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Orthopaedic AHP Therapy

Introduction

This booklet gives you information about hip arthroscopy. It will explain what will happen when you come into hospital, what to expect before you go home and when you are at home. The success of the operation is a team effort including doctors, nurses, physiotherapists but most importantly you.

Please note that your aftercare and rehabilitation will vary depending on what you have done to your hip during the operation and also on your surgeon’s wishes.

Next: Who may be suitable for a hip arthroscopy?

What is a hip arthroscopy?

A hip arthroscopy is a surgical procedure where we look inside the hip joint uisng a small camera on the end of a flexible tube (an arthroscope). This allows the surgeon to see any problems in the hip joint. The surgeon can then use small instruments to treat some of these problems if appropriate. Hip arthroscopy can help with the following problems:

• Labral tears

• Hip impingement

• Damaged cartilage

• Loose bodies in the joint

Next: What to expect

What to expect

The Operation:

You will have a general anaesthetic which means you will be asleep. The operation usually takes 1 to 2 hours. We use a special table to access your hip joint. This moves the joint a little further apart and allows space to insert the arthroscope. The surgeon will make 2 to 4 small cuts around your hip area. They will insert the arthroscope and any instruments needed to treat your hip through these cuts.

The Wound:

Sometimes we stitch the cuts but not always. We will cover them with a sterile dressing. Usually the nursing staff change this dressing if you stay in overnight, however if it is dry and intact they may leave it. We will give you dressings to take home with you. The nursing staff will discuss this with you on the ward.

Pain Control:

We will inject some local anaesthetic into the joint and around your cuts to help reduce the pain when you wake up. We will also give you pain killers. It is important to let a member of staff know if you are sore so they can give you something to help.

Discharge (Going Home):

Most patients go home the day after their operation but some people go home the same day. This depends what time you are back on the ward and how you are feeling.

Next: Complications

Complications

After a hip arthroscopy it is likely that you will have some muscle bruising and swelling around the hip and thigh. As with any surgical procedure there is a small risk of other complications. These may include:

  1.  Difficulty passing urine or having a bowel movement after the operation.
  2.  Problems with the anaesthetic or development of an acute medical problem (clarify).
  3.  Wound Infections: If you notice a change in the area around your wounds and they become red, very hot and swollen, or if you develop any discharge from your wounds please see your GP as soon as possible?
  4. Blood clots in your calf are known as a DVT (deep vein thrombosis):

• You may go home on aspirin to help prevent this however the best way to reduce the risk is to do the exercises in this booklet regularly and by moving around.

• If you experience pain and tenderness in your calf and it becomes hot and swollen please see your GP.

    5. Blood clots in your lung known as a PE (pulmonary embolis):

• If you experience a sudden shortness of breath which is unusual for you please see your GP.

    6. Damage or bruising to a minor nerve leading to numbness or tingling in your thigh, groin or genitalia.

    7. Damage to the major blood vessels or nerves around the joint or the joint itself.

Next: Physiotherapy

Physiotherapy

You will normally see a physiotherapist before you go home. They will show you some exercises to help keep the muscles around your hip strong and to get the hip moving. These exercises are shown in this booklet.

We will give you elbow crutches to help you walk after the operation. You may be able to take as much weight as you feel able to through your hip (fully weight bearing) but we will often advise you to take some weight off the hip by leaning through the elbow crutches (partial weight bearing). This will depend on what treatment you have done and on your consultant’s wishes. For example if you have a simple labral tidy up you will usually be able to fully weight bear. However if you have a more extensive procedure such as microfracture on your joint surface we will normally advise you to take minimal weight through your hip for 4-6 weeks. The physiotherapist will advise you how much weight to take through your hip and how long you will need to use your elbow crutches.

We will show you how to go up and down stairs before you go home.

Your physiotherapist is likely to refer you to your local physiotherapy department for ongoing rehabilitation and in some places they may refer you for hydrotherapy (rehabilitation in water). This will depend on where you stay and on your consultant’s wishes.

Next: Exercises

Exercises

1. Ankle pumps: Pull your ankles backwards and forwards and circle them around. This increases the blood flow in your legs and helps prevent clots forming.

2. Static Quads: Point your toes to the ceiling. Press the back of our knee against the bed tightening up the muscle at the front of your thigh. Hold for 5 seconds then relax. Repeat 10 times.

3. Static Gluts: Squeeze your bottom muscles together. Hold for 5 seconds then relax. Repeat 10 times.

4. Static Hamstrings. Dig your heel into the bed as if trying to bend your knee. Hold for 5 seconds then relax. Repeat 10 times.

5. Hip Flexion: Bend your hip and knee up and down. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg up. Do 2 sets of 10.

Following some procedures this movement may be restricted for 4-6 weeks. Your physiotherapist will advise you if this is the case.

6. Hip Abduction: Bring your leg out to the side then back in again. You might find this easier at first if you hook a scarf around your foot and use this to help pull your leg out to the side and back in. Do 2 sets of 10.

It is important to do these exercises regularly. We advise you to try and do them 4 times a day or even a set of 10 every hour or two.

 Next: Going Up and Down Stairs

Going UP and Downs Stairs

If a handrail is available then always use it as well as one crutch. Your physiotherapist will teach you how to carry your other crutch up the stairs as you will need it when you get to the top.

Going up stairs:

1. Place your un-operated leg up onto the step

2. Lift your operated leg onto the same step

3. Bring the crutch up onto the same step

Going down the stairs:

1. Place your crutch down onto the step below

2. Step down with your operated leg

3. Bring your un-operated leg down onto the same step

 Next: General Advice Following your Hip Arthroscopy

General Advice Following your Hip Arthroscopy

Ice:

This may help with pain and swelling around the hip or thigh area. Wrap an ice pack or a bag of frozen peas in a towel and rest this on your hip or thigh area. Do not leave on for any longer than 20 minutes at a time.

Pain Relief:

We will usually give you a 7 day supply of pain killers to take home with you and can get more from your GP if necessary once these run out. If you experience more pain when you go home and do not feel the pain killers are helping, please see your GP.

Wound Care:

If you have stitches you will need to visit your practice nurse 10-12 days after your operation to have these removed. The nursing staff will discuss your wound care with you before going home.

Rehabilitation:

It is important to do the exercises in this booklet regularly to prevent your hip becoming stiff and weak. Most patients are referred for physiotherapy locally once they are home. The length of time you need to go to physiotherapy will depend on the treatment that you have and also on what activities you plan on getting back to. You are likely to attend physiotherapy for at least 3 months.

Next: Return to Activity

Return to Activity
  • Driving: You can begin driving when you are allowed to be fully weight bearing, walking without crutches and feel comfortable to do so. Only return to driving when able to comfortably and safely change gear and carry out an emergency stop. This will vary depending on what treatment you have and on your consultant’s wishes.
  •  Work: This will depend on your job and on what treatment you have done. People in manual jobs or jobs involving a lot of walking are likely to need longer off than those who have jobs involving mainly sitting. Please discuss this with your consultant while in the hospital or in the clinic
  •  Sport: Your physiotherapist will advise you about returning to sport. Again this will depend on what treatment you have done and on the sport you wish to return to.

Next: Routine Follow-Up

Routine Follow-Up

We will see you back at the clinic 4-6 weeks after your operation. You may then have a further appointment about 12 weeks after the operation. If you need further appointments we will arrange these.

What is an ankle fracture

A fracture is a break or crack in a bone. The ankle is formed by three bones. These bones are the tibia, fibula and talus. Treatment depends on where and which bones are affected, if the fragments are badly aligned or if it causes joint instability.

Sometimes this can be managed by putting a plaster cast or splint on.

Sometimes surgery is carried out to realign and hold the bones together to improve healing.

Sometimes this is followed by a period in a plaster cast or splint and by keeping your weight off that foot using crutches.

If my injury is being treated with surgery?

The aim of surgery is to realign and stabilise the bone while it is healing. This is to try and prevent permanent stiffness, weakness and pain. Some ankle fractures can be treated in a plaster or splint if the bone is not displaced and stable, you accept the displacement or surgery would be too risky for you.

If I need it, what does surgery involve?

Surgery involves the bone being held with plates and screws that sit on the bone under the skin. More than one bone may need to be fixed and this sometimes needs to be done through more than one cut (wound) in the skin. The most common wounds will be on both sides of the ankle. There are always risks of surgery, these will be explained to you before surgery takes place by your surgeon. Surgery will either involve a general anaesthetic (going to sleep) or a spinal anaesthetic (numbing your leg so you don’t feel the surgery). This will be decided between you and your anaestheti

What happens next?

You will usually be discharged from hospital on the same or next day after surgery. Before you go home a doctor or nurse will discuss with you whether you need to take any blood thinning medication. They may also discuss whether some of your appointments may be carried out using a videophone or telephone. You will usually have follow up at 2 weeks and 6 weeks after surgery. These appointments will should be given to you before you leave hospital.

At around 2 weeks after your surgery, you will be seen by one of the fracture clinic nurses or podiatrists. They will examine your wound and ankle. They will change your cast or offer you a new walking boot and remove your clips/stitches. They may then send you for an X-ray of your ankle. They will then make sure you have another appointment booked for week 6 with either the fracture clinic or podiatry clinic.

At around 6 weeks after your surgery, you will come back to hospital for an X-ray and to see a healthcare specialist. Most people will be discharged after this appointment to patient initiated return but some may need more appointments or a physiotherapy referral.

What Problems Should I Look Out For?

Some problems patients can develop after surgery are infection, blood clots in the leg, poor bone healing, arthritis, nerve damage, tendon irritation, complex regional pain syndrome, irritating or prominent metalwork, walking difficulties, poor balance, pain, stiffness or weakness. If you are suffering from any of the list below, it may mean you have a problem from your surgery.

Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the ankle. Sometimes the wound can become red, painful or start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.

Pain – This can be caused by many problems. If your pain is getting worse or you still have moderate or severe pain 12 weeks after surgery then contact the clinic using the details below.

Stiffness – If you are having problems with ankle stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.

Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.

Breathing problems – For around 1 in 100 patients, a blood clot can form in the veins of the leg after surgery. This might cause pain and swelling in the leg. Very rarely a clot can travel to the lung through the bloodstream. This can give people chest pain or breathing difficulties. If you think you have one of these problems phone an ambulance or NHS24 immediately.

Walking difficulties or balance problems – There are different reasons why patients can have problems with walking or balance after surgery. If these problems continue for more than 12 weeks after surgery you may benefit from speaking to a healthcare professional. You may also have stiffness or pain that affects your ability to walk. If your problem is mainly caused by pain, you should contact the clinic. If it is mainly caused by stiffness, or you have balance problems, you should arrange to see a physiotherapist. It is ok to call the clinic to discuss this first if you are not sure.

If you have a problem related to your ankle fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

When Can I Walk Again?

This depends on your injury and the surgery you have. Your surgeon will advise you about this after your surgery. Most patients will be allowed to walk as their pain allows them immediately after surgery. You will need to wear a walking boot while you are walking for the first 6 weeks after surgery. You can take it off when you are sitting down, sleeping or doing your exercises.

If you are wearing a cast, you will usually not be allowed to put any weight through that leg for 2 weeks. Once the cast is changed you might be allowed to put some weight through it from week 2 – 6 after surgery. Sometimes people need to use crutches for some of this period. This will be assessed by a physiotherapist before you go home.

When Can I Return To Work?

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties might be possible, but you should avoid anything which makes your ankle uncomfortable, such as prolonged standing or walking. For manual work requiring lifting, you will need at least 6 weeks off, which may be longer depending of the extent of your injury. If your job involved driving you will be off work for at least 6 weeks.

When Can I Return To Driving?

You should not drive while you are in a cast or walking boot. You cannot drive for at least 6 weeks after surgery. After this you can drive when you are able to control your vehicle and safely perform an emergency stop. This is your decision. You can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

When Can I Return To Sport?

It is advised that you do return to sport until at least 12 weeks after your injury – please seek advice from your doctor or physiotherapist who will guide you.

Do I Need Physiotherapy?

If you carry out the exercises in this leaflet your movement will probably return to normal. If you are having problems with stiffness and this is affecting what you can do discuss this at your clinic appointment and you may need a physiotherapy referral. If you have been discharged from Orthopaedic clinic, please self refer to your local physiotherapy department or arrange this with your GP.

What Will My Recovery Be Like?

Below is a rough guide of what most patients will be able to do after ankle fracture surgery. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0-6

  • You will be in a cast or walking boot depending on your injury
  • Keep foot elevated when you are not walking to reduce swelling
  • If you are in a walking boot you will be allowed to weight bear as your pain allows. Move your toes often.
  • If you are in a walking boot you can remove this when you are sitting down or in bed.
  • If you are in a walking boot you can begin stage 1 exercises.

If you are in a cast you will not normally be allowed to weight bear on that leg.

Weeks 2-6

  • Continue stage 1 exercises
  • Return to desk based work if required and comfortable.

Weeks 6-12

  • The fracture is united (healed)
  • You can begin to resume normal activity but be guided by any pain you are experiencing.
  • Carry out day to day activities.
  • Carry out stage 2 exercises
  • If you no longer require to wear a walking boot you may wish to consider driving provided you can safely operate a car.
  • If you were in a cast and it has now been removed you can start stage 1 exercises followed by stage 2 as your pain allows.
  • Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Week 12

  • Return to manual work, sport and heavy activities.
  • If you are still experiencing significant pain or swelling then please contact the Fracture Care Team for advice.
Exercises – Stage 1 (week 0-6)
  • Lying on your back or sitting. Bend and straighten your ankles. If you keep your knees straight during the exercise you will stretch your calf muscles.
  • When sitting or lying, move your ankle slowly in large circles. Repeat in opposite direction.
  • Sitting on a chair, alternatively raise your toes and your heels.

Repeat each exercise 10 times, 5 times per day.

When you are comfortable doing these exercises you can begin the gentle resistance exercises below.

  • Sit on a chair or on the floor. Put one foot on top of the other foot. Try to point the toes of the foot that is on top while preventing any movement with the foot that is underneath.
  • Sit on a chair or on the floor. Put the inner borders of your big toes together. Press the inner borders of your big toes together. Hold approx. 5  secs.
  • Sit on a chair or on the floor. Cross your feet and put the outer edges of your little toes together. Press the outer edges of your little toes together. Hold approx.  5  secs. 
Exercises – Stage 2 (week 6+)
  • Sitting on a chair. Cross the ankle to be stretched over the other knee. Place your hand on top of your foot and help to point your toes. This will stretch your ankle. You should feel the stretch in the front of your shin.
  • When standing, place your foot on a chair. Line your heel up with the front edge of the chair. Hold the back of the chair for balance. Gradually move your knee towards the back of the chair keeping your whole foot in contact with the chair.This will stretch your ankle. You may feel a stretch in your calf and at the front of your ankle.
  • Note: if you walked with assistance of a walking stick or walking aid prior to ankle injury then please do not attempt this exercise.
  • Sit on the floor or on a chair with one leg out straight in front of you. Put a rubber exercise band or towel around your foot.Use the band / towel to gently pull your foot up towards your body. You will feel a stretch in your calf.
  • 1. Sit with operated leg crossed over and hold foot as shown
    2. Turn foot (forefoot and heel) upward so that you feel a stretch,
    3. Hold 3 seconds
    4. Then turn foot downwards, feel the stretch and hold for 3sHold each exercise for 10 seconds. Repeat 10 times, 5 times per day.

  • Sit on a chair or on the floor. Put one foot on top of the other foot. Try to point the toes of the foot that is on top while preventing any movement with the foot that is underneath.
  • Alternatively, sit on the floor or on a chair with one leg out straight in front of you.
  • Tie a rubber exercise band to something secure and put the rubber exercise band around your foot (make sure there is some tension on the band to pull against). Pull your foot up towards your body against the resistance of the band.

Hold each exercise for 5 seconds. Repeat each exercise 10 times, 5 times per day.


  • Sit on a chair or on the floor. Put one foot on top of the other foot. Try to lift the foot that is under while preventing any movement with the foot that is on top.
  • Alternatively, sit on the floor or on a chair with one leg out straight in front of you. Put a rubber exercise band or towel around your foot. Pull the band/towel towards you to provide some resistance. Point your toes towards the floor, against the resistance of the band/ towel. Slowly return to starting position.

Hold each exercise for 10 seconds. Repeat each exercise 10 times, 5 times per day.

Exercises – Stage 3

The exercises in this section are not intended for anyone who required assistance of a walking stick or walking aid prior to injury.

The exercises in this section should be completed along side on-going physiotherapy input with the aim of returning to specific hobby or sport that demands higher level rehabilitation. If you are not attending physiotherapy and wish to return to sport please request referral through fracture clinic or self- refer to your local physiotherapy department.

It is normal to feel some discomfort when starting a new exercise. If any of these exercises cause increased pain at your ankle then stop the exercise and speak with your physiotherapist. 

  • Mini Band Resisted Marching: Start by standing with a mini band around both feet and arms relaxed by your side.
    Lift one leg and bring your knee towards your chest against the resistance from the band. At the same time keep the hip of the supporting leg straight. Keep your upper body upright and let arms swing by your sides at the same tempo as your legs march.

    Repeat 10  times.
  • Stand as pictured below. 
    Start in standing with your feet hip-width apart and a mini band around both feet close to your ankles. Feel how the band pulls your feet inwards.
    Step to side keeping your toes pointing forwards. 3 steps in each direction.
    Note: Keep your toes relaxed during this exercise.

    Repeat 3-5 times in each direction.
  • Stand. Step sideways and place your foot on a balance pad/ folded pillow.
    Hold 10  seconds, increase as you are able.
    Repeat 10  times.
  • Stand on one leg holding onto support of chair. Push up on your toes.

         This can be progressed into a walking exercise. As you walk try to push up on

          to your tip toes, you should feel like your heading bobbing up and down.          Repeat times 10 times.

  • Stand on one leg on a step with your heel over the edge holding onto support. Let your heel drop downwards. Push up on your toes.
    Repeat 10  times.
  • Stand on one leg on a step facing down. Slowly lower yourself by bending your knee to 30 degrees. Return to starting position.

Repeat 10  times.

  • Stand with feet together.When you feel ready try initially to jump on the spot, as you get more confident try jumping forward and backward in a Z pattern. Reverse the Z pattern.
  • Stand on one foot.
    When you feel ready try hopping on the spot, this will be closer to the 12 weeks and may even take longer than that.
    Once hopping on the spot becomes easy try to hop forward and backward, then try side to side and finally try to hop in a Z pattern. Reverse the Z pattern.
Further Information and Contact Details

Contact Details

Queen Elizabeth University Hospital main switchboard – 0141 201 1100

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Appointments booking office – 0141 347 8347 (Monday – Friday, 08:00 – 20:00)

Physiotherapy – 0141 452 3713 (Monday – Friday 8.30- 1600)

MSK Physiotherapy Self Referral  https://www.nhsggc.org.uk/your-health/health-services/msk-physiotherapy/

Further information is available at https://www.nhs.uk/conditions/broken-ankle/

Patient Initiated Return

At the end of your final appointment you will usually be discharged from further follow up. This information sheet has advice on problems to watch out for and advice on exercises you should carry out. You should read through this leaflet closely as they will tell you about what you should expect for your recovery. They will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your ankle fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

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What is an ACL (anterior cruciate ligament)?

The following diagram shows the main structures in a healthy (right) knee.

The ACL joins the back of the femur (thighbone) to the front of the tibia (shinbone). It helps to stabilise the knee. You can damage it by a twisting movement or a movement where your body continues to move forwards but your foot stays put e.g. dodging, pivoting or landing from a jump. The main goals of ACL surgery and rehabilitation are to restore knee stability and to allow your return to work and sport as soon as possible.

Surgery

Reconstruction of an ACL involves replacing the torn ligament usually with part of the hamstring (from behind the knee) or sometimes part of the patellar tendon (in front of the knee).

The surgeon drills tunnels through the bone. Your new ACL is brought through these tunnels, and then secured.

As healing occurs, the bone tunnels fill in to secure the tendon.

Rehabilitation

Rehabilitation starts immediately after your surgery. This is where all members of the Hospital Care Team (doctors, nurses and physiotherapists) help you to achieve your full potential following your ACL reconstruction. The rehabilitation is just as important as the surgery itself. You need commitment and effort to make the most of your rehabilitation.

To make sure your progress is quick and safe your physiotherapist(s) will follow a specially designed programme based on up to date information.

Why do I need physiotherapy after my operation?

• To minimise swelling

• To regain full range of movement

• To restore normal walking

• To strengthen muscles

• To allow safe return to sporting activities

Your physiotherapy care

Immediately after surgery

You will return from theatre with a padded crepe bandage from your calf to thigh.

You may have had a nerve block (an injection into a nerve to reduce pain after your surgery) or local anaesthetic put into your knee. These often cause numbness and a feeling that you are unable to move your leg. This is normal and usually improves within a few hours.

The medical and nursing staff will offer painkillers and we strongly advise you to take these regularly to minimise discomfort and swelling.

The padded bandage will change to a light wound covering and tubigrip.

Going home from hospital

Getting Up and About:

We will give you sticks or elbow crutches to help you walk and to get about, until you have better control of your leg muscle.

We will show you how to use them properly to walk and when on stairs.

It is really important that you take good care of your wound and pain control. It is also important to keep down any swelling.

Pain:

• Wound pain is normal, this will gradually lessen over the next few days. Use the painkillers supplied by the hospital regularly.

• If pain or swelling increase contact, your physiotherapist, GP, orthopaedic clinic or attend your local minor injuries clinic for advice.

Wound Care:

• Change the clear wound dressing. You may see dark blood stains – don’t worry this is normal.

• If your wound becomes hot, red and weeps fluid, contact physiotherapist, GP, orthopaedic clinic or attend your local minor injuries clinic for advice.

Swelling and Warm:

• Swelling is normal immediately after surgery. Use a cold pack if your knee is hot and swollen. You can make a cold pack by wrapping a bag of frozen peas in a damp tea towel. Remove the tubigrip and apply the cold pack to your knee for not more than 15 minutes at a time. You may reapply it once your knee has returned to its normal temperature.

• Wear the tubigrip during the day but remove it at night to allow your circulation to flow properly.

Stairs

Going up stairs:

1. Place unoperated leg up onto step

2. Place operated leg onto same step

3. Finally place sticks or crutch onto step

Going down stairs:

1. Place crutches or stick down onto step

2. Place operated leg onto same step

3. Finally place unoperated leg onto same step

Remember –

“up with the good, and down with the bad”

Always use your crutches or sticks to support the operated leg. Always use the hand rail, if there is one, as well as one stick or crutch.

When can I return to normal activities?

