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How long does it take to recover from a total knee replacement? A surgeon’s timeline.

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A few weeks ago, Channel 5 aired a documentary called Operation Live: Total Knee Replacement. Did you catch it?

It caused quite a stir, mainly due to its no-holds-barred content. As the title implies, the programme featured live coverage of a patient (his name was Howard) undergoing a total knee replacement at the Royal London Hospital. You can see it on catch-up here (free My5 account required), though do exercise viewing caution, for obvious reasons.

For anyone who works with Total Knee Replacements (TKR) or is considering one, Operation Live was a fascinating watch. It wasn’t for the squeamish. But that was the key take-home point: for all its great benefits, TKR does take significant recovery time. More than many patients realise.

So what does that look like in practice? Keep in mind that recovery times vary from person to person, but here is a general guide.

24 hours

Right before your operation, you’ll be given an anaesthetic to send you to sleep. This is usually done by injection into the spine, and its pain-relieving effects last for about 24 hours. When you wake up, you’ll see your surgeon. Medical staff will be coming in and out to check your progress. Even on Day 1, you’re likely to be practising with crutches and getting in and out of bed. By Day 2, you might venture into the corridor. Your new knee will be fully weight-bearing from the start, though the area will feel very painful.

3 days

Day 3 (or sometimes four) is when most people are able to leave hospital. To be sent home, we need to tick four key boxes: your wound will be dry, your knee can bend to 90 degrees, you can walk with crutches and you can get yourself up and down stairs (again, with crutches). Here and at the Pre-Assessments, you’ll be getting help and tips from the physiotherapy team. They will also give you exercises to do at home over the coming weeks.

2 weeks

On leaving hospital, you’ll be given a two-week supply of pain relief to take home. This is normally a simple analgesic like Cocodamol, taken every six hours or so. By two weeks, however, most people have already stopped taking them. At this point you will come back to the hospital to meet the physiotherapy team again. They will want to know about your progress. They’ll check that you can bend and straighten your knee. They will also give you some more exercises to work on.

6 weeks

At six weeks, we expect life to be returning to something like normality. You won’t be entirely pain-free. The knee will still feel sore. But by now you should be feeling more familiar with your new joint, and you should be going for short walks – ideally without crutches. Six weeks is also the point that most patients are able to drive again. You need to be certain that you can remain in control of the vehicle at all times. (If you’re still unable to drive after three months, you’ll need to inform the DVLA.)

6 months +

For many knee patients, six months is the first key horizon for a full recovery. This is the point where you should feel the benefits of surgery in daily life. That means different things for different people depending on age, fitness and inclination, from pottering about the house to going for three or four-mile rambles in the countryside. Even then, however, there’s scope for progress. The Oxford Knee Score, a questionnaire that tests pain and function after knee replacements, demonstrates that patients often continue to improve for up to two years after the operation.

Interested in finding out more about Knee Replacement and how you can improve recovery times? We are always happy to meet with patients to offer advice, direction and support. Why not get in touch? We’d be delighted to hear from you.

Preparing for major surgery: 11 things to do now

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You’ve booked the operation – or you’re ready to. You’ve pencilled the dates in your diary. You’ve even thought about setting the Sky+ for Neighbours while you’re away. So what next?

Actually, there are quite a few things to think about when planning for a major surgical procedure. Some of these will be covered in your Pre-Assessments, where you can ask questions, meet the physio team and get coaching on your procedure at a so-called ‘joint school’.

Others things may not be so obvious. So meet the Pre-Surgery Checklist – a quick guide to some of the things you may like to consider before your operation. With surgery, it always pays to be prepared.

Sort your backup

The first days after surgery can be tough. Following a major operation like a knee replacement, you’ll need home help for the first fortnight: think dressing, cooking, cleaning, putting the bins out. If you don’t have a partner or family member to do that, think about hiring a care assistant, or even booking into a rehabilitation centre. Your GP will be able to help with local contacts. The NHS has some useful resources, too.

Stock up

Getting around the kitchen – let alone the shops – will be difficult after surgery. So consider planning meals in advance, or popping some in the freezer beforehand. Make sure you’re prepping a well-balanced diet: your body will need plenty of fluids, protein and calories as it recovers.

Be bed-ready

We generally don’t advise people to bring their bedroom downstairs after surgery. Just check that your bed is easy to access. Very low beds can be hard to get out of after knee surgery. If that’s the case, you might consider adding a temporary extra mattress to raise the height.

Focus on downstairs

While the physiotherapy team will help you practise getting up and down stairs with crutches after surgery, you won’t want to be going up and down like a yoyo. Plan to have your essentials downstairs for the daytime. Consider hiring a commode if your only bathroom is upstairs.

