The people we interviewed got information from many sources, including health professionals, the internet and others who’d had a partial knee replacement in the past (see Sources of information on knee replacement).
Some said that they had all the information they needed from health professionals, often describing it as excellent and informative.
David said that his questions were always answered and Geoff that the care and information he got was “first class… like going private” (see Views and experiences of healthcare from people who had a knee replacement).
The doctor explained to Phillip why he needed surgery, which hes had to both knees. Medical staff made him feel at ease. He recovered quickly.
Other people appreciated having leaflets and videos to watch but would have liked to know more. Sometimes the information they needed was in the leaflets they’d been given but not on the technology-enhanced patient information (TEPI) videos they could watch at home, and they felt that it should be available in both formats. Some people felt that the TEPI videos were very informative but could have been improved by including a bit more detail.
Information before surgery
The information that people felt was missing before going into hospital focussed on:
- the pre-operative assessment
- the cleanser, Hibiscrub
- waiting around on the day of surgery
- having anaesthetic
- using bedpans
- length of stay in hospital and what to take in
Several people felt that watching the TEPI videos about the pre-operative assessment before the actual appointment would be helpful. Although they’d got a letter from the hospital with details about the appointment and who they’d see, having a web address for the videos at the end of the letter would have been useful.
Lesley wishes shed taken someone with her to the pre-op assessment. She was given a list of professionals shed see but would have liked to watch the video beforehand.
A few people felt the TEPI videos should have mentioned that they would need to bathe in Hibiscrub before they came to hospital. Hibiscrub is an antimicrobial skin cleanser that can be used at home. It is a proven antiseptic, antibacterial and disinfectant that is effective against a wide range of bacteria, viruses, yeasts and some fungi. It is also effective against MRSA.
On the day of surgery, some participants were told to come to hospital at 7am but weren’t seen by medical staff until the afternoon. They wondered why and felt that they should have been warned that this might happen and the reasons for it.
Most were given general anaesthetic before the operation so that they would sleep through it. A few who had other medical conditions said they were given a spinal nerve block and would have liked to have known more about this beforehand.
A doctor talks about general anaesthetic and a spinal nerve block.
Lesley, who had a nerve block, was worried why she couldn’t feel her legs when she came round. When the anaesthetic wore off, she could move her toes and felt fine.
Several women we spoke to were surprised that they had to use a bedpan when they first needed the toilet after surgery. One woman advised older women with mild incontinence to take protective pants (e.g. Tena pants) with them if they were worried about leaking or not getting to the toilet on time.
Janice felt a bit tearful after surgery and having to use a bedpan came as a big shock. It was fine after the first time, and the physio got her up the next day.
A few people were unsure how long they’d spend in hospital. Alice was told she’d leave the day after surgery but ended up staying a few days. Had she known, she’d have brought more clothes with her. She was also unsure what shoes were most suitable for exercising in. Most people go home the day after surgery if they feel well enough and can show the physiotherapist that they can climb the stairs and manage at home.
If Alice has knee surgery again, shed take more clothes in case she stays longer than expected and shoes she can slip on easily before exercising.
Information about recovery
Most people left hospital with painkillers, injections to prevent blood clotting, stockings to prevent deep vein thrombosis and a booklet of exercises to do at home. Many wanted more information about these, especially exercising (see Information about exercises for knee replacement).
Some people wanted to know more about the anticoagulant injections they’d have to give themselves once they were home again. An anticoagulant is a medication that helps to prevent blood clots. It is often taken as a pill, but is sometimes given as an injection. The injection should be given in the fatty areas at the sides of the waist. This was usually for about 2 weeks.
Lesley didn’t realise she’d have to have them for so long, and Helene didn’t know about the injections until she was leaving hospital. Janice felt it would have been helpful to have more information about them on the videos as well as in leaflets. Because she has a blood clotting disorder (factor V Leiden), she had to have the injections for 6 weeks.
Janice was shocked to learn that shed have to inject herself every day at home. She hated having the injections and dreaded doing them in the evenings.
A doctor explains why injections are needed and how to do them.
Knowing how to manage the knee pain was also important to several people, who said they’d been told by the physiotherapist to manage it themselves with the painkillers they’d been given. However, they were unsure what this meant. Others felt that it would have been helpful to know beforehand that they would be taking lots of strong painkillers every day for a few weeks.
Peter was in a lot pain for about 2 days and couldn’t sleep. He wasn’t told when he left hospital that he should be taking codeine as well as paracetamol.
Geoff was only given a week’s worth of painkillers. He phoned an emergency number to get a prescription for more but was unsure how long to take them for.
Peter took painkillers for knee pain for around 10 years. Being self-employed, he’d felt unable to take time off work so had been taking painkillers prescribed by his GP. Geoff said he weaned himself off a painkiller called tramadol and was unprepared for the side effects he got.
Peter delayed having surgery until he retired because of the time hed need to take off work. Hes been taking painkillers for a long time and plans to wean himself off.
Geoff was unsure how long to take tramadol. When he was weaning himself off, he felt hot, shaky and couldn’t sleep. It took 1½ weeks.
Painkillers are given to all patients when they leave hospital, usually paracetamol and codeine.
A doctor talks about pain relief and how to manage it.
Sleep was another concern for some people, who said they’d been told little or nothing about how their sleep patterns might be affected. Lesley found it hard to sleep when she first came back home and said it would have been helpful to know how long this would last. Janice couldn’t sleep for about a week but Keith said his normal patterns still hadn’t returned 12 weeks into recovery.
Keith kept waking up because of knee pain. His GP prescribed sleeping tablets for 10 days. Other people he spoke to also had disrupted sleep after surgery.
A doctor talks about the effects of surgery and medications on sleep.
A few people wondered how long they were meant to keep the plaster on their knee to avoid infection, and how long to wear the stockings. People recovering from partial knee replacement should wear the stockings for 6 weeks.
Geoff would have liked to know more about looking after the wound, preventing infections and how long to wear the stockings.
When asked how long the knee replacement would last, many people were unsure. Some said they would ask at the follow-up appointment but others mentioned that they weren’t told. Penelope asked other people she knew who’d had a knee replacement and was told it would last around 10 years.
A doctor talks about how long a partial knee replacement usually lasts and the timing of surgery in terms of age.
The follow-up appointment
Many people we interviewed were unsure what would happen at the follow-up appointment or who they’d be seen by, some saying they’d have liked to have watched a TEPI video about follow-up (see Views and experiences of healthcare from people who had a knee replacement).
Some wondered whether they’d have X-rays or physiotherapy and others wanted to ask about having the other knee replaced, something they’d discussed with the consultant at previous appointments.