Every individual is different and you should follow the advice of your physiotherapist(s) and consultant. The following is a rough guideline:

  • Walking without crutches as advised by your physiotherapist
  • Work at a desk approximately 2 – 4 weeks, other jobs depends on activity
  • Driving approximately 4 – 6 weeks
  • Return to sport as advised by your physiotherapist
Exercise Programme

Your exercise programme should start from day one and has been carefully designed for safe and rapid progress.

Exercise:

• Rest your knee between sessions of exercise. When resting keep your leg up on a stool or settee.

• Walk only short distances for the first few days.

• Continue using your crutches as shown by the physiotherapist until we tell you otherwise.

• It is important that you can straighten your knee fully and you are walking without a limp before you stop using crutches.

• Finally, it is important to continue with the exercises as shown by your physiotherapist.

The early phase of your rehabilitation is included in this information sheet and your

physiotherapy sessions should start a few days following surgery.

Exercises Programme – Initially your physiotherapist will assist you to move your knee.

Then they will teach you how to do exercise 1 – 5 safely (see Exercise Programme over page)

1. Static quadriceps

2. Knee bending.

3. Straight Leg Raise

4. Terminal extension

5. Prone Stretch

Continue with exercise No.1 to 5 as shown until your first Outpatient physiotherapy appointment.

Ongoing physiotherapy:

You will attend out-patient physiotherapy for at least 3 months.

Your rehabilitation usually takes at least 6 months depending on goals or sports.

Exercises Week 1-2

You will see the physiotherapist after your surgery. They will teach you the following exercises.

You may feel some discomfort with some of the exercises. If you have any concerns discuss these with your physiotherapist.

1. Static Quadriceps (thigh muscle). Position – lying down or Sitting.

Action – tighten the thigh muscle, pull your foot towards you and push your knee down into the bed or settee.

Hold for 5 seconds then relax

Repeat 10 times every 1-2 hours

2. Knee bending Position – lying down.

Action – Slowly slide your heel up towards your bottom. Stop at the point of pain and

hold for 5 seconds then straighten again.

Repeat 10 times every 1-2 hours.

3. Straight leg Raise You Must keep your knee straight and locked out. Position – lying down.

Action- Tighten the thigh muscle and keep your knee straight, slowly raise your leg off the bed. Do not lift the leg higher than 10 -15cm (4-6inches) from bed.

Hold for 5 seconds.

Repeat 10 times 3 times per day

4. Terminal Extension Position- lying down with your heel on a rolled towel. Or in a sitting position  with unsupported on a stool.

Action – tighten the thigh muscle, pull your foot towards you and press your knee down.

Hold for 5 seconds then relax

Repeat 10 times every 1-2 hours

Or

Rest in this positions for 10 minutes every 1-2 hours.

5. Prone Knee Stretch Position – Lying on your front with feet over the bed edge.

Action – Place a pillow or towel under your thigh for comfort. Allow the weight of your legs to stretch the back of your knee.

Hold position for 10 minutes.

Rest in this position for 10 minutes every 1-2 hours.

6. Calf Stretch Position – lying or sitting.

Action – Use a towel or belt around your foot, to pull your foot gently towards you to stretch your calf.

Perform 3 times, holding stretch for 20-30 seconds.

Repeat every 1-2 hours

Exercises Week 3 – 6

Only start the following exercises when your physiotherapist tells  you it is OK to do so.

7. Knee Flexion and Hip Extension

Knee Flexion Position – Lie face down.

Action – Tuck your good leg bend your operated leg to help bend your knee to 90

degrees.

Hip extension

If you can bend knee freely to 90 degrees, extend your hip by lifting your thigh off the bed.

Return to starting position.

Repeat each 10 times 3 times per day.

8. Hip Abduction Position – Lie on your side with your back against a wall.

Action – Keeping the heel in contact with the wall, slowly raiseyour leg.

Return to starting point. Repeat 10 times 3 times per day.

9.

Action- Move your weight from side to side over your feet.

Repeat 10 times 3 times per day.

10. Single leg balance Position – Standing on one leg.

Action – Practise standing on your operated leg. Try to increase the time to match your good leg.

Hold for 30 Seconds

Repeat 10 times 3times per day.

11. Calf stretch Position– Stand by a chair or wall for support.

Action – Step back with one leg and stretch the calf by pushing the front knee forward.

Make sure your feet are pointing forwards and your heels stay in contact with the floor.

Hold for 30 Seconds

12. Mini Squat Position – Stand by a chair for balance if needed.

Action – Bend your knees and hips as if going to sit on a chair.

Do not bend the knees more than 50 degrees (halfway down).

Return to starting position.

Repeat 10 times 3 times per daily.

13. Heel raise Position – Stand by a chair for balance if needed.

Action – Slowly raise your heel up from floor, move up onto your toes.

Repeat 10 times 3times per day.

To progress you can add a hand weight.

14. Cardiovascular exercise

Using a Static bike and cycle with low resistance.

Cycle for 10 -15 minutes – before (as a warm-up) and following your exercises.

Your physiotherapist will give you guidance on all exercises.

Contacting your care team

Please contact your Physiotherapist, G.P, orthopaedic department or attend your nearest Minor Injuries clinic if you have any issues regarding your knee.

Your Accident & Emergency (A&E) centre is for serious medical emergencies. Their staff prioritise patients on the severity of the condition.

Introduction

This leaflet will provide you with some information and exercises for you to follow after your shoulder surgery. This leaflet is for rehabilitation following shoulder surgeries that involve immobilisation which means your arm will be in a sling for 4 – 6 weeks.  

Your surgery may be planned weeks in advance (Elective) or done at short notice due to trauma.

Elective Surgeries:  surgeries that are planned in advance and may include repairs of the shoulder joint structures such as rotator cuff or joint replacement.

Trauma Surgeries: surgeries that are undertaken at short notice due to fall or accident which has caused damage to the shoulder bone or soft tissues.

Next: What Surgery Involves

What Surgery Involves

Your surgery maybe keyhole (arthroscopy); this involves the surgeon making small incisions around your shoulder and using a tiny camera to look inside your shoulder joint. Some surgeries require larger incisions but your surgeon will inform you prior to your surgery which approach they will take.

They will look for any areas of possible damage and undertake any treatment. Scans and x-rays allow your surgeon to plan surgery but sometimes the treatment required can be more or less than anticipated prior to surgery.

You will have a general anaesthetic which means you will be asleep. In some cases, we may use a nerve block to numb the area. You will have little or no movement of your full arm or hand initially after your surgery. This should return within 24 hours of surgery. The anaesthetist will speak to your before surgery about these.

Next: After Surgery

After Surgery

Most patients go home on the day of their surgery or the day after. Your arm will be in a sling after your surgery.

A physiotherapist and/or Occupational Therapist will see you on the ward after your surgery to provide advice, sling education and complete exercises with you. They will refer you for further physiotherapy as an outpatient. You will be contacted with an appointment by telephone or letter with your outpatient appointment.

Next: Post Operative Advice

Post Operative Advice

Pain:

There will be some pain and discomfort after your surgery. You should take painkillers as prescribed, do not wait for your pain to worsen prior to taking pain relief. Ensure your sling is in correct position; your arm should rest in it across your stomach with your elbow at 90 degrees. Your arm should feel fully supported by the sling.

Swelling/ bruising:

It is normal to have some swelling/ bruising around your shoulder and down your arm or chest. Often this is worse following trauma or more complicated surgeries. Bruising can be more common if you are medication to thin your blood.  You can reduce swelling in your hand and elbow by ensuring you complete the exercises provided and ensuring your sling is applied correctly. If your sling is too loose your arm will hang downwards allowing swelling to gather in your fingers and hand.

If you have swelling around your shoulder you can apply an ice pack to help reduce swelling and ease pain. This should be wrapped in a towel and applied for 15 minutes at a time, monitor your skin to ensure you are not getting ice burns.

Wound:

You will go home from the ward with a dressing over your wound. The nursing staff will give you dressings to use at home and tell you about when and where to get your stitches out. This is usually about ten days after your surgery.

Sleeping:

We advise you to sleep in any comfortable position. However, sleeping on your operated shoulder will probably increase your pain. Your sling will need to remain on during the night.

Washing and dressing:

Avoid getting your wound dressing very wet.

If showering you can remove your arm from your sling and let it hang by your side. Do not lift your arm to assist with washing. To clean under your operated arm, lean to that side so there is a gap between your body and arm, do not lift your operated arm.

When dressing your upper body place your operated arm into your clothes first for comfort. When undressing remove your operated arm last.

The physiotherapist will have shown you how to remove and apply your sling on the ward but below is a link if you need some assistance.

Your sling should only be removed for washing, dressing and completing your exercises. 

Very occasionally, some people are advised to where their sling under clothes to avoid excess movement. We will advise you if this applies to you.  

Next: When Can I Start to Drive Again?

When can I start to drive again?

 You should not drive will your arm is in a sling. Do not drive until you have regained full control and movement of your arm.

Before driving sit in your car and try using all of your controls to make sure you are able to do so comfortably. When you return to driving, start with a short journey to ensure you are comfortable and in control.

We also recommend that you speak with your insurance company before you start to drive. The law states you should be in complete control of a car to drive.

Next: When Can I Return to Work?

When Can I Return to Work?

This depends on your occupation, most people can return to work around 6 -12 weeks after their surgery. If your job does not involve use of your operated arm you may be able to return sooner.

Please discuss this with your surgeon, doctor or physiotherapist.

Next: When Can I Return to Hobbies and Sport?

When Can I Return to Hobbies and Sport?

Your physiotherapist will guide your return to heavy activities and sport.

This will depend on your pain, shoulder movement and strength as your rehabilitation progresses. Pain would be a sign that you are not ready to return to a specific activity.

Next: Physiotherapy

Physiotherapy

You will be referred for physiotherapy by the ward physiotherapist or from fracture clinic when they are happy for you to start rehabilitation following surgery for trauma. You will need to attend physiotherapy to regain movement and strength of your arm.

Rehabilitation will not start until after your period of immobilisation around 4-6weeks after your surgery. 

While your shoulder is immobilised it is important to maintain the other joints of your arm such as your elbow to stop these from stiffening up. The exercises included in this booklet are safe to start once you have the feeling back in your arm, normally the same day or the day after your surgery. 

Next: Exercises

Exercises
  • Hand and fingers: Make a fist (thumb over fingers). Straighten your fingers and bring them apart.

Repeat 10 times 3 x daily

  • Wrist movement: Bend and straighten your wrist keeping your fingers straight throughout the exercise.

Repeat 10 times 3 x daily

  • Elbow Rotation: With your arm in your sling across your stomach , turn your palm up and down rotating your forearm.
  • Or with your arm out of sling across your stomach with your elbow bent at 90 degrees, turn your palm up and down rotating your forearm.

Repeat 10 times 3 x daily

  • Elbow bend and straighten: Stand with your arm out of your sling, your elbow bent at 90degrees and forearm across your stomach.
  •   Bend your elbow and then straighten your elbow.

Repeat 10 times 3 x daily

  • Shoulder blades: Stand. Pinch shoulder blades together as shown.

Repeat 10 times 3 daily

Next: Follow Up

Follow Up

All patients will attend follow up appointment but trauma and elective patients will be seen at different clinic types and at different timescales post-operatively.

You will be given your first return appointment by the nursing staff prior to discharge from the ward.

If you have any concerns following surgery please contact your follow up clinic, your GP or physiotherapist for advice.

