Most people we interviewed were very happy with the care they got in hospital from doctors, nurses and physiotherapists. For some, the process of being referred to hospital was the most difficult part as it was sometimes slow. Once participants had seen a consultant and decided to have surgery, the next appointment was usually the pre-operative assessment.
The pre-operative assessment
At this appointment routine medical tests are carried out, including blood tests, a urine test and an ECG to record the electrical activity of the heart.
A doctor explains what happens at the pre-operative assessment.
This video explains more about the pre-operative assessment:
Many people described the pre-op assessment as very efficient and well organised. They recalled having lots of tests, one after the other, several noting that there was very little waiting around. Participants felt prepared for the appointment because they’d been sent a letter beforehand telling them the appointment date, how long the appointment would be and the tests they’d have.
Helene describes what happened at the pre-op assessment. She saw lots of different professionals and had lots of tests. It was all very efficient.
Joan said that all the health professionals she saw at the pre-operative assessment were “really, really nice”. Helene felt that medical staff were “fantastic” and Lesley that they were friendly and “had time for you”.
Jennifer saw the consultant, physio and various nurses at the pre-op assessment. It all went well and she felt she had excellent service.
Alice said that, although she had lots of tests done, she would have liked more feedback on the results. Reassurance that everything was normal was important but she felt that she’d been told very little. A few people said that their tests highlighted a problem so surgery was postponed until the matter was resolved. Peter’s tests showed that he had high blood pressure and he had surgery 2 weeks later than planned:
Hearing that he had high blood pressure was disappointing. Peter’s GP prescribed tablets and his blood pressure went back to normal.
Most people we interviewed praised the staff who cared for them while they were in hospital. They talked positively about the different professionals they saw, including consultants, physiotherapists, nurses and anaesthetist. Like many people, Phillip felt that the nurses he saw in hospital were lovely and that he couldn’t fault the care he was given. For Nancy, aged 81, “everything was wonderful” both times she had partial knee replacement surgery and Jacky, a 51-year-old, felt that all the staff were “fantastic”.
The health professionals couldn’t have been better. They were attentive and Penelope thought the hospital was excellent.
Keith, aged 71, noted that some nurses were better than others and described the difference:
Some of the nurses said they’d do something to help but didn’t come back. The good nurses paid attention to you as a person.
Helene and Alice felt that health professionals should focus on the whole person, not just specific problems, because patients may be living with other conditions as well. A few people were disappointed when their surgery was postponed. Alice, who had a cold, asked several professionals if her surgery would still go ahead, but it wasn’t until she saw the anaesthetist that she found out it wouldn’t. She had fasted, was in her hospital gown and had even had arrows drawn on her knee.
The anaesthetist advised against surgery because of Alices cold. She arrived at the hospital at 7am, left at 8am and went back to work.
Hugh’s surgery was postponed three times. He couldn’t understand why and contacted a patient advice service for help.
Most people went home the day after surgery or a few days later and had no need to contact the hospital again, only going back for a routine follow-up appointment. A telephone number was often provided in case there were problems, though people were sometimes reluctant to call the number as they didn’t want to bother busy medical staff. Peter was glad that he could phone the hospital for advice when he first came home because he was in a lot of pain. He wasn’t told that he should have been taking codeine as well as paracetamol when he left hospital.
A few other people said they hadn’t been given enough painkillers when they were discharged and had to get a prescription for more. They felt that health professionals should check the medications carefully before discharging patients. Some people didn’t know who they should contact if they had any concerns at home and hadn’t been given a telephone number. Lesley was given a contact number and, when she had hip pain, she spoke to the physiotherapist who reassured her that it was nothing to worry about.
Information about the exercises to do at home was a major concern for many people (see Information about exercises for knee replacement), as was seeing a physiotherapist shortly after surgery. Although they’d been given a booklet of exercises to do at different stages, some people were unsure if they were doing them correctly. David would have liked a physiotherapy appointment 3 or 4 weeks after surgery so he could find out if he could progress to more challenging exercises or if this would damage his knee.
Some people were very sporty before their knee problems and felt that a physiotherapy appointment tailored to their particular needs and goals would have been helpful. They had wanted to progress but were wary of doing so without consulting a professional first.
David couldn’t tell how well he was progressing. Seeing a physio would have been reassuring. He felt wary of phoning the hospital.
Keith felt strongly that people who have partial knee replacement surgery should have physiotherapy afterwards, and ended up seeing a physiotherapist privately.
Regular physiotherapy should be part of the recovery process. Keith feels it’s wasteful’ of NHS resources to have expensive surgery and no physio afterwards.
Some people were very disappointed to learn that, despite the good information and care they’d got in hospital, there was “no aftercare”. Helene would have liked to see a physio about a month after surgery and had no idea how well she was progressing.
The hospital was fabulous’ but there was a black hole afterwards. Physio one month after surgery would have helped Helene know if she was healing well.
A doctor talks about the importance of exercise during recovery. It’s difficult to damage the knee unless someone has a very bad fall.
Geoff wondered if people could be offered physiotherapy locally after surgery, and Janice felt group exercise classes at the hospital might have been helpful. Like several participants, she felt that physiotherapy would have motivated her and helped her to stick to the exercises when she was mobile again.
Geoff would have liked physio before going back to work. He would have been happy to have it locally and pay a small fee towards the costs.
It’s a shame not to have physio after surgery. Having a specific time to exercise would help, including drop-in or group classes for knee surgery patients.
Managing alone can be difficult for people who have had surgery. Helene, who lived on her own, said she would have liked support from a district nurse in the first couple of weeks after surgery. Such support was discussed with Hugh, aged 61, who was home alone during the day, but it never happened. Getting in and out of the bath was challenging, as was cooking, cleaning and doing the shopping. Friends and his son helped.
It was frightening getting into the bath to have a shower. Helene kept her phone nearby in case she fell. District nurse support would have been helpful and encouraging.
Having and recovering from surgery can be particularly concerning for people who care for relatives. Keith praised medical staff at the hospital who organised his operation date around his wife’s care. She has a degenerative disease and he is her main carer. Carers looked after Keith’s wife while he recovered.
Keith discussed his situation with the physio and surgeon. Moving his wife from chair to wheelchair would be impossible when hed just had surgery.
The follow-up appointment
Most people were unsure what would happen at the follow-up appointment or who they’d be seen by.
A doctor explains what happens at follow-up and who to contact if there are knee problems after that.
Having follow-up sooner rather than later was often important and, while some people were told it would be 6 weeks after surgery, several had an appointment 8 weeks after surgery, which they felt was too long a wait. They would have liked it at 6 weeks as they were concerned about how their knee was healing. David was given a follow-up appointment at 12 weeks and, when he queried this, it was changed to 8 weeks. He felt anxious about waiting 12 weeks and wanted reassurance that his knee was recovering normally. Helene was disappointed that there was no follow-up until 6 weeks and felt that patients are “left on your own” after surgery:
The care before and in hospital was fantastic. Helene had her dressing changed at the GP surgery so a professional could give feedback on her progress.
David, like a few people we interviewed, didn’t know what would happen after the follow-up appointment: