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Information for patients Discharge Instructions and Advice Following Knee Arthroscopy Under General Anaesthetic Martlesham Ward: Tel: 01473 702290 (24 hour) Raedwald Day Surgery Unit: Tel: 01473 702705 (Mon – Fri, 7.30 am – 8 pm) DPS ref: 04969-16(RP) Physiotherapy advice line: Tel: 01473 702385 (Answer phone service) Issue 2: November 2016 Review date: October 2019 © The Ipswich Hospital NHS Trust, 2016. All rights reserved. Not to be reproduced in whole, or in part, without the permission of the copyright owner. After your operation you will be looked after by the nursing staff on the ward. It is not routine to be seen by a physiotherapist and we advise that you follow the advice given in this booklet unless informed otherwise. You have had an operation under general anaesthetic. Although you will be fit to go home when you are discharged, the effects of the anaesthetic may linger for some hours. You should go home and rest under supervision until you feel fully recovered. It is important that a responsible adult remains with you overnight after your operation. You should not drive, cycle, drink alcohol or operate machinery (including a cooker or kettle) for at least 48 hours from the time of the anaesthetic. Wound care The wound should be kept clean, dry and free from infection until healed. You may remove the bandage and padding after 24 / 48 hours and apply the tubigrip you have been given in a single / double layer thickness. You have adhesive strips (steri-strips) which should be removed in days after the operation. the bath Your stitches should be removed by the practice nurse at your GP surgery 10 days after the operation. You will be seen in Outpatients No follow-up appointment is required. Other instructions Page 2 after your operation. Post-operative advice It is normal for your knee to be slightly sore and swollen for a few days and you are likely to need pain relief to help this settle. It is very important to keep your pain well controlled so you can mobilise (get up and move about) comfortably, perform your exercises and resume normal activities after your surgery. Pain relief You will be given pain relief medication to take at home. It is important that you take this medication regularly and do not wait for any pain to start. Elevation If the knee is swollen, lie down and elevate your leg on pillows for 15 minutes and keep your ankles moving. Repeat this regularly throughout the day but remember that you should not stay in bed. It is important that you ‘potter about’. This will aid your circulation and reduce the risk of developing post-operative complications such as a deep vein thrombosis (DVT). It is normal for the swelling to last 2 – 3 weeks after this operation. Ice After you remove the bandage, ice will help reduce pain and swelling in your knee. Instructions for applying an ice pack at home: • You should ensure that the area to be treated is sensitive to temperature by placing a cold then a warm object against it and making sure you can tell the difference. • Ideally, ice packs should be made from crushed ice, but a bag of frozen peas or a gel pack available from some sports shops will be OK. • The ice pack (or frozen peas) must be wrapped in an evenly dampened towel and not applied directly to the skin, or skin damage due to an ice burn may occur. Page 3 • The pack, wrapped in towelling, should be placed on the knee and wrapped around the joint, so that it covers the entire load-bearing surface. Do not rest the joint or limb on the pack or an ice burn may occur. • The ice pack should be lifted from the knee after 5 minutes to check for adverse reactions. The skin should be red in colour and cool. If it is white and very cold, remove the pack immediately. If no adverse reactions are noted and particularly if the skin is warm and not cold, the pack may be reapplied for a further 10 – 15 minutes. If the skin is in poor condition or the circulation is particularly bad, the pack should be checked every 5 minutes. • Ice packs are more effective when applied on a regular basis for 10 – 15 minutes every 3 – 4 hours, rather than on a once-a-day basis for half an hour. You should be aware that a poorly applied ice pack or one that is left on for too long can cause an ice burn. If you feel pain or intense cold during application of the ice pack, you must remove it and check the skin for signs of loss of circulation, such as: white or purple skin, instead of pink and red. Ice packs used incorrectly can cause ice burns, a form of frostbite. Page 4 Exercises It is important to prevent stiffness and weakening of your leg after your operation and to start your exercises as soon as possible. The strength of the quadriceps muscles (the muscles on the front of the thigh) is vital for knee stability and prevention of further injury. In order to strengthen these muscles and reduce the risk of any associated post-operative complications you should start the exercises below as soon as you are sufficiently recovered from the anaesthetic. The exercises should be performed 3 – 4 times a day. Start with 10 repetitions and build up to 30 repetitions if you can manage them. Exercise 1 Flex your ankle, bring your foot up so that your toes point towards your head, and then extend them to point towards the end of the bed. Repeat with your other foot. Exercise 2 Lie on your back and straighten your leg by pushing the back of your knee onto the bed. Tighten your thigh muscle and pull your toes up towards you. Hold for 5 seconds and then relax. Exercise 3 Lie on your back, bend your knee up and down on the bed slowly. Keep your kneecap and foot facing the ceiling all the time. Page 5 Exercise 4 Lie on your back or sit up in bed. Place a roll (cushion or rolled-up towel) under your operated leg just above the knee. Push your knee into the roll. Pull up your foot, lift your heel and straighten your knee (keeping your knee on the roll). Hold for 5 seconds then slowly relax. Exercise 5 Lie on your back, exercise the operated leg by pulling the toes up, straightening the knee and lifting the leg just clear of the bed. Hold for 5 seconds then slowly lower. Exercise 6 Sit on a chair or the edge of the bed. Pull your toes up, tighten your thigh muscle and straighten your knee. Hold for 5 seconds and then slowly relax your leg. Walking Unless you are told otherwise, you will be able to walk on your leg unaided. You should not need a walking aid (stick or crutches). If walking is very uncomfortable and you are unable to walk unaided then you will be issued with an appropriate aid to use until the knee is more comfortable (usually 2 – 3 days). Page 6 Returning to work Your return to work will depend on your job. In general, if your job involves sitting for the majority of the day you can return after 3 days. If your job is more physically demanding and involves heavy manual handling or standing for long periods then you should discuss this with your consultant or GP. Driving You may start to drive again when your leg is strong, mobile and without excessive pain. Try sitting in the car using the controls while stationary and ensure you are able to perform an emergency stop. We advise you to inform your insurance company of your operation to ensure your cover is valid. Sport You can return to more strenuous activity once your leg is strong and mobile, without excessive pain and swelling. It is advised to gradually increase your level of activity. Competitive sport such as running, skiing, racquet and contact sports can be returned to gradually after six weeks. ***************** You may experience a small amount of discomfort or a minor degree of nausea following your operation. If any of these symptoms are more severe than you would expect or are causing you concern, please contact the ward staff on 01473 702290, or your GP. The NHS 111 service is also available as a source of medical advice and can be contacted by phoning 111. Page 7 Produced by: The Ipswich Hospital NHS Trust Heath Road, Ipswich, Suffolk IP4 5PD Hospital switchboard: 01473 712233 www.ipswichhospital.nhs.uk