• Able to complete the stairs if applicable.
• Able to complete your exercises.

Pre-operative Assessment

Prior to coming in for your surgery, you will be asked to attend a pre-operative assessment. You will have a medical assessment to make sure you are medically fit enough for surgery.
At your clinic appointment you will have an ECG (heart trace), blood tests, an x-ray and will be screened for any infections. If there are any concerns at this appointment, staff will consult with the appropriate medical professionals.
So that we can ensure you are medically safe, it is important that you tell the staff at your pre-operative assessment about any medication you take. This includes pain relief or blood thinners.

What is a Knee Replacement?

A knee replacement is an operation to replace a worn or damaged knee joint. Knee replacements are performed usually because you are suffering pain and movement difficulties.

Total Knee Replacement            Partial Knee Replacement 

During a knee replacement the surgeon removes the rough damaged surfaces of your knee and replaces these with new smoother surfaces made from metal and plastic.
Osteoarthritis of the joint is the most common reason for needing a knee replacement. Osteoarthritis damages the cartilage and roughens the bone surfaces. It is this damage that causes the pain on movement and decreases joint flexibility and strength. Any condition that damages the cartilage covering the bones can cause pain. These include rheumatoid arthritis, avascular necrosis and previous knee trauma
It is a major operation with risks attached, it should only be undertaken if your tablets are not controlling your pain and severely affecting your lifestyle.

Alternative Treatments

There is no absolute requirement for you to have a knee replacement. It is usually a decision you make with your surgeon based on your quality of life. If your surgeon offers you a knee replacement the decision to proceed with the operation is yours alone and you may cancel the operation at any time before the anaesthetic if you change your mind. Total knee replacements are usually performed on patients suffering from severe arthritis (although there are other reasons). Most patients are above the age of 55 years.
Alternative treatments for arthritic knee pain include:
• Lifestyle modification: Weight loss Avoiding or modifying strenuous exercises or work Physiotherapy and exercises
• Medication Pain killers and anti-inflammatory drugs e.g. ibuprofen
• Alternative surgeries Partial or unicompartmental knee replacement Leg realignment known as osteotomies
• Walking aids such as a stick or a crutch

Benefits of Surgery

Provided that you work hard with your exercise programme before and after your operation, you can expect to improve significantly the quality of your life, reduce your pain, improve your mobility and benefit from your new knee replacement.

Risks/Complications of Surgery and Total Knee Replacement

All surgery and anaesthetics carry some risks, particularly if you have other medical problems or are overweight. The healthcare team looking after you have been trained to make sure that these are minimised and your treatment is carried out safely. There are, however, some specific risks relating to knee surgery that you need to be aware of:

1. Infection – sometimes despite the strictest precautions, infections can occur. Superficial infection may occur at your wound site.
2. Deep infections – may occur early after the operation or much later. For this reason we recommend any infection that you develop in any part of your body is treated promptly and that you tell your Dentist when you see them that you have had a knee replacement.
3. Deep vein thrombosis (DVT) – despite taking precautions to try and prevent a blood clot (a thrombosis) forming in the veins of your leg after surgery, this still remains one of the commonest risks after knee replacements. Occasionally these clots can dislodge and travel through the heart to the lungs. This is known as a pulmonary embolism.
4. Loosening of the prosthesis (new joint) – this is a risk of all artificial joints and is caused by a weakening of the bond between the new joint and your bone. It is hoped that your new knee will last at least 10-15 years, but it may loosen before this time, particularly if you are overweight or damage the joint by falling on it or return to heavy employment. If it does loosen then it is usually possible to remove it and replace it with another one although this is a more complicated operation with greater risks.
5. Persistent pain – the operation may not relieve all of your pain and you may continue to experience some mild discomfort. Complex regional pain syndrome, while uncommon, may be the cause of pain, swelling, stiffness and skin changes.
6. Nerve damage – very occasionally nerves can be damaged or stretched during your operation. This usually recovers over a period of time.
7. Persistent knee stiffness – sometimes despite your exercises your knee joint may become very stiff. This seems to be due to excessive scar tissue forming around and within your joint. Sometimes this is helped by a further operation to manipulate your joint. It is very important that you do your exercises regularly after your operation.
8. Other recognised risks of knee surgery include bone fracture, bruising, urinary retention and the risks associated with anaesthesia and blood transfusion.
9. Very rarely even death can occur.