If you have any urgent concerns please call NHS 24 on 111.

What is a distal radius fracture?

A wrist fracture is a break in the radius bone, close to the wrist joint. In medical terms this is called a “distal radius fracture”. Occasionally a small chip or fracture can occur in the ulna.

Fractures happen when a force is applied to a bone that is greater than the strength of the bone. The angle at which the force is applied and how the strong the force is can affect the type of fracture that happens. Fractures can happen with a fall, while playing sport or exercising, through a work injury or road traffic accident for example.

Next: Do I need surgery for my injury? 

Do I need surgery for my injury?

The aim of surgery is to realign and stabilise the bone while it is healing. This aims to prevent stiffness, weakness and pain. Some wrist fractures can be treated in a plaster if the bone is not displaced, you accept the displacement or surgery would be too risky.

Surgery involves the bone being held with either pins that go through the skin (k-wires) or by a plate and screws that sit under the skin and muscle on the bone. The type of surgery carried out depends on what is needed to safely fix your fracture. It is carried out with either a general anaesthetic (were you are asleep) or a regional anaesthetic (were you are awake but can’t feel your arm). Surgery usually takes 30-60 minutes.

Next: What happens after surgery?

What happens after surgery?

You will be seen back at the fracture clinic 2 weeks after your surgery. This should have been arranged with you before you were discharged from the hospital.

Closed Reduction and K-Wire Fixation Surgery

You will be seen by the fracture clinic staff, they will remove your cast, check your wounds, hand function, sensation and blood supply. They will then send you to get an x-ray of your wrist and this will be reviewed by one of the surgeons. If there are no concerns then you will be given a new cast. You will then be given a further appointment for 3 weeks later. At this appointment the cast will be removed and you will be given a removable splint to where for 1 week. The wires will be removed in the clinic. This is not safe and is usually not painful.

Open Reduction and Internal Fixation Surgery

You will be seen by the fracture clinic staff, they will remove your dressings or cast, check your wounds, hand function, sensation and blood supply. They will then send you to get an x-ray of your wrist and this will be reviewed by one of the surgeons. If there are no concerns then you will be given new cast, removable splint or no splint depending on your injury. You will then be given a further appointment for 4 weeks later. At this appointment the splint/cast will be removed.

Next: Patient Initiated Return

Patient Initiated Return

Before you are discharged from hospital you will be given advice on problems to watch out for and advice on hand and wrist exercises. You will be given this patient information sheet. You should read through this leaflet closely as it will tell you about what you should expect for your recovery and exercises to carry out. It will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your wrist fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

Next: What problems should I look out for?

What problems should I look out for?

Some problems patients can develop after surgery are infection, poor bone healing, arthritis, tendon irritation, complex regional pain syndrome and carpal tunnel syndrome. These problems can cause you to feel unwell, develop pain, stiffness, swelling, pins & needles or weakness.

Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the wrist. Sometimes the wound can start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.

Pain – This can be caused by many problems. If your pain is getting worse at any time after surgery, or you still have moderate or severe pain 12 weeks after surgery then contact the clinic using the details below.

Stiffness – If you are having problems with wrist stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.

Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.

Tendon Irritation – If you are getting pain or a grating/cracking sensation when you are trying to move one of your fingers or thumb then allow it to rest for 1-2 weeks. If the pain doesn’t go away or gets worse then contact the clinic using the details below.

Carpal Tunnel Syndrome – If you develop pins and needles, or numbness in any of your fingers that doesn’t go away after an hour, contact the clinic using the details below. If it is severe and the hand becomes numb and it is out-with the clinic hours, attend your local emergency department.

If you have a problem related to your wrist fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Next: When can I return to work?

When can I return to work?

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties should be possible, but you should avoid anything which makes your wrist uncomfortable, such as prolonged typing. For manual work requiring lifting, you will need at least 6 weeks off, which may be longer depending on the extent of your injury.

Next: When can I return to driving?

When can I return to driving?

You should not drive while you are needing to wear a cast or splint. After this you can drive when you are able to control your vehicle without distraction. This is your decision, you can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

Next: When can I return to sport?

When can I return to sport?

You should only return to contact sport 12 weeks after your injury. Other sport may be earlier but you should take the advice of your doctor or physiotherapist who will guide you.

Next: Do I need physiotherapy?

Do I need physiotherapy?

Most patients don’t need physiotherapy. If you carry out the hand and wrist exercises in this leaflet your movement will probably return to normal. If you are having problems with stiffness and this is affecting what you can do 12 weeks or more after surgery, please self refer to your local physiotherapy department or arrange this with your GP.

Next: What will my recovery be like?

What will my recovery be like?

Below is a rough guide of what most patients will be able to do after wrist fracture surgery. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0-2

  • You will be in a cast, splint or bulky bandage depending on your injury
  • Use the sling for the first few days if the arm is painful.
  • Move your fingers often.
  • Carry out stage 1 exercises

Weeks 2-6

  • You can use the arm for simple tasks as pain permits.
  • Depending on your injury and if you are comfortable the nurse in clinic may remove your cast, splint or bulky bandage.
  • Continue stage 1 exercises
  • Return to desk based work if required and comfortable.

Weeks 6-12

  • The fracture is united (healed)
  • You can begin to resume normal activity but be guided by any pain you are experiencing.
  • Carry out day to day activities.
  • Carry out stage 2 exercises
  • Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Weeks 12+

  • Return to manual work, sport and heavy activities.
  • You are still experiencing significant pain and swelling then please contact the Fracture Care Team for advice.

Next: Exercises – stage 1 (weeks 0-6)

Exercises – stage 1 (weeks 0-6)

Finger exercises:

  • Keep your fingers moving whilst you are in the splint.

Elbow Bend to Straighten and Forearm Rotations:

Elbow Bend to Straighten:

  • Bend and straighten your elbow as far as you can without pain. You should not feel more than a mild to moderate stretch.
  • You can use your other arm to assist if necessary. Repeat 10 – 15 times if there is no increase in pain.

Forearm Rotations:

  • Begin this exercise with your elbow at your side and bent to 90 degrees. Slowly turn your palm up and down as far as you can go without pain.
  • You should not feel more than a mild to moderate stretch. You can use your other arm to assist if necessary. Repeat 10 – 15 times if there is no increase in pain.

Next: Exercises- stage 2 (week 6 onwards)

Exercises – stage 2 (week 6 onwards)

Finger and wrist flexion and extension

  • Open and close your hand as shown 10-15 times. Then move your wrist up and down 10-15 times.
  • After a few days, hold a soft ball / ball of socks. Squeeze the ball as hard as possible without pain.
  • Hold for 5 seconds and repeat 10 times.

Next: Further Information and Contact Details

Further Information and Contact Details

Contact Details

Queen Elizabeth University Hospital main switchboard – 0141 211 1100

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Appointments booking office – 0141 347 8347 (Monday – Friday, 08:00 – 20:00)

Physiotherapy – 0141 452 3713 (Monday – Friday 8.30- 1600)

MSK Physiotherapy Self Refer  https://www.nhsggc.org.uk/your-health/health-services/msk-physiotherapy/

Further information is available at https://www.nhs.uk/conditions/broken-arm-or-wrist/

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Introduction

This booklet gives you and your family a basic knowledge of knee joint replacement, outlining things you should know both before and after the operation. The aftercare may vary according to your surgeon’s wishes.

The success of you operation is a team effort including doctors, nurses, physiotherapists, occupational therapists, your family and most importantly you.

Next: Why may I benefit from a Total Knee Replacement?

Why may I benefit from a Total Knee Replacement?

There are several reasons why you may need a knee replacement. The most common is osteoarthritis; this simply means that the cartilage in your knee has worn out. This results in the bone ends losing their smooth surfaces and causing bone to grind against bone. This can cause pain and stiffness in the knee.

Rheumatoid arthritis or a previous injury to your knee can also cause your knee to become stiff and painful.

Next: What is a Knee Replacement?

What is a Knee Replacement?

A knee replacement involves removing only the damaged surfaces of your knee (the end of your thigh bone, the femur, and the top of your shin bone, the tibia) and replacing them with metal and plastic pieces which fit together to mimic the natural movement of the knee. The kneecap may be left untouched or sometimes the under surface may be smoothed off allowing a plastic button to be fixed to the back of it. The components are usually held in place by special bone cement.

There are different types of knee joint replacement. The most suitable type for you will depend on the extent of arthritis affecting the bones.

• A uni-compartmental knee replacement is a partial knee replacement and is suitable if only one part of your knee is affected by arthritis.

• If more than one part of your knee is affected by arthritis you will need a total knee replacement which covers the whole surface of the knee (Figure 2). Your consultant will discuss which type of knee replacement is most suitable for you.

The aim of a knee replacement is to reduce the pain and stiffness in your knee and this should improve your ability to walk.

Next: What should you do once on the waiting list for knee replacement?

What Should You Do Once on the Waiting List for a Knee Replacement?

You should make sure you are as fit as possible before coming in for your operation. This will make it easier for you to recover after the operation and help you get home quickly. We will have you mobile as soon as possible after the operation to prevent complications. You will find this easier if you exercise before you come into the hospital. We suggest you stay as active as possible and start the exercises in this booklet straight away.

It is also important to eat healthily as this will help your body recover from the operation. If you drink alcohol or smoke, cutting back will help reduce the risk of any complications and help you recover more quickly.

In some hospitals you may have a health check at a clinic before your operation. However if this is not the case and you have any concerns regarding your health you should discuss these with your GP. It is useful if you have your GP check your blood pressure and make sure you receive treatment for any skin problems as these may delay your operation. It will also be beneficial to attempt losing weight if you are overweight.

To prepare for going home after your operation it may be useful to discuss the following with family or friends.

Things to consider are:

• How you will get home from hospital

• Who will help out at home

• Any questions you have regarding the operation and recovery afterwards (write these down)

• Organising your home so things you need are easy to get to and anything you could trip over is cleared away.

We aim to get you home as soon as you are safe to do so and have met your discharge criteria. This is to reduce the risk of post-operative complications such as hospital acquired infection.

Next: Pre-operative Assessment Clinic

Pre-Operative Assessment Clinic

Before coming into hospital, we will ask you to attend the pre-operative assessment clinic.

At this clinic you will see a nurse and, or a doctor and you may see your consultant or their registrar. You may also see an occupational therapist if necessary.

We carry out full investigations to make sure that you are as fit as possible before your operation. This involves taking a record of your medical history and a list of your current medications. (It is useful if you bring a list of these with you.)

At the clinic we will:

• Measure your height and weight

• Check your blood pressure

• Take samples of your urine and blood for analysis

• Take an ECG (a tracing of your heart)

We will also take swabs of your nose, throat and groin. This is to make sure that you are clear of MRSA (methicillin resistant staphylococcus aureus) before coming into hospital.

The staff at the clinic will also discuss your operation with you. Please take this opportunity to ask any questions you may have regarding your operation and hospital stay. It may help if you write a list and bring it with you (there is space for questions at the back of this booklet).

Next: What to bring into hospital

What to bring into hospital

You should bring any medication you are already taking in its original packaging.

You should expect to be in hospital for 2-4 days so bring enough comfortable daytime clothing and nightwear. You should bring sensible footwear: flat shoes or slippers that are easy to get on and off. Slippers should preferably have support around the heel. Your feet often swell up a little after the operation so make sure if you buy new slippers that they are big enough. You may find it helpful to bring in a long handled shoe horn.