Clear the floors

Slips, trips and falls are by far the most common cause of injuries at work. And what’s true at work is even more true at home. So do a domestic health check: pay special attention to loose carpets and rugs. Move or remove any objects that impede your paths through the house (like that handy new robot vacuum cleaner).

Get a grip

Shoe grips, that is. We often ask patients to think about their footwear before they have surgery. It sounds like obvious advice, but a pair of slippers with grip on the undersoles can drastically reduce the risk of an accident when you’re less steady on your feet.

Keep a phone handy

In the early days of recovery, you’ll be less mobile. But you may not always have someone around to help if you get stuck. Keeping a mobile phone close to hand – and a portable battery charger for when it runs out – gives you backup in case of an emergency.

Consider a dosette box

Generally, the only tablets you’ll leave hospital with are short-course anticoagulants and pain relief (such as Cocodamol). But if you already take pills and supplements for other conditions, they soon stack up. A dosette box (or pill organiser) with clear labels and slots will keep you on top of them.

Think smart

Up to a third of us are now said to own a smart speaker with voice assistant. While we wouldn’t want to offer ourselves as a personal shopper for Google and Amazon, it’s easy to see how hands-free devices might be helpful to a recovering patient. Just bear in mind that regular movement is important for recovery, to encourage blood flow and build muscle strength. So switching lights off the traditional way is no bad thing.

Remember Rover

If you own a pet – particularly a dog – make sure you have someone to look after them while you’re in hospital, and when you’re back home but unable to get out and about. You might want to consider kennels for a few weeks, or a local dog walking service.

Treat yourself

It’s easy to get bored when you’re inactive – particularly if you find yourself up in the middle of the night, unable to sleep. Try turning the time to your advantage by devoting it to something you’ve always been meaning to tackle – a learning project, some good books, a DVD box set, or even that 500-piece jigsaw puzzle.

We hope you found this list helpful. If you have any thoughts or tips of your own, why not drop us a line on Facebook? We would love to hear from you.

When surgery isn’t the answer: a guide to conservative knee treatment

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“You don’t have to have surgery.”

Six words you might not expect to hear from an orthopaedic surgeon! But it’s true: when it comes to serious knee problems, surgery isn’t always the answer.

In fact you might be surprised to learn that it’s usually not the answer. Of all the patients we see here at Chris Bailey Orthopaedics, roughly 60 to 70% will end up being treated conservatively – that is, without surgical intervention.

Why would we avoid surgery? There are several reasons. Firstly, it’s invasive. It takes time for your body to recover from it. So it follows that surgery shouldn’t be undertaken lightly. Sometimes the surgery is right but the timing’s wrong – if you’re struggling with a serious illness, for example. And sometimes we can achieve a similar, or even a better, outcome by using other options.

So what are the alternatives to knee surgery? Here are five.

Pain relief

With pain medication, we’re aiming to relieve the symptoms of a knee problem. If that problem is reversible – an injury, say – it can buy time. We can use it to let the body heal itself naturally, or wait to see how the injury develops before moving to treatment. If the problem is arthritis, it’s more about managing those symptoms to make life more comfortable. Pain relief comes in a kind of ‘ladder’, starting with over-the-counter medicines like ibuprofen (which is also an anti-inflammatory) and paracetamol, before progressing to more powerful codeine-based drugs, and finally opiate medications or analgesics for nerve pain.

Injections

We can also treat knee pain with injections into the joint. There are two main types. Corticosteroids reduce inflammation, targeting the swelling and friction that worsen pain. This can be a big help with arthritis, particularly if you are prone to acute flare-ups. The effects generally last from six to 12 months. Hyaluronic acid injections aim to supplement the level of this naturally-occurring molecule in your joint. Think of it as a gel rather than an acid. Its chief function is to provide lubrication – and injecting it may therefore help to reduce pain and inflammation.

Braces

Some knee problems are best treated with supports. Here the idea is to help the healing process by easing pressure away from the problem area. If you’ve had a ligament injury, for example, we might recommend a brace to provide extra stability to your knee; there are various types depending on the instability involved. If you have a malalignment problem, an ‘offloader’ type brace can encourage the joint to move differently, shifting your bodyweight away from the damaged area.

Physiotherapy

Physical therapy can be particularly helpful if your knee pain is related to a muscle issue. Weakened muscles provide less support to the joint which, naturally, increases pressure on the knee. A good physiotherapist will show you build up leg muscles – like the quadriceps, for example – in just the right way. Over time, this can help to increase stability and reduce stiffness.