Pre-Op Exercises

In the weeks before your operation, it is important that you maintain the mobility of your knee joint and the soft tissues around it. You also need to strengthen the muscles around the knee.
By strengthening the muscles around the knee, you will help to support your new joint, improve your posture and walking pattern, as well as greatly aiding your progress after your operation.
Start these exercises as soon as you have been given this booklet. You should not feel too much pain or discomfort with them.

Please do all of the exercises on BOTH legs
Exercise 1

Lie on your back or sit up with your legs out straight in front of you on your bed.
Bend your ankle up and push your knee down firmly against the bed. Hold for 5 seconds.
Repeat 6 times, 3 times a day.

Please do all exercises on BOTH legs

Exercise 2

Lie on your back, or sit up with your legs out straight on your bed.
Exercise your knee by pulling your toes up, straighten your knee and lift your leg 10cm off the bed. Hold for approx 5 seconds, then slowly relax.
Repeat 6 times, 3 times a day.
Increase to more than 10 repetitions each time if you are able.

Please do all exercises on BOTH legs

Exercise 3

Sit or lie as shown. Put a rolled up towel or block under your knee.
Exercise your knee by pulling your foot up, tightening your thigh muscle and straightening your knee. (Keep the back of of your knee on the towel or block). To make the exercise harder put a small weight on your ankle.
Hold for 5 seconds. Slowly release. Repeat 6 times, 3 times a day. Increase to 10 or more repetitions, as it feels easier.

Please do all exercises on BOTH legs

Exercise 4

Sit on a chair.
Pull your toes up, tighten the front of your thigh muscle and straighten your knee slowly. Hold for approx 5 seconds. Slowly release.
To make the exercise harder put a small weight on your ankle.
Repeat 6 times, 3 times a day.
Increase to 10 repetitions each time if you are able.

Please do all exercises on BOTH legs

Exercise 5

Sit on a chair with your feet flat on the floor.
Slowly bend your knee as much as possible. Hold for 5 seconds. Then straighten your knee as fully as you can.
Repeat 6 times, 3 times a day.
Increase to 10 repetitions each time if you are able.

Please do all exercises on BOTH legs

Exercise 6

Lie on your back or sit semi reclined on your bed with a plastic board/bag under your leg.
Bend and straighten your hip and knee, as much as you can, by sliding your foot up and down the board.
Repeat 6 times, 3 times a day.
Increase to 10 repetitions each time if you are able.
If you wear a sock, your foot will slide easier and the sock will help to protect your heel from any soreness.

What do I Need to Bring into Hospital with Me?

Please do not bring lots of valuables or unnecessary items with you – you are likely to only be in hospital for 1-2 nights. The table below shows some of the items we recommend that you bring with you.

The Day of Your Surgery

It is usual for you to be admitted to the surgical admissions unit on the day of your surgery. You will be sent further information regarding the time to come into hospital and which unit to attend nearer to the time.
On the morning of your operation please have a shower/bath before coming into hospital. When you are admitted to hospital, members of the health care team will prepare you for theatre. The limb to be operated on will be marked before the operation. A member of the health care team will escort you to the operating theatre.