Next: Immediately After the Operation

Immediately After the Operation

We will transfer you from the recovery room back to the ward in your bed. You are usually off the ward for roughly 3-6 hours. You may have a tube into a vein, “a drip”, to replace lost fluids but this will be removed as soon as possible. We will encourage you to eat and drink once back on the ward. You may also have a face mask or a nasal cannula to give you oxygen. You will have a large padded dressing around your knee.

The nursing staff will regularly monitor your blood pressure, pulse, temperature and oxygen levels.

We advise you to nominate 1 family member or friend to phone the ward to enquire how you are. Ask them to tell others about your progress rather than lots of different people calling the ward.

We will aim to get you up after you have recovered from the anaesthetic.

Next: Pain Management

Pain Management

Some patients having a knee replacement operation have mild pain and others have more pain. Everyone is different but you should expect to have some pain. You must let the nursing staff know when you start to feel pain so that they can help you. It is harder to get the pain under control if you wait too long.

The anaesthetist and ward staff will discuss pain relief options with you and a pain management nurse may visit you after the operation.

We may inject nerve blocks or local anaesthetic into the new joint while you are in theatre. As these wear off you will tend to feel the pain increasing. It is very important that you let the nursing staff know when this happens so they can get you pain killers. Powerful pain-killing tablets (Opiates) are the most commonly used method of pain relief. Sometimes we use patient controlled analgesia (P.C.A.) however this is much less common.

Do not wait until you are very sore before asking for pain killers.

Next: Pain Killing Tablets

Pain Killing Tablets

A long acting tablet taken in the morning will release a powerful pain killer for twelve hours. The nursing staff will give you another one at bedtime to help with the pain throughout the night. You will also get regular paracetamol. Most people need more than this to control the pain however you will not get the strong break through painkiller unless you ask for it. It is very important to let the nurses know when you are sore so they can give you this to help you. Always think about how the pain is when you are moving and doing your exercises and not just sitting or lying still. The emphasis after the operation is to get you moving so your pain control is hugely important.

Before you go home we will take you off these pain killers and prescribe something that you can take regularly yourself.

Pain killers can cause constipation. If you are affected by this or think you are likely to be please let the nursing staff know so they can give you a gentle laxative to help.

Some patients experience nausea or vomiting after an operation. If you feel sick let the nurse know. They can give you medication to help reduce this.

Next: Recovering From Your Operation

Recovering From Your Operation

At first you will be lying on your back and you may find moving around the bed awkward. Try bending your good leg up and push down through the bed with your foot and arms to lift your bottom off the bed. This helps prevent any sores developing. You should also keep your feet moving to help your circulation. People are often scared to move after their operation but there is no harm in starting the exercises shown in this book once you are able to move your legs.

The nursing staff will encourage you to be as independent as possible, whilst making sure of your safety. They will give you whatever help you need with washing and dressing etc following your operation, however they encourage you to do as much as possible on your own.

We will remove the padded bandage the day after your operation, and will usually replace it with a lighter dressing. We will check your wound dressing everyday and will only change it if necessary. If you have wound clips or stitches that need to be removed, the nursing staff will organise for a district nurse to do so when you are home.

We will encourage you to be as mobile as possible after your operation. Where possible the nursing staff or physiotherapists will aim to have you out of bed the same day as your operation. This helps you return to independence, and helps prevent complications after your operation.

One possible complication is a blood clot in the calf, known as a DVT (deep vein thrombosis). A DVT can move to the lungs, this is known as a pulmonary embolism (PE). We will give you medication and or other mechanical means such as stockings to help prevent blood clots. However moving and walking as soon as possible after the operation is one of the best ways of preventing this.

We will take an x-ray of your knee before you go home.

Some patients require a blood transfusion or iron tablets after their operation. We will discuss this with you if necessary.

Next: Physiotherapy

Physiotherapy

The physiotherapist will visit you either the afternoon of your operation or the next morning. They will teach you exercises to increase the circulation in your legs and increase the movement and strength of your new knee. These are important because the muscles around your knee are often weak and tight. This is because the pain and stiffness of the arthritic knee stopped you from moving it normally. It will help you if you start these exercises straight away unless we tell you otherwise.

We aim to have you up walking on the same day as your operation or the next morning. The physiotherapist may also check your breathing and offer advice to help your lungs stay clear of infection.

After your operation the physiotherapist will continue with your exercises and practice walking. You will use a walking frame to walk initially and will progress onto walking sticks or elbow crutches as soon as you are ready. You will also practice going up and down stairs before going home.

If you have had a total knee replacement, we aim to get people home within 2-4 days of their operation but this varies and you may get home sooner or later than this. If you have had a unicompartmental knee replacement we will aim to get you home on the same day as your surgery. 

Next: Exercises

Exercises

Below are the exercises that the physiotherapist will do with you. You should aim to do these 4 times a day while in the hospital.

1. Ankle Pumps: Pull your ankles backwards and forwards and circle them around. This increases the blood flow in your legs and decreases the chance of blood clots forming. Repeat 10 – 20 times.

2. Static Quads: Point your toes to the ceiling. Press the back of your knee against the bed and tighten up the muscle in your thigh. Hold for 5 seconds then relax. Repeat 10 times.

If your knee is not quite straight then do this exercise with a rolled up towel under your ankle.

3. Inner range Quads: Place a roll underneath your knee. Point your toes to the ceiling, rest the back of the knee against the roll and lift your heel off the bed while straightening your knee. Hold for 3-5 seconds then relax. Repeat 10 times.

4. Straight leg lift: Lying on your back with one leg straight and the other leg bent. Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 20 cm off the bed. Hold approx 5 secs. – slowly relax. Do 2 sets of 10.

5. Knee Flexion: Bend your knee up and down. Do 2 sets of 10.

6. Knee flexion while sitting: Slide your foot backwards and forwards so that you are bending and straightening the knee. Do 2 sets of 10.

7. Through Range Quads: While sitting and your leg out straight pull your toes back and straighten your knee. Hold for 3-5 seconds then relax. Repeat 10 times.

8. Stretch: In sitting or lying. Rest your ankle on a stool or a rolled up towel. Stay in this position for 5-10 minutes to stretch the back of your knee.

9. Hamstrings: While standing, hold onto a steady object (e.g. the back of a chair). Bend your knee so you are bringing your heel up towards your bottom. Hold for 3-5 seconds then relax. Repeat 10 times.

Although the physiotherapist will be there to teach and guide you it is important that you do your exercises independently and have regular walks on the ward once the physiotherapist says you are safe to do so. It is ultimately your effort that will get your knee working properly again. If you find you are struggling to do the exercises or walking because of pain please let a member of staff know – we cannot help unless you tell us!

There are some things we look for before you are discharged from physiotherapy and these are what you should aim for:

• Your knee bends to about a right angle

• You can fully straighten your knee

• You are able to lift your leg off the bed keeping it straight

Next: Getting in and out of bed

Getting in and out of bed

Whilst in hospital the therapy and nursing staff will show you how to get in and out of bed safely. You will practice from whatever side of the bed you get in at home.

Next: Standing Up and Sitting Down

Standing Up and Sitting Down

Standing up:

To stand always make sure that you place your hands on the bed or chair. Your operated leg should be out in front of you before standing up. Push through your hands and stand up taking most of your weight through your un-operated leg (Figure 3). Do not hold or pull on an object such as a walking frame as these can easily move or tip causing you to fall backwards.

Sitting down:

Always make sure you can feel what you are going to sit on at the back of your legs before sitting. Place your hands back onto the chair or bed and sit down slowly sliding your operated leg out in front of you (Figure 4).

Next: Walking

Walking

We will aim to have you walking the day of your operation or the next morning. Initially you will walk with a frame and progress onto walking sticks or elbow crutches as soon as you are able (Figure 5).

To walk, move the walking aid forward. Step forward with your operated leg. Take some weight through your arms as you step forward with your un-operated leg. When turning, make sure that you take small steps. Do not twist on your operated leg.

Next: Going Up and Down Stairs

Occupational Therapy

You may see an occupational therapist (OT) while you are in the hospital. The OT can look at activities that you do every day at home, e.g. dressing and going to the toilet. They can give you advice on how to make activities easier and if necessary may provide you with aids to help you with these activities. If you do not see an OT and feel you need advice or aids to help you at home, please let a member of staff know as soon as possible. This will allow the OT time to see you and to order equipment and arrange to have it in place in your home if you need this.

Next: Information for When You Go home

Information for When You go Home

You will normally go home 2-4 days after your operation. You should arrange for family or friends to take you home by car. Please note if hospital transport is necessary we will have discussed this at your pre-assessment appointment.

Homecare:

Homecare is available if you do not have anyone to help at home but only if it is absolutely necessary. They can assist with personal hygiene, shopping and cooking but may not assist with cleaning. Please think about this in advance and discuss with the nursing staff so there is adequate time to organise.

Please note there may be a charge for this service.

Wound:

For a while after you go home, your wound may appear red, warm to touch or the wound may feel itchy. You may have swelling which can affect your whole leg. You may also have a change in sensation around your wound. In most cases these are normal after your operation.

If you notice a marked change and the area around your wound becomes much redder and is very hot and swollen, or if you develop any discharge from your wound it is important that you get this checked for signs of infection as soon as possible. We advise that you see a member of your consultant’s team. You can either contact them directly or contact the ward where you had your operation and they can direct you to the appropriate person.

Pain:

It is important that you continue to take regular painkillers once you are home (The ward will have given you some home with you).

Remember painkillers can make you constipated so please drink plenty of fluids and have fibre in your diet.

Painkillers are important to control your pain to allow you to continue to do your exercises. If your painkillers are not controlling your pain then please speak to your GP.

Swelling:

When you go home it is important that you have regular rest and raise your leg (higher than your hip if possible). You may also find that an icepack on your knee now and again will help. If you notice that your operated leg is swelling please rest more between your exercises. This is not unusual.

Please note if your calf is hot, swollen and painful to touch then contact your GP urgently. If you suddenly become very breathless and do not normally suffer form breathing difficulties then you should get advice from your GP urgently.

TED Stockings:

If you are given these you can stop wearing them 6 weeks after your operation.

Exercises:

Continue to do the exercises you were shown in hospital 2-4 times every day. Knee movement and the strength in your leg will gradually improve over time.

Walking:

Try not to sit for long periods. Go for short walks regularly and keep using your walking aids as instructed by your physiotherapist. Build up your walking distance gradually from short distances around the house to getting out and about. After 6 weeks you can gradually start to wean yourself off the walking aids. If you start to use 1 stick use it on the opposite side from your new knee.

Kneeling:

Most people find it extremely difficult to kneel on their operated knee and it is probably best to avoid this. However it is acceptable to kneel for short periods if need be. We would advise you to use a cushion to kneel on.

Housework:

Try to spread your housework evenly over the week. Do not stand for long periods at a time. Try to adapt activities e.g. prepare vegetables or iron sitting down.

Physiotherapy:

Not everyone needs routine physiotherapy follow up. However your physiotherapist can arrange this if appropriate.

Driving:

You should avoid driving for 6 weeks after your operation. This allows some healing to take place and the leg muscles to become stronger. Plan your first drive. Only return to driving when able to comfortably and safely change gear and carry out an emergency stop. Avoid any long journeys at this stage. We advise you to tell your insurance company that you have had a knee replacement.

Flying:

There is no universal agreement on this however we advise you to avoid short-haul flights for 6 weeks after your operation and long haul flights for a minimum of 3 months. If you are flying remember to do some circulatory exercises and if possible get up and move around. At 6 months after your operation the risks associated with sitting for long periods will be back to what they were before the operation.

