Surgeon Tony Smith describes how new techniques have improved knee replacement operations at Shropshire's Robert Jones and Agnes Hunt hospital.

Total knee replacement has changed quite a bit under the new ‘enhanced recovery’ programme.

We have been able to reduce both operating and recovery times by a combination of less invasive surgery, better instrumentation and implants, and the widespread use of the ‘LIA’ technique (local anaesthetic infiltration analgesia).

• Once a decision to operate has been made, the patient will attend the educational Joint school and the pre operative assessment clinic prior to admission on the day of surgery.
• Admission day of surgery, meet the team again and go through a series of safety checks including  confirmation of the side for surgery
• Transfer to the operating theatre – you may be asked to walk there with an escort
• Into the holding bay for further safety checks then into than anaesthetic room
• You will have discussed the type of anaesthetic with the anaesthetist by now, but increasingly we are encouraging a spinal anaesthetic with sedation to keep you sleepy if you wish
•  Into the operating theatre for your operation, including the LIA technique
• After about 1 hour in theatre you go into the recovery bay for further monitoring and back to the ward after 30 – 40 mins
• After something to eat and drink and completion of any i-v fluids you will be got up for the first time for a short walk by the physiotherapist or other member of the team 2-3 hours after your operation
• Day 1 post op you will be up, dressed and sat out for breakfast, then off to the gym for physio, coming back to the ward for lunch and a period of rest. In the afternoon you may do further exercises and at some point go for an x-ray of the new joint.  Patients with a ‘half’ knee replacement may be ready for home
• Day 2 is much the same as day 1 and some patients may be ready for home
• Day 3 more of the same and discharge home if not already gone
• At home you will continue with out patient physio for as long as it is needed, the district or practice nurse will check the wound and remove any clips or sutures.  Most people will be seen by their surgeon in the clinic 6-12 weeks after surgery

Due for review February 2013