The Operation

The anaesthetist will discuss anaesthetic options with you. Usually, a spinal anaesthetic is used. This is an injection of local anaesthetic into your lower back which will numb you from the waist down for the duration of the operation; you will be awake for the operation unless you decide to have sedation which will relax you during the operation. Alternatively, a general anaesthetic is sometimes given. This will send you to sleep for the duration of the operation.
The operation involves the surgeon making an incision (cut) over the front of your knee, the worn/ damaged knee joint is carefully removed and the prosthesis (artificial joint) which has been measured and adjusted to ensure an exact fit is inserted. The surgeon will then close your skin with stitches or clips, and a large dressing and bandage is applied to the wound.

After the Operation

You will spend a short time in the recovery area of the operating theatres before you are taken to the ward. You will be offered drinks in the recovery area and you should be able to eat and drink normally
when you go to the ward. You will have a cannula in your hand or arm which will be used to give you some medications you may need.
Some discomfort will be experienced following the operation, please let the ward staff know if you are struggling with pain.
Proper nutrition and hydration after surgery are critical to a successful recovery, acting as the
foundation for tissue repair, immune system support and restoring strength. We will encourage you to eat and drink normally and as soon as possible after surgery as the nutrition helps your body to recover more quickly, and adequate fluids (approximately 2 litres per day) help prevent dehydration, drops in blood pressure, bloods clots, constipation and kidney issues. Sometimes surgery and medication can make you feel nauseated (sick), affecting your dietary intake, please let us know if you feel sick as we can give you medication to settle this feeling and review any of your medications.

Post-operative Pain Relief

An operation will inevitably result in some pain, however, pain can be a very different experience in every person and the best way to treat it can be different as well. What you experience may not be the same as your family or friends.
We have a number of methods to treat pain including tablets and liquids. You may have been given more than one type of pain killer. They can work in different ways and are often better when combined
It is important that your pain is under control so that you can get out of bed and start your
rehabilitation; please follow medical advice on how often to take pain medication. Let the nursing staff know how you feel as they can vary your dosage, change pain relief medications and treat the most common side effects of the stronger pain relief medications, with anti-sickness and constipation medications as required.
Once you are home, it is important to manage your pain relief yourself. Keeping it well controlled and taking painkillers regularly, when prescribed, will help you to complete your exercises and aid your long-term recovery. Pain is more difficult to get under control if you let it build up. Most pain killers take about 30 minutes to start working. You should contact your GP if your pain does not get better once you are at home.

Post-operative exercises

It is essential that you commence the following exercises as soon as you can after your operation. These exercises replace the previous exercises that you were doing before your operation.

Exercise 1

After your operation it is very important that whilst you are not as mobile as usual, that you do deep breathing exercises, to try to prevent the occurrence of any chest infections. You can start this exercise yourself after your operation.
Sit upright in bed or your chair. Take a normal breath in through your nose, allowing the air to flow to the bottom of your lungs, so that your abdomen rises slightly on inhalation. Breathe out through your mouth. Repeat 5 times.
Follow this with 3 deep breaths, allowing your lungs to fully expand to their maximum capacity.
If you hear any secretions in your chest or throat, when doing your deep breaths then try to cough them up.
Repeat another 2 times. Do for 10 seconds every hour.
Continue this exercise daily until you are up and about as normal and your chest is normal ‘for you’.

Please do this exercise on BOTH legs
Exercise 2

Start this exercise yourself, as soon as you can after your surgery. This exercise is very important as it can reduce your risk of getting a DVT. (Deep vein thrombosis).
Lie on your back or sit on your bed or chair.
Slowly move your toes and ankles away from you so that you are pointing your toes, then pull your toes and ankles up towards you – as far as you can.
Moving your ankles up and down like this is more effective at preventing a DVT than moving ankles round in circles. Do for 10 seconds every hour.

Please do this exercise on BOTH legs
Exercise 3

You can start this exercise yourself straight after your operation.
Lie on your back or sit up with your legs out straight in front of you on your bed.
Bend your ankle up and push your operated knee down firmly against the bed. Hold for 5 seconds.
Repeat 4 times, slowly every hour.

Exercise 4

This exercise is important as it helps to provide support
to your new knee by strengthening your quadriceps (at the front of your thigh) muscles.
Lie on your back, or sit up with your legs out straight.
Exercise your operated knee by pulling your toes up, straighten your knee and lift your leg 10cm off the bed. Hold for approx 5 seconds, then slowly relax.
Repeat 2 times, every hour, until you can easily do this and then reduce to 2 every other hour.

Exercise 5

This exercise is very important as you need to ensure that your operated knee can go as straight as possible, to support you whilst you are walking.
Lie on your back, or sit up on your bed, with your legs out straight in front of you.
Place a rolled up towel or an exercise block under your ankle.
Relax your operated leg and try to allow the back of your knee to rest on the bed.
Rest in this position for 2 - 3 minutes every hour.
It will be quite uncomfortable, but getting a straight knee will help to prevent it from giving way whilst you are walking.

Exercise 6

This exercise is important as it helps to get your operated knee moving after your operation.
During your operation, your knee will have been in a flexed, (bent) position throughout most of the procedure. The surgeon will have checked that your knee does fully bend and straighten before the end of your operation.
You now need to work hard to ensure that you can fully bend your knee yourself.
Sit with the heel of your operated leg on a plastic or wooden board or plastic bag.
If you wear a sock, your foot will slide easier and the sock will help to protect your heel from any soreness.
Bend your knee as far as you can, by sliding your foot towards your bottom, along the slippery surface.

When you cannot bend your knee any further with your muscles, place your hands under your thigh to assist you to bend your knee further.
Hold your knee at the peak of the bend for a couple of seconds. This will feel painful.
Take your hands away and slowly straighten your knee. Repeat 6 times, slowly every 4 hours.
Remove the board immediately after completing the
exercises.
This exercise will be very painful. It will be less painful if you try to relax as much as possible whilst trying to bend your knee.

Please do this exercise on BOTH legs
Exercise 7

From the SECOND day after your operation, you can practice this exercise whilst you are sitting in your chair.
Pull your toes up, tighten the front of your thigh muscle on the operated leg and straighten your knee slowly. Hold for approx 5 seconds. Slowly release.
Repeat 6 times, every 4 hours.
When you are sat in your chair, you MUST ensure that your operated leg is placed up on a stool, fully straight at all times, unless you are doing these exercises.
Elevation will help to ease the swelling, which will make your exercises more difficult and could delay wound healing.

Exercise 8
You should also make sure that you massage your knee and thigh firmly in an upwards direction for a few minutes every hour. Do not massage directly over your dressing.

Mobility

As a general rule you will be allowed to get out of bed on the day of your surgery. The ward staff will do this with you. Do not worry if this is not the case for you. You will be told as soon as possible when you will be able to get up. Do not attempt to get up after your surgery without the assistance of the staff.
At first, the Orthopaedic Therapy Team or nurses will help you to get yourself out of bed. You will be shown how to use a walking aid and the correct way to walk. Once assessed by the Therapy Team, you should then be able to walk as frequently as possible with the staff. The aim is to help you regain your independence quickly as possible. ‘Little and often’ in walking and changing position is important. If your walking distance has been limited, it is best to gradually increase your distance and speed.

Do NOT walk on your own until you have been advised that you are safe to do so, by a member of staff.

Make sure that you try and have a short walk with your frame or crutches every hour during the day and the evening.
This will help to promote your mobility and strength and greatly reduces the risk of you developing a DVT. It will also help to reduce the risk of chest infections and pressure sores.
Do NOT walk on your own until you have been advised that you can do so, by the physiotherapists or nurses.
You should also continue to have short hourly walks around your house when you go home. When walking, remember:
FOG: Frame - Operated leg – Good leg
COG: Crutches – Operated leg – Good leg

Stairs

Once you are walking well enough, you will be taught how to manage stairs or a step (according to your needs).
• Take one step at a time
• Going upstairs: use the banister on one side and the crutch/stick on the other side.
• Leading with your non-operated leg first place your foot on the step and then with your operated leg, place your foot on the same step, and lastly your crutch/stick. In the picture below the operated leg is the right leg.
• Going downstairs: use the banister on one side and the crutch/stick on the other side. Place your crutch/stick first on to the step, then your operation leg onto the step and then the non operated leg onto the same step. In the picture below, the operated leg is the right leg.
• Steps without rails or kerbs: as above but use crutches/sticks together.