Supplements

Our osteoarthritis patients often ask us about supplements. They are usually thinking about things like glucosamine and chondroitin sulphate, both of which are naturally present in knee cartilage. Adding them to your diet sounds logical, but the science is inconclusive. Studies have tended to show limited or no effectiveness in improving pain relief or joint damage. Having said that, around one in five patients who take a supplement tend to report some benefit. For that reason you may feel it’s worth a try. If you see no benefit after six weeks, it’s probably not worth continuing.

Keen to find out more about non-surgical options for your knee treatment? This blog is just a small part of the picture. If you’d like to discuss the alternatives in more detail, we would be very happy to help.

(Not) making the cut: five alternatives to shoulder surgery

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When it comes to persistent shoulder problems, surgery is often the only option: true or false?

If you’re new to orthopaedics, the answer might surprise you. Essential surgery is actually very rare for shoulders. Perhaps only one percent of the issues we see at Chris Bailey Orthopaedics is an unavoidable case for the operating theatre.

The main reason for this is that shoulder injuries rarely threaten life and limb – thankfully! Which means that shoulder surgery is usually elective. We lay out the options. You choose the one that feels best for you.

Now, sometimes surgery may actually be the best option. Or we may highly recommend it. But the good news is that there are usually conservative alternatives.

So what are they?

Changing habits

The first port of call for shoulder treatment is activity modification. Many shoulder issues are caused by repeated actions – particularly overhead movements. If you’re a pace bowler for the England cricket team, this will be obvious. But the same applies to more prosaic tasks like painting and decorating, or even that weekly session at the tennis club. Pressing pause on repetitive strains – without giving up movement entirely – gives your shoulder respite while we assess the next steps.

Physical therapy

Since shoulders are generally more about movement than weight-bearing (unlike knees [insert link to “When surgery isn’t the answer: a guide to conservative knee treatment”]), physiotherapy can be particularly effective. What we’re looking for is a good balance of movement between the ball-and-socket joint and shoulder blade; the correct ratio is two-thirds ball-and-socket to one third shoulder blade. A physiotherapist can help you with exercises that strengthen your muscles and improve your range of movement.

Pain relief

Pain-relieving medication (analgesics) makes life more comfortable while your body attempts to heal itself. This can give us time to see whether your issue will settle, or require intervention. There’s a ‘ladder’ of pain relief. At the low-strength end are over-the-counter drugs like paracetamol and ibuprofen. Next come codeine-based products like Cocodamol, followed by stronger opiate-based drugs. Depending on the issue, we may refer you to a Pain Team for specialist treatment.

Injections

Injections can be very helpful for shoulder pain. In fact sometimes we find that they are all that’s required to resolve an issue entirely. There are two major forms: corticosteroids and hyaluronic acid. Steroids target inflammation, reducing the swelling that causes rubbing within the shoulder. Hyaluronic acid is a lubricant that occurs naturally in the body; injecting it into the shoulder can help to reduce pain and inflammation.

Supports

Slings and braces are more effective in healing certain injuries than we used to think. One recent trial on patients with proximal humerus fractures – one of the most commonly-broken bones in the body – found that wearing a sling was just as effective as surgery in terms of outcome. Mobility is important, in order to avoid ‘stiffening up’ through lack of activity. But providing a little protection in the early stages of a shoulder injury can be beneficial to the healing process.

Keen to find out more about non-surgical options for your shoulder treatment? This blog is just a small part of the picture! If you’d like to discuss the alternatives in more detail, we would be very happy to help.

Winter Primer: 5 simple tips for cold-weather exercise

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So autumn is setting in again… how’s that exercise regime coming along?

Let’s be honest – when it comes to cold-weather exercise, most us feel pretty bearish. That is, the shortening days and plunging temperatures often make us want to find a cave and re-emerge in April.

Perhaps I’m an exception here, because I quite enjoy exercising in the cold. For one thing, it’s usually easier to warm yourself up on a freezing run than it is to cool down on a scorching one.

Not all of us feel that way, of course. But year-round exercise is important for our health. For our joints, our muscles and our all-round wellbeing. It’s just a case of approaching it in the right way.

Start warm, stay warm

No-one’s body relishes going from 0mph in a centrally-heated hallway to 60 in a howling gale two seconds later. Running in cold weather generally feels more comfortable when your muscles have had a 10-minute warm-up beforehand. So do a little stretching or jogging on the spot before you turn up the speed dial – even before you leave the comfort of the hallway.

