Having just had my second knee transplant (sorry, total prosthetic knee replacement) I thought that for this month’s Ten Things I should maybe write a few of the important things I’ve learnt about knee replacement operations.
Ten Things I’ve Learnt about Knee Replacement
I’m taking as read all the usual stuff about operations, general anaesthetics, etc. (like anti-DVT stockings, morphine causing constipation). This is knee replacement specific things. First of all it is important to realise that no two knee operations are the same, so what follows is based on my experiences; yours may be different.

1. There are three key people in a good outcome: a good surgeon, a good physiotherapist and you! Yes, you! A good surgeon and good physio are critical, but it is equally critical that you put in the work at rehab!
2. If you can find out who your surgeon will be, check him (or her) out. If you have a choice, ensure you get someone who specialises in knee replacements rather than a generalist. What’s their track record? How many have they done? The more experienced they are the better.
3. Anything you can do before your operation to strengthen your legs muscles, specifically the quads at the front of the thigh, is going to be helpful in rehab.
4. Before you go into hospital ensure everything is ready at home, especially think about trip hazards: gangways are clear, rugs are stuck down or removed.
5. Get a urinal (maybe two) with a lid – something to pee into in the middle of the night. (They’re cheap and many come with a “female funnel attachment”.) Even with a light on, you do not want to be staggering to the bathroom, on crutches, maybe in pain, barely half-awake, in the wee small hours and while trying to avoid the lurking cats and dogs.
6. Unless you have a “slave” (aka. a partner) to fetch and carry for you, get a good bag (shopping bag size) which you can put over your shoulder or round your neck to carry things around when you’re using crutches.

A typical before and after x-ray; note the realignment of the femur and tibia
7. Post-op your #1 enemy is infection. Ensure no-one (and I mean no-one) touches your operated leg without having visibly washed their hands and are preferably wearing disposable gloves.
8. Do as much as possible to ensure you get a good physiotherapist. Poor, or no, physio is the fastest way to ensure you don’t recover your mobility. Rehab physio will start in hospital; they’ll likely have you standing with a frame and walking a few gentle paces just 12 or so hours after your operation. You will be given exercises to do. Do them – as much as you can through the pain (but stop when it gets too painful). And keep doing them. Make sure you get as much post-op out-patient physio as you can and that your first session is within 7-10 days of leaving hospital; these sessions will help monitor your progress and adjust the exercises to your needs. The physios are not there to be sadistic (though sometimes it feels like it!) but to get you doing the right exercises, the right way, and at the right time, to ensure the best possible outcome.
9. Recovery is painful! Think about what has been done – someone has done around 90 minutes serious carpentry to remove the degraded bone and replace it, very accurately, with some highly engineered metalwork; and that’s all on one of the most complex joints in the body. Discuss pain control with your clinicians; they will prescribe the right analgesics. Although the pain will recede over time, do not expect to be pain-free for several weeks. But a good outcome is well worth the pain.
10. You should be provided with elbow crutches and taught to use them in the day or so after your operation. You will need them for several weeks. Go carefully and don’t get over-confident as this will lead to accidents. On the other hand you should be encouraged to dispense with the crutches as soon as you safely can.

There is a lot more I can say, and I do intend to try to write all this up for the benefit of others. But that will do for now!