Getting Ready for Home

The average length of stay for elective total knee replacement patients is 1-2 days. Before you go home, we will make sure you can:
• Walk independently with your crutches/ frame.
• Bend and straighten your knee.
• Get in/out of bed and on/off the chair and toilet by yourself. The aim is to be able to get on/off ordinary heights of furniture as this encourages you to strengthen your muscles and bend your knee.
•Be able to get up and down stairs if you need to be able to manage this at home.
•Do the prescribed home exercises regularly and independently.

A member of the Orthopaedic Therapy Team will refer you for outpatient physiotherapy. Where you are referred to will depend on your postcode, but you will be contacted by the appropriate team once you are discharged. It may be a few weeks following your surgery before you are contacted. Please continue to do the exercises in this booklet until you speak to or see the outpatient physiotherapist.

Medication

You will be given a supply of any new medication that you have started while in hospital. This will include your pain relief.
• DVT Prophylaxis – whilst in hospital you will have started to take medication to prevent blood clots. This will be by tablet or injection. If you are on injectable medication the nursing staff will have assessed your ability to self-inject. If you are unable to do so, they will teach a relative/friend or organise a District Nurse. If you were previously taking warfarin (or similar medications), you should have an anti-coagulant appointment booked prior to discharge. The ward staff will arrange this for you. It is important to take this medication for the prescribed time to help prevent clots forming in the weeks after surgery.
• Antibiotics – If you have an infection, you may be discharged with a course of antibiotics. You will be informed of the course length on discharge. All antibiotics have side effects. If you feel you are unable to cope with these side effects, please contact your GP.
• Pain relief – You will be sent home with a small supply of the pain relief that you have been taking in hospital. You will need to contact your GP to arrange further pain relief prescriptions. Please do this 2-3 days before you are going to run out of medication.

Once at Home

Please remember you have undergone major surgery, and your recovery can take up to 12 months. Everyone heals at different rates, so you may find you are able to carry out some of the activities fairly quickly following your operation. Provided this does not cause you pain or discomfort you can continue with caution.

DOs:
✓ Carry on with the exercises in this booklet.
✓ Take regular, short walks. Increase your distance gradually as you pain and stiffness allows.
✓ Manage the swelling. Swelling can last for several months after surgery. You can help this by regularly elevating your leg.
✓ Wear sensible shoes to limit the risk of falling.
✓ Keep taking your pain relief as you feel you need it.
✓ Keep eating a healthy diet. This will help the healing process.
DON’Ts:
✗ Cross your legs. It can increase your chances of DVTs.
✗ Stay in one position for too long. Regularly moving will prevent stiffness.
✗ Put cushions or pillows under your knee. Doing so can make straightening your knee much harder.
✗ Kneel on your operated knee until you have seen your Consultant.
✗ Do heavy lifting, housework or gardening too early – gradually increase your activity as able.

Daily Activities

Washing and dressing
It is essential to keep your wound dry to reduce the risk of infections. A strip wash is advised initially. Once the wound has healed you may return to your usual regime. You may need help with washing your feet. Do not remove your dressing until you are advised to do so.
When dressing it is advised to dress your operated side first.
Sexual intercourse
We advise that you abstain from sexual intercourse until 6 weeks after your surgery. You will need to take a passive role initially, with your partner on top. Pay particular attention to the position of your operated leg, ensuring that you are not putting excessive strain on the new joint. If you experience pain in the knee, STOP and try again another time.
Exercise and sport
Regular exercise is crucial to your recovery. Walking is excellent exercise for the first few weeks following surgery. Swimming is very good exercise once your wound has been checked and is healed. Speak to you Consultant if you have any specific questions about exercising or returning to sport.