Get the gear

If you have any spare change in the piggy bank, now might be a good time to reassess your sporting wardrobe. Go for the pro-runner’s layered approach rather than heading out in the closest available thick woolly jumper. Layers of clothing gives you more flexibility as the temperature fluctuates. Also remember reflective straps if you’re intending to run anywhere near a road as the day darkens.

Plan your route

Regular routes lull us into a false sense of familiarity. When the weather changes, the conditions can change quite drastically. So plan ahead. Find a route that avoids the worst of the uneven ground, or boggy spots that will have you vaulting into the unknown every two minutes. For grass-based sports like football and rugby, remember that softer ground has an effect on studs. ‘Planting’ – where the foot sticks in the turf – is one of the most common causes of twists and wrenched joints.

Mix it up

Running on uneven ground isn’t necessarily a bad thing. In fact it can help to build up different kinds of muscles – and our body’s proprioception, that natural ability to maintain joint balance and equilibrium as the environment changes around us. Bear this in mind if you’re planning to switch from very firm and even conditions (like a treadmill) to off-road running. If you rarely run on bumpy courses, build up to them gradually.

Keep going!

Cold weather can be a motivation killer. But try not to be cowed by it. Turn it to your advantage. Remember that exercise improves energy levels and our overall sense of wellbeing – no small thing if winter often leaves you feeling low and gloomy. Getting into the sunlight also allows our bodies to make the ‘sunshine vitamin’, Vitamin D (recent studies have shown that a lack of Vitamin D is linked to muscle pain). And there’s the calorie factor: we burn more energy in cold conditions as our bodies work harder to keep warm. More impact for the same effort: a payoff that even the most bearish of bears might well appreciate.

Looking for more running tips? Read our blog post on preparing for marathons.

Looking for the right consultant? 6 things you need to ask first

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So you know that you need to see a consultant. OK – but what next? The rise of patient choice has been a good thing for the healthcare industry. But that doesn’t mean it’s easy to find the right doctor for your own particular needs. So how should you approach it? Here are six things that, I think, can help.

Phone a friend!

(Or a friend-of-a-friend.) When it comes to decision-making, there’s nothing quite like a personal endorsement. One recent survey found that around 80% of diners base their restaurant choices on word-of-mouth tips. And if finding the right pizza is important, how much more a medical consultation? So ask around. Have friends faced the same issue recently? Were they happy with their treatment? Would they use the same consultant again? Your GP is an important source of advice, too. They will be familiar with surgeons in your area through correspondence and feedback. They may not have been in the clinic or theatre with them, but they’ll know their reputation.

Go online

However you feel about the Internet, its impact on choice has been seismic. Now we don’t have to fish around endlessly for information about doctors. We can find it with a few clicks. Independent review sites like iWantGreatCare can give real insight into consultants from former patients (here’s my page as an example). Read a few and you soon get a sense of that person’s strengths. Complement the reviews by visiting their personal website, if they have one, or by visiting the National Joint Registry , a government-endorsed site that collects key data about hip, knee, ankle, elbow and shoulder joint replacement surgery and implant performance.

Consider location

If you’re facing surgery, where will your operation take place? Hospital quality isn’t always the first thing that springs to mind when searching for a consultant. But it’s important for your overall care. Once you’ve learned where a consultant is based, you can find out more about the hospitals they work in. A useful resource for the private sector is the Private Healthcare Information Network (PHIN), a government-mandated organisation that collates information and customer satisfaction for hospitals across the UK.

Look for responsiveness

You should always feel comfortable making first contact with a consultant. And I think you can gather some insight from their reply. Do they respond to your questions clearly and promptly? A swift, helpful reply is part of what it means to provide a good service. But it also suggests a consultant who values your time and – hopefully – takes an interest in you and is motivated to help you get better.

Check for experience

You can find out how practised a consultant is simply by asking them. If they’ve performed a particular operation several thousand times before, for example, it’s likely to be a good, successful procedure. But they should be able to expertly judge your suitability for an operation, too. Timing is important in surgery. If a consultant thinks it would be better to wait and use non-surgical alternatives, they need to say so. That kind of decision comes with experience – experience of both conservative and operative care.

Prioritise trust

This could go right to the top of our list. But let’s end with it here to reinforce the point. Trust is so important when it comes to medical advice, because that doctor is taking your future in their hands. So make sure he or she is a good listener. Someone who will sit down with you and answer your questions and concerns. Many fears and anxieties can be allayed by clear communication. And having a rapport with your consultant helps achieve that. At the end of the day, you’re not a statistic – you’re a person! So make sure your consultant is someone you feel comfortable with.