Next: Return to activity and work

Return to activity and work

You should avoid high Impact sports such as jogging, skiing, squash and high impact aerobics. If there is a certain sporting activity you usually do please ask for advice.

You should avoid activities such as bowling, golf and dancing for 6 weeks. After this reintroduce such activities gradually. Use how your knee feels as a guide. If something feels uncomfortable, stop and try again the following week.

Gentle exercise such as swimming can be helpful. You must however wait until your wound is completely healed and should avoid breaststroke for 6 weeks after your operation.

Returning to work depends on how physically demanding your job is. Your consultant will advise you about this.

Next: Follow Up

Going Up and Down Stairs

If a handrail is available then always use it as well as one stick or crutch. Your physiotherapist will teach you how to carry your other stick or crutch up the stairs as you will need it when you get to the top.

Going up stairs (Figure 6)

1. Place your un-operated leg up onto the step

2. Lift you operated leg onto the same step

3. Bring the stick or crutch up onto the same step.

Going down the stairs (Figure 7)

1. Place your stick or crutch down onto the step below

2. Step down with your operated leg

3. Bring your un-operated leg down onto the same step

Next: Occupational Therapy

Introduction

This booklet gives you and your family a basic knowledge of hip joint replacement, outlining things you should know both before and after your operation. The aftercare may vary according to your surgeon’s wishes.

The success of your operation is a team effort including doctors, nurses, physiotherapists, occupational therapists, your family and most importantly you.

Why may I benefit from Total Hip Replacement?

Joint problems develop when the head of the thigh bone (femur) and its socket in the pelvis (acetabulum) lose their protective cartilage due to wear and tear (osteoarthritis), injury or types of inflammatory arthritis e.g. rheumatoid arthritis. The bone ends become rough and misshapen and this can lead to stiffness, pain and sometimes shortening of the leg (Figure 1). As these changes progress they can interfere with normal daily life. Walking, climbing stairs, shopping, housework, gardening and employment can become more difficult and sometimes impossible.

What is a Hip Replacement?

A hip joint replacement operation involves removing the damaged bone, replacing the head of the femur and relining the hip socket (acetabulum), see Figure 2. The type of replacement operation or components used will depend on the degree of damage to the joint surfaces, your consultant’s preference and your suitability for a particular joint.

A hip replacement has a long metal femoral stem which sits inside the thigh bone; it has a ball which replaces the damaged femoral head (this may be metal or ceramic) and a cup which relines the hip socket (this may be plastic, metal or ceramic), see Figure 3. These components may or may not be cemented into place. Your consultant will discuss what type of hip replacement is most suitable for you.

What should you do once on the waiting list for a hip replacement?

You should make sure you are as fit as possible before coming in for your operation. This will make it easier for you to recover after the operation and help you get home quickly. We will have you mobile as soon as possible after the operation to prevent complications. You will find this easier if you exercise before you come into the hospital. We suggest you stay as active as possible and start the exercises in this booklet straight away.

It is also important to eat healthily as this will help your body recover from the operation. If you drink alcohol or smoke, cutting back will help reduce the risk of any complications and help you recover more quickly.

In some hospitals you may have a health check at a clinic before your operation. However if this is not the case and you have any concerns regarding your health you should discuss these with your GP. It is useful if you have your GP check your blood pressure and make sure you receive treatment for any skin problems as these may delay your operation. It will also be beneficial to attempt losing weight if you are overweight.

To prepare for going home after your operation it may be useful to discuss the following with family or friends.

Things to consider are:

• How you will get home from hospital

• Who will help out at home

• Any questions you have regarding the operation and recovery afterwards (write these down)

• Organising your home so things you need are easy to get to and anything you could trip over is cleared away.

We aim to get you home as soon as you are safe to do so and have met your discharge criteria. This is to reduce the risk of post-operative complications such as hospital acquired infection.

Pre-operative Assessment Clinic

Before coming into hospital, we will ask you to attend the pre-operative assessment clinic.

At this clinic you will see a nurse or a doctor, and you may see a member of the occupational therapy team (please bring your measurement sheet to the clinic if you were provided with one beforehand).

We carry out full investigations to make sure that you are as fit as possible before your operation. This involves taking a record of your medical history and a list of your current medications (it is useful if you bring a list of these with you). At the clinic we will:

• Measure your height and weight

• Check your blood pressure

• Take samples of your urine and blood for analysis

• Take an ECG (a tracing of your heart)

We will also take swabs of your nose, throat and groin. This is to make sure that you are clear of MRSA (methicillin resistant staphylococcus aureus) before coming into hospital.

The staff at the clinic will also discuss your operation with you. Please take this opportunity to ask any questions you may have regarding your operation and hospital stay. It may help if you write a list and bring it with you (there is space for questions at the back of this booklet).

What to bring into hospital

You should bring any medication you are already taking in its original packaging.

You should expect to be in hospital for 2 – 4 days so bring enough comfortable daytime clothing and nightwear. You should bring sensible footwear: flat shoes or slippers that are easy to get on and off. Slippers should preferably have support around the heel. Your feet often swell up a little after the operation so make sure if you buy new slippers that they are big enough.

Before the operation

You will come into hospital either the day before or on the morning of your operation. We will give you advice on when to stop eating, however normally you will have nothing to eat from midnight the night before your operation.

The anaesthetist may visit you before your operation, if they haven’t already seen you. They will discuss the type of anaesthetic you will have. They may prescribe a pre-medication which the nursing staff will give to you before you leave the ward.

Your operation will be carried out in a specialised operating theatre.

Immediately after the operation

We will transfer you from the recovery room back to the ward in your bed. You are usually off the ward for roughly 3-6 hours. You may have a tube into a vein, “a drip”, to replace lost fluids but we will remove this as soon as possible. We will encourage you to eat and drink once back on the ward. You may also have a face mask or a nasal cannula to give you oxygen. You may have a large padded dressing over the hip wound.

The nursing staff will regularly monitor your blood pressure, pulse, temperature and oxygen levels.

We will aim to get you up after you have recovered from the anaesthetic.

We advise you to nominate 1 family member or friend to phone the ward to enquire how you are. Ask them to tell others about your progress rather than lots of different people calling the ward.

Pain Management

Some patients having a hip replacement operation have mild pain and others have more pain. Everyone is different but you should expect to have some pain. You must let the nursing staff know when you start to feel pain so that they can help you. It is harder to get the pain under control if you wait too long.

The anaesthetist and ward staff will discuss pain relief options with you and a pain management nurse may visit you after the operation.

We may inject nerve blocks or local anaesthetic into the new joint while you are in theatre. As these wear off you will tend to feel the pain increasing. It is very important that you let the nursing staff know when this happens so they can get you pain killers. Powerful pain-killing tablets (Opiates) are the most commonly used method of pain relief. Sometimes we use patient controlled analgesia (P.C.A.) however this is much less common.

Do not wait until you are very sore before asking for painkillers.

Pain killing tablets:

A long acting tablet taken in the morning will release a powerful pain killer for twelve hours. The nursing staff will give you another one at bedtime to help with pain throughout the night. You will also get regular paracetamol. Most people need more than this to control the pain however you will not get the strong break through painkiller unless you ask for it. It is very important to let the nurses know when you are sore so they can give you this to help you. Always think about how the pain is when you are moving and not just sitting or lying still – the emphasis after the operation is to get you moving so your pain control is hugely important.

Before you go home we will take you off these pain killers and prescribe something that you can take regularly yourself.

Pain killers can cause constipation. If you are affected by this or think you are likely to be please let the nursing staff know so they can give you a gentle laxative to help.

Some patients experience nausea or vomiting after an operation. If you feel sick let the nurse know. They can give you medication to help reduce this.

Recovering from your operation

At first you will be lying on your back and you may find moving around the bed awkward. Try bending your good leg up and push down through the bed with your foot and arms to lift your bottom off the bed. This helps prevent any sores developing. You should also keep your feet moving to help your circulation. People are often scared to move after their operation but there is no harm in starting the exercises shown in this book once you are able to move your legs.

The nursing staff will encourage you to be as independent as possible, whilst making sure of your safety. They will give you whatever help you need with washing and dressing etc following your operation, however they encourage you to do as much as possible on your own.

We will remove the padded bandage the day after your operation, and will usually replace it with a lighter dressing. We will check your wound dressing every day and will only change it if necessary. If you have wound clips or stitches that need to be removed, the nursing staff will organise for a district nurse to do so when you are home.

We encourage you to be as mobile as possible after your operation. When possible the nursing staff or physiotherapists will aim to have you out of bed the same day as your operation. This helps you return to independence, and helps prevent complications after your operation.

One possible complication is a blood clot in the calf, known as a DVT (deep vein thrombosis). A DVT can move to the lungs, this is known as a pulmonary embolism (PE). We will give you medication and or other mechanical means such as stockings to help prevent blood clots. However moving and walking as soon as possible after the operation is one of the best ways of preventing this.

Some people find that their operated leg feels a bit longer or a bit shorter than the other leg. This usually corrects over time. If it is still a problem after several months you can get a raise on your shoe to level the legs out. You will have an x-ray of your hip before you go home. The x-ray will show any difference in length that is unlikely to settle overtime.

Some patients require a blood transfusion or iron tablets after their operation. We will discuss this with you if necessary.

Precautions

Not all patients need to follow precautions following total hip replacement, your physiotherapist and occupational therapist will advise you if you need to follow the precautions outlined in this section.

To prevent you placing your hip in positions that may lead to dislocation please follow the precautions below. You should follow these for 12 weeks:

1. Do not bring your operated leg past the midline of your body i.e. do not cross your legs or ankles (Figure 4).

2. Do not bend your operated leg up past 90i.e. when sitting do not bend down or forward and do not let your knee become higher than your hip level (Figure 5).

3. Do not let your operated leg twist or rotate inward i.e. when turning make sure you take small steps around instead of twisting your hip and don’t roll onto your side when getting out of bed (Figure 6).

Physiotherapy

The physiotherapist will visit you either the afternoon of your operation or the next morning. They will teach you exercises to increase the circulation in your legs and increase the movement and strength of your hip. These are important because the muscles around your hip are often weak and tight. This is because the pain and stiffness of the arthritic hip stopped you from moving it normally. It will help if you start these exercises straight away unless we tell you otherwise. We will show you how to use your walking aid safely.

We aim to have you up walking on the same day as your operation or the next morning. The physiotherapist may also check your breathing and offer advice to help your lungs stay clear of infection.

After your operation the physiotherapist will continue with your exercises and practice walking. You will use a walking frame to walk initially and will progress onto elbow crutches or walking sticks as soon as you are ready. You will also practice going up and down stairs before going home.

At present we aim to get people home within 2-4 days of their operation but this varies and you may get home sooner or later than this.

Please note: there may be some circumstances when your consultant does not want you to start exercises straight after your operation. If this is the case then your physiotherapist will tell you.

Exercises

Below are the exercises that the physiotherapist will do with you. You should aim to do these 4 times a day while in the hospital.

1. Ankle Pumps: Pull your ankles backwards and forwards and circle them around. This increases the blood flow in your legs and decreases the chance of blood clots forming.

2. Static Quads: Point your toes to the ceiling. Press the back of your knee against the bed and tighten up the muscle in your thigh. Hold for 5 seconds then relax. Repeat 10 times.

3. Static Gluts: Squeeze your bottom muscles together and hold for 3-5 seconds then relax. Repeat 10 times.

4. Hip Flexion: Bend your hip and knee up and down. Be careful not to bend it too far (a right angle between your trunk and thigh is your limit!). Do 2 sets of 10.

5. Hip Abduction: Bring your leg out to the side then back in again. Do 2 sets of 10.

6. Hip Abduction: While standing, hold onto a steady object (e.g. the back of a chair). Keep your trunk still in an upright position and lift your leg out to the side. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier). Repeat 10 times.

7. Hip Extension: While standing, hold onto a steady object (e.g. the back of a chair). Keep your trunk still in an upright position and bring your leg backwards. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier). Repeat 10 times.

8. Hip Flexion: While standing, hold onto a steady object (e.g. the back of a chair). Bend your knee and hip as if you were going to lift your leg onto a step. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier). Repeat 10 times.

Although the physiotherapist will be there to teach and guide you it is important that you do your exercises independently and have regular walks on the ward once the physiotherapist says you are safe to do so. It is ultimately your effort that will get your hip working properly again. If you find you are struggling to do the exercises or walking because of pain please let a member of staff know – we cannot help unless you tell us.

Getting in and out of bed

Whilst in hospital the physiotherapist, occupational therapist and nursing staff will show you how to get in and out of bed safely. You will practice from whatever side of the bed you get in at home. The main thing to note is that you should not roll onto your side while doing this as this can cause your hip to twist (Figure 7 and 8).

Standing up and sitting down

Standing up:

To stand always make sure that you place your hands on the bed or chair. Your operated leg should be out in front of you before standing up. Push through your hands and stand up taking most of your weight through your un-operated leg (Figure 9). Do not hold or pull on an object such as a walking frame as these can easily move or tip causing you to fall backwards.

Sitting down:

Always make sure you can feel what you are going to sit on at the back of your legs before sitting. Place your hands back onto the chair or bed and sit down slowly sliding your operated leg out in front of you (Figure 10). The occupational therapist will check that your chair is not too low. We encourage you to sit as normally as possible (do not sit at the edge of your chair with your leg out in front of you). As long as your knee is not above your hip when you are sitting, your position will be fine. Do not cross your legs whilst sitting as this can be harmful to your hip.

Next: Walking

Walking

Initially you will walk with a frame and progress onto elbow crutches or walking sticks as soon as you are able (Figure 11).

You may not be allowed to put your full weight through your operated leg for at least 6 weeks after your operation. If needed, your physiotherapist will teach you how to do this.

To walk, move the walking aid forward. Step forward with your operated leg. Take some weight through your arms as you step forward with your un-operated leg. When turning, make sure that you take small steps. Do not twist on your operated leg.

Going up and downs stairs

If a handrail is available then always use it as well as one crutch or stick. Your physiotherapist will teach you how to carry your other crutch or stick up the stairs as you will need it when you get to the top.

Going up stairs (Figure 12)

1. Place your un-operated leg up onto the step

2. Lift you operated leg onto the same step

3. Bring the crutch or stick up onto the same step

Going down the stairs (Figure 13)

1. Place your crutch or stick down onto the step below

2. Step down with your operated leg

3. Bring your un-operated leg down onto the same step

 

Occupational Therapy

It is important that you follow the precautions against dislocation in everyday activities if you have been advised to follow precautions by your occupational therapist. During the first 12 weeks, you may need some equipment and, or adaptations to perform certain activities of daily living safely. You may also need to modify the ways in which you carry out some activities. The occupational therapist (OT) will give you advice on both these aspects, and will assess what would be most appropriate for use in your home. Where possible the OT will see you at the pre-operative assessment clinic and can arrange delivery and fitting of any equipment that you may need.

Bending and dressing lower half:

Do not bend to pick things up off the floor or to reach to your feet. To prevent you from doing this the OT will provide you with long handle aids (helping hand and shoe horn) and teach you how to use these.

Seating:

To prevent your hip bending too much you should sit in a chair that is an appropriate height. If your chair at home is too low it is usually possible to raise it using special blocks or with a cushion. The OT will discuss this with you.

Bed:

You should avoid sleeping in a low bed. Where necessary and if possible the OT can arrange to have your bed raised.

Toilet:

A raised toilet seat and, or rails may be required. The OT can supply these if you need them.

Bathing:

For the first 3 months you should not attempt to use the bath or a shower over the bath unless the OT has shown you how to do so and the necessary equipment is in place. The equipment is usually a shower board. We advise you to have someone with you the first time you use this.

1. Stand with your back to the bath and sit down on the board.

2. Turn yourself around to face the end of the bath, lifting your legs over the side of the bath as you turn (keep your operated leg straight at the knee as you lift it). If it is difficult to lift your legs over the edge of the bath yourself, get someone to help you.

3. To come out of the bath reverse the procedure.

Remain seated while you shower or wash and take care not to twist round while sitting on the board. If necessary get somebody else to operate the shower controls.

Equipment:

Depending on where you stay a central store or community OT will supply your equipment. Some smaller items are supplied on the ward by the OT.

• All equipment provided should be in good working order, and be fitted securely.

• When your equipment is fitted you should be provided with equipment instructions and a contact number.

• Once fitted the equipment should not be positioned elsewhere.

• If the equipment is not fitted securely, do not use it. Contact the supplier or OT Department. The equipment is provided on a short term loan (approximately 12 weeks).

To return equipment no longer required phone the supplier. If you are unable to do this contact the OT Department.

Getting In and Out of a Car

Getting into a car:

1. Move the front passenger seat back as far as it goes and recline the chair.

2. Put a pillow on the seat to make it higher if necessary.

3. With your back towards the seat, sit down with your operated leg stretched out in front.

4. Gradually move your bottom backwards and turn to face forwards. Help your operated leg into the car with your hands. Do not twist.

Getting out of a car:

1. Move your bottom to the edge of the seat.

2. Help your legs out of the car and move your bottom round.

3. Stretch your operated leg out in front of you.

4. Stand up leaning most of your weight through your un-operated leg.

Do not drive for six weeks after your operation.

Information For When You Go Home

You will normally go home 2-4 days after your operation. You should arrange for family or friends to take you home by car. Please note if hospital transport is necessary we will have discussed this at your pre-operative assessment appointment.

Homecare:

Homecare is available if you do not have anyone to help at home but only if it is absolutely necessary. They can assist with personal hygiene, shopping and cooking but may not assist with cleaning. Please think about this in advance and discuss with the nursing staff so there is adequate time to organise. Please note there may be a charge for this service.

Wound:

For a while after you go home, your wound may appear red, warm to touch or the wound may feel itchy. You may have swelling which can affect your whole leg. You may also have a change in sensation around your wound. In most cases these are normal after your operation.

If you notice a marked change and the area around your wound becomes much redder and is very hot and swollen, or if you develop any discharge from your wound it is important that you get this checked for signs of infection as soon as possible. We advise that you see a member of your surgical team. You can either contact them directly or contact the ward where you had your operation and they can direct you to the appropriate person.

Pain:

It is important that you continue to take regular painkillers once you are home. (The ward will give you some home).

Remember painkillers can make you constipated so please drink plenty of fluids and have fibre in your diet.

Painkillers are important to control your pain and to allow you to continue to do your exercises. If your painkillers are not controlling your pain then please speak to your GP.

Swelling:

When you go home it is important that you have regular rest and raise your leg (not higher than your hip). If you notice that your operated leg is swelling please rest more between your exercises. This is not unusual.

Please note if your calf is hot, swollen and painful to touch then contact your GP urgently. If you suddenly become very breathless and do not normally suffer from breathing difficulties then you should get advice from your GP urgently.

TED Stockings:

If you are given these you can stop wearing them 6 weeks after your operation.

Exercises:

Continue to do the exercises you were shown in hospital 2-4 times every day. Hip movements and the strength in your leg will gradually improve over time.

Walking:

Try not to sit for long periods. Go for short walks regularly and keep using your walking aid(s) as instructed by your physiotherapist. Depending on your type of hip replacement you may need to use 2 crutches for 6 weeks after the operation. Build up your walking distance gradually from short distances around the house to getting out and about. After 6 weeks you can gradually start to wean yourself off the walking aids. If you start to use 1 stick or crutch use it on the opposite side from your new hip.

Housework:

Try to spread your housework evenly over the week. Do not stand for long periods at a time. Try to adapt activities e.g. prepare vegetables or iron sitting down. We advise you to avoid hoovering for 12 weeks.

Sleeping:

Continue to sleep on your back for six weeks after your operation. After this you can sleep on your operated side or on your un-operated side if necessary but you should place a pillow between your legs (Figure 16). It is also good to lie flat for at least half an hour each day to stretch out the front of your hip.

Gardening:

Do not garden for the first 12 weeks. After this you still need to be careful to avoid twisting or excessive bending at the hip. You should avoid digging for several months.

Physiotherapy:

Routine physiotherapy follow up is not usually necessary. However your physiotherapist can arrange this if needed.

Driving:

You should avoid driving for 6 weeks after your operation. This allows some healing to take place and the leg muscles to become stronger. Plan your first drive. Only return to driving when able to comfortably and safely change gear and carry out an emergency stop. Avoid any long journeys at this stage. We advise you to tell your insurance company that you have had a hip replacement.

Sex:

Avoid any kind of strain to the hip during sex for the first 3 months after your operation. Please ask us if you would like an information sheet.

Flying:

There is no universal agreement on this, however we advise you to avoid short-haul flights for 6 weeks after your operation and long haul flights for a minimum of 3 months. If you are flying remember to do some circulatory exercises and if possible get up and move around. At 6 months after your operation the risks associated with sitting for long periods will be back to what they were before the operation.

Return to activity and work

As soon as the wound heals you may start gentle activity such as swimming, however you should avoid breast stroke for 3 months. Swimming is beneficial because you are not weight-bearing and therefore puts less stress on the hip joint and the buoyancy allows you to move and exercise easier.

Activities such as golf or bowls can be played 3 months after your operation. Avoid high impact sports such as jogging, skiing, squash and high impact aerobics are best avoided. If there is a certain sporting activity you usually do please ask for advice. If you are dancing you should take care not to pivot on the operated leg.

Returning to work depends on how physically demanding your job is. Your consultant will advise you about this.

Follow Up

In some hospitals the orthopaedic outcomes team or arthroplasty service will carry out your routine follow up on behalf of your consultant. In other hospitals your consultant or their registrar will see you in clinic.

Your follow up appointment will be 6-12 weeks after your operation. This will depend on your Consultant’s instructions.

The purpose of the appointment is to monitor your progress and to offer advice, reassurance and information on any aspects of your surgery and recovery. You may have an x-ray carried out at this time and we will ask you to complete some questionnaires at your follow-up clinic to help us monitor your progress.

Visiting Times

Visiting times vary in different hospitals. Please ask for the visiting times on your ward.

Visitors do not need to stay for the full time. They can pop in and out any time during these periods. There should be no more than 2 visitors at a time.

Please note that visiting times can be very long and you may have to undergo treatment or go for x-ray during these times. We apologise for this but it is simply not possible to see everyone out with these times.

Useful telephone numbers

This booklet gives you some information and advice but please ask any member of the team who cares for you in hospital about anything you are unsure of.

Once you are at home if you have any questions then please speak with your GP or if out of hours contact NHS 24 on 08454 24 24 24.

What Is An Tibial Fracture?

A fracture is a break or crack in a bone. The Tibia is the ”shin bone” in the lower leg, between the knee and ankle. The top of the tibia is the bottom half of the knee. The bottom of the tibia is the top half of the ankle. The fibula is a smaller bone that sits on the outside of the tibia. A tibial fracture is a break or crack in the tibia. It happens when a force is applied to the bone that is stronger than the bone can withstand. This sometimes happens after a fall, playing sport, a road traffic accident or a fall from height. Occasionally the skin will be damaged at the same place as the fracture which is then called an ”open fracture”. Sometimes the fracture goes into the knee or ankle joint, which is then called an “intra-articular fracture”.

 Next: Why is my injury being treated with surgery?

Why is my injury being treated with surgery?

The aim of surgery is to realign and stabilise the bone while it is healing. This is to try and prevent permanent stiffness, weakness and pain. Some tibial fractures can be treated in a plaster or splint if the bone is not displaced and stable, you accept the displacement or surgery would be too risky for you.

Next: What does surgery involve?

What does surgery involve?

Surgery usually involves the bone being realigned either through pulling the leg straight or with a clamp through small cuts in the skin. The bone is then held together with a metal rod that is put within the bone. This rod goes from just below the knee to just above the ankle. Screws lock the rod in place at the top and bottom. There are other ways that tibial fractures can be fixed surgically but your surgeon will discuss them with you if that is necessary. Usually the other methods are if you have an open or intra-articular fracture.

You will usually have a small cut (wound) at the front of the knee, two small stab wounds just below this and another 2 small stab wounds just above the ankle. If another wound is needed to realign the fracture with a clamp you may have another wound at the level of your fracture.

There are always risks of surgery, these will be explained to you before surgery takes place by your surgeon. Surgery will either involve a general anaesthetic (going to sleep) or a spinal anaesthetic (numbing your leg so you don’t feel the surgery). This will be decided between you and your anaesthetist. The surgery usually takes between 1-2 hours.

Next: What Happens Next?

What Happens Next?

You will usually be discharged from hospital within a day or two after surgery unless you have problems with your mobility. Before you go home a doctor or nurse will discuss with you whether you need to take any blood thinning medication. You will usually have follow up at 2 weeks and 12 weeks after surgery. These appointments will should be given to you before you leave hospital.

Walking Boot : You will usually go home wearing a walking boot that you can put as much weight through as you are able. You should wear this for 2 weeks after surgery (you can wear this for up to 6 weeks if you find it helpful). You can take it off when you are sitting down, in bed, or doing your exercises.

Physiotherapy : You will also see a physiotherapist before you go home that will show you how to do some knee and ankle exercises. These are also shown in this information sheet. If they think you might need some extra help they will arrange an appointment for you to see them once you have gone home.

Next: Follow Up Appointments

Follow Up Appointments

At around 2 weeks after your surgery, you will be seen by one of the fracture clinic nurses. They will examine your wounds and leg. They will look at your wound, remove the clips. They will then make sure you have another appointment booked for week 12 with the fracture clinic. If they are concerned they may ask you to come back later that day or the next day to see a surgeon.

At around 12 weeks after your surgery, you will come back to hospital for an X-ray and to see a surgeon. Most people will be discharged after this appointment to patient initiated return but some may need more appointments or a physiotherapy referral.

If your bone has not healed back together yet, some bloods will be taken at this clinic and you might be referred onto a specialist. They will then phone you at around 6 months after surgery to find out how you are doing and to review your tests. If your bone hasn’t healed you might be offered further surgery at around 1 year following your original operation. This is only required for around 1 in 20 patients.

Next: Patient Initiated Return

What Problems Should I Look Out For?

Some problems patients can develop after surgery are infection, blood clots in the leg, poor bone healing, arthritis, knee pain, nerve damage, irritating or prominent metalwork, , knee or ankle stiffness, walking difficulties or poor balance. If you are suffering from any of the list below, it may mean you have one of these problems from your surgery.

Infection – You might feel unwell or feverish with increased pain, swelling or stiffness in the knee or ankle. Sometimes the wound can become red, painful or start to leak. If you develop any of these problems contact the clinic using the contact details below. If it is out-with clinic hours and you feel unwell then go to your local Emergency Department.

Pain – This can be caused by many problems. If your pain is getting worse or you still have moderate or severe pain more than 12 weeks after surgery and it hasn’t been discussed with your surgeon, then contact the clinic using the details below.

Stiffness – If you are having problems with knee or ankle stiffness that is affecting your ability to do things at 12 weeks after surgery you should arrange physiotherapy using the details below.

Swelling – If you have new or worse swelling after you have been to your final clinic appointment then contact the clinic using the details below.

Breathing problems – For around 1 in 100 patients, a blood clot can form in the veins of the leg after surgery. This might cause pain and swelling in the leg. Very rarely a clot can travel to the lung through the bloodstream. This can give people chest pain or breathing difficulties. If you think you have one of these problems phone an ambulance or NHS24 immediately.

Walking difficulties or balance problems – There are different reasons why patients can have problems with walking or balance after surgery. If these problems continue for more than 12 weeks after surgery you may benefit from speaking to a healthcare professional. You may also have stiffness or pain that affects your ability to walk. If your problem is mainly caused by pain, you should contact the clinic. If it is mainly caused by stiffness, or you have balance problems, you should arrange to see a physiotherapist. It is ok to call the clinic to discuss this first if you are not sure.

Irritating or prominent metalwork – If you can feel a prominent lump around one of your scars, it might be that one of the screws has become loose. If this happens you should contact the fracture clinic.

If you have a problem related to your fracture or surgery that is not listed here but you would like to see someone about it then please contact the clinic using the details below.

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Next: When Can I Walk Again?

When Can I Walk Again?

This depends on your injury and the surgery you have. Your surgeon will advise you about this after your surgery. Most patients will be allowed to walk as their pain allows them immediately after surgery. You will need to wear a walking boot while you are walking for the first 2 weeks after surgery but you can wear it for up to 6 weeks if this is helpful. You can take it off when you are sitting down, sleeping or doing your exercises. Sometimes people need to use crutches for some of this period. This will be assessed by a physiotherapist before you go home and sometimes at their clinics.

Next: When Can I Return To Work?

When Can I Return To Work?

This depends on the demands of your job. It is likely that you will require 2-3 weeks off to recover from the surgery and allow the discomfort to settle. If you have an office job, returning to work after this for light duties might be possible, but you should avoid anything which makes your ankle uncomfortable, such as prolonged standing or walking. For manual work requiring lifting, you will need at between 6-12 weeks off, and this may be longer depending of the extent of your injury. If your job involves driving you will be off work for at least 6 weeks. Once you can do the activities required by your job without significant pain, you can go back to work.

Next: When Can I Return To Driving?

When Can I Return to Driving?

You should not drive while you are in a cast or walking boot. You cannot drive for at least 6 weeks after surgery. After this you can drive when you are able to control your vehicle and safely perform an emergency stop. This is your decision. You can discuss this with your doctor or physiotherapist if you are unsure. You must be safe and in control of the vehicle. The law is very clear that you have to be able to prove to the police that you are ‘safe’ to drive, so it is entirely your own responsibility and we cannot give you permission to drive.

Next: When Can I Return to Sport?

When Can I Return To Sport?

You should only return to contact sport at least 12 weeks after your injury. Other sport may be possible earlier but you should take the advice of your doctor or physiotherapist who will guide you.

Next: Do I Need Physiotherapy?

Do I Need Physiotherapy?

Before you are discharged you will be seen by a physiotherapist and they will go over the exercises in this book with you. If they feel that you might need extra help they may arrange an appointment at their clinic for you. If you are having problems with stiffness and this is affecting what you can do discuss this at your clinic appointment and you may need a physiotherapy referral. If you have been discharged from Orthopaedic clinic, please contact the physiotherapy department below or arrange this with your GP.

Next: What Will My Recovery Be Like?

What Will My Recovery Be Like?

Below is a rough guide of what most patients will be able to do after surgery for a tibial fracture. Everyone is different and some people may take longer or shorter to be able to do these things. If you are unsure please discuss them with your nurse or surgeon.

Weeks 0-2

  • You will be in a walking boot for 2 weeks (up to 6 weeks if you find if helpful).
  • Keep foot elevated when you are not walking to reduce swelling.
  • You can weight bear as your pain allows.
  • You can remove this when you are sitting down, in bed or doing your exercises.
  • You can begin the knee and ankle exercises.

Weeks 2-6

  • Continue knee and ankle exercises
  • Return to desk based work if required and comfortable.

Weeks 6-12

  • The fracture is still healing.
  • You can begin to resume normal activity but be guided by any pain you are experiencing.
  • Carry out day to day activities.
  • Continue knee and ankle exercises.
  • If you no longer require to wear a walking boot you may wish to consider driving provided you can safely operate a car.
  • Heavy tasks, heavy lifting or sport may cause some initial discomfort.

Week 12+

  • The fracture is still healing for most people. It is usually healed by around week 14.
  • Return to manual work, sport and heavy activities may be possible.
  • If you are still experiencing significant pain or swelling that has come on after your week 12 clinic appointment then please contact the fracture clinic for advice.

 Next: Exercises

Exercises

Daily exercise programme

Aim to complete this exercise program every day, five times daily. You should spend around 2 minutes per exercise.

Bed Exercise:

1. Straight leg raise

  • Sit in bed with your legs straight and your back supported
  • Point your toes up to the ceiling, tighten your thigh muscles of your operated leg and press the back of your knee down into the bed.
  • Keep the knee straight and lift your leg up off the bed (clearing approx 30cm)
  • Hold for five seconds and then relax for five seconds.

Repeat 10 times

2. Ankle Movement

  • Sit in bed with your legs straight and your back supported.
  • Write out the alphabet with your foot, allowing your ankle to move through the movements of all the letters A to Z. All the movements should come from your ankle joint

3. Active assisted toe up with towel

  • Sit in bed with your legs straight and your back supported.
  • Loop a long towel/cloth around the front of your foot.
  • Hold the two ends with your hands.
  • Keeping you knee straight, try to bring your toes up towards your face. Assist the movement by pulling the ends of the towel/cloth.
  • Hold this position for 30 seconds and then release and relax.

Repeat 10 times

Chair Exercises

1.Knee bending

  • Sit upright in a chair, with both feet flat on the floor.
  • With the operated leg, slide your foot underneath the chair, keeping your toes on the floor, trying to bend your knee as much as possible, within your pain limits.
  • Hold this bent position for 10 seconds and then slowly return your leg to a comfortable position.
  • Relax between repetitions.

Complete this exercise 10 times.

2. Knee extension

  • Sit in a chair, with your knees at 90 degrees, and with both feet on the floor.
  • With the operated leg, tighten the muscles in your thigh, lift your toes and straighten your leg as much as possible.
  • Hold this straight position for five seconds and then slowly lower back down to the floor.
  • Relax between repetitions.

Repeat 10 times.

 Next: Further Information and Contact Details

Patient Initiated Return

At the end of your final appointment you will usually be discharged from further follow up. This information sheet has advice on problems to watch out for and advice on exercises you should carry out. You should read through this leaflet closely as they will tell you about what you should expect for your recovery. They will also tell you how to get arrange a further appointment should you have any problems.

Once you have finished at your final appointment, if you develop a problem related to your tibial fracture or surgery, you can contact the clinic and arrange a new appointment yourself. You do not need to contact your GP to do this.

Next: What Problems Should I Look Out For?

Further Information and Contact Details