Frequently Asked Questions

When should I start my exercises?
You should start your exercises before your surgery date, during your inpatient stay and should continue after surgery until you are seen by the outpatient Physiotherapy team.
Will I have pain after my operation?
Yes, it is normal for you to have pain after surgery. This pain will improve as you become more mobile. You are likely to need regular pain relief for the first few weeks after your surgery. You will be given some pain relief to take home with you after your surgery. Please speak to the Nurses and Therapy Team on the ward if you’re pain is not well controlled.
Will I be referred for further Physiotherapy?
Yes, a member of the Therapy Team will refer you to the Outpatient Physiotherapy team on the day of your discharge. Where you go is based on your postcode and someone from the appropriate outpatient team will contact you. Keep using your walking aid until someone from the Outpatient Physiotherapy assesses you and says you’re safe to progress.
When can I travel?
Try to avoid long journeys in your immediate recovery period. You will need to speak to your Consultant if you are planning on flying but generally you can fly short haul at 6 weeks postoperatively and long haul 3 months postoperatively.
When can I drive?
Most Consultants suggest 6 weeks. Prior to driving you should no longer be taking strong painkillers. You should try sitting in your car and press the appropriate pedal firmly to see if that causes pain. If you are in pain, it may be too early for you. You are advised to contact your insurance company before you start driving.
Can I sleep on my operated side?
Yes, as long as this doesn’t increase your pain. You should avoid putting a pillow or cushion under your knee as it encourages your knee to become stiff in a flexed position.

Out-patient Appointments

Your out-patient appointments are all from the date of surgery. Your follow-up appointment may be carried out by a specialist nurse, registrar or your consultant. Please note that all follow up appointments will take place at the Orange Reception, Blackpool Victoria Hospital.
If your appointment is not given on discharge, you should receive it within two weeks. If for any reason you do not receive an appointment through the post, please contact the ward that you were on, Monday to Friday, between the hours of 8am and 4pm.
Your ward physiotherapist will also arrange for you to attend outpatient physiotherapy. The physiotherapy staff will discuss this with you prior to your discharge home.

Useful Websites

Other useful information can be found at the following websites;
• www.nhs.uk/
• www.nice.org.uk/guidance
• www.arthritisresearchuk.org/
• www.helpdirect.org.uk/
• www.ageuk.org.uk/
• www.gov.uk/government/publications/the-eatwell-guide
• www.bda.uk.com/foodfacts

Research

Research is undertaken to add to the existing scientific knowledge on a particular subject. There are a number of staff within the Trust who conduct Research studies. It is possible that during the course of your treatment you may be asked to take part in a research study, however, you do have the right to refuse, and this will not affect the care that you receive.

Your NHS Number, Keep it Safe

Every person registered with the NHS in England and Wales has their own unique NHS Number. It is made up of 10 digits for example 123 456 7890.
Everyone needs to use the NHS Number to identify you correctly. It is an important step towards improving the safety of your healthcare.
Always bring your NHS number with you to all hospital appointments or quote it if you need to telephone the hospital for any enquires. This will allow staff to check that they have the right patient details by checking this against your NHS number.
To improve safety always check your NHS Number on correspondence the NHS sends to you.

Ways of finding out your NHS Number

If you do not know your NHS number, contact your GP or local Primary Care Trust. You may be asked for proof of your identity, for example a passport or other form of identity this is to protect your privacy.
Once you have obtained your NHS Number write it down and Keep it Safe.
My NHS Number  

Information Rights and Access

The Trust will keep your information secure and confidential at all times. The General Data Protection Regulation (GDPR) and the Data Protection Act 2018 state that personal data must be processed lawfully, fairly and in a transparent manner. This applies to all personal information we hold about you, whether on paper or electronically.
As a Trust, we ensure that you:
• Are always informed about what personal information we collect about you;
• Understand the reasons for us collecting and using your personal information;
• Are given opportunity to consent or opt-out of your information being collected or used when appropriate;
• Feel confident about how we handle your information;
• Are aware of your rights in relation to your information, including your right of access.

You can find further guidance about how we use your information and your information rights in our leaflet, ‘How We Use Your Health Records’, which is available in clinical areas, and via our Trust privacy notice, which can be found on our website: https://www.bfwh.nhs.uk/privacy-notice-for-our- service-users/

Patient Relations

The Patient Relations Team provides confidential on the spot advice, information and support to patients, relatives, friends and carers. We will do our best to help you to resolve any concerns you may have about the care you received. We can also give you information on the services provided by the Trust.
If you have a concern or there is a problem, the best way to get it resolved is usually to tell someone there and then. If you are on a ward, talk to the sister or charge nurse on duty, in a clinic, talk to the receptionist or one of the nursing staff. If you want to talk to a senior manager or to someone who has not been directly involved in your care and treatment, we can usually arrange this during office hours. You can also ask to speak to a member of the Patient Relations Team.
Staff in any ward or department will be able to contact a member of the team for you, or you can telephone 01253 955589 or 01253 955588. The Patient Relations Team is open Monday to Friday, 9am to 5pm. Outside of these hours there is an answer-phone service.
If you wish to make a formal complaint you can telephone or write to:
The Patient Relations Manager
Blackpool Teaching Hospital NHS Foundation Trust
Whinney Heys Road Blackpool
FY3 8NR
Your views of the service that we provide are important. You can also let us know how you feel by posting your comments on the Patient Opinion website. You can access this from the Trust website; www.bfwh.nhs.uk.uk

Social Media

Along with keeping patients, visitors and staff up to date with news and events on our internet site, the Trust also has 2 Facebook pages and a Twitter page.

Facebook:
• facebook.com/BlackpoolHospitals
• facebook.com/BlueSkiesHospitalsFund

Twitter:
• @Blackpoolhosp
• #EndPJparalysis

Blackpool Teaching Hospitals Charitable Fund

Blackpool Teaching Hospitals Charitable Fund (Registered Charity Number 1051570) aims to further improve the quality of the patient experience and care. The charity relies on the generosity and support of the local community.
If you feel you can help or would like more information please visit our website at;
https://www.bfwh.nhs.uk/blueskies/ or contact our Fundraising Office at;
Blue Skies Hospitals Fund, Fundraising Office,
Blackpool Teaching Hospital NHS Foundation
Trust Whinney Heys Road
Blackpool
FY3 8NR
Tel: 01253 957904
Fax: 01253 957959
Or e mail us at; bfwh.blueskies@nhs.net

Contact information

If your call is connected to an answering machine, please clearly leave your name, date of birth and telephone number.

Further Information

There are some more leaflets available to accompany this booklet for further information regarding your surgery and post op care. They are;
• Coming into Hospital for an Operation
• Analgesia in Surgery – Information for Discharge
• Medication Advice Leaflet
• Stop the Clot
• Constipation in Adults
• Monitoring Surgical Wounds for Infection
• Working Together to Prevent Pressure Ulcers
• Why am I being Treated for M.R.S.A.
• National Joint Registry Leaflet

Acknowledgements:

Wrightington, Wigan, Leigh NHS Trust.
Pictures: BTH Medical Photography Department

We are aware this PDF are might not be accessible to all users. If you would like to request an accessible version, please contact bfwh.trustpolicyteam@nhs.net 

Read our accessibility statement to learn more. 

Author Orthopaedic Department 

Approved by Orthopaedic Directorate Meeting 

Date of Publication 26/03/2026

Reference No PL/434 (v5) 

Review Date 01/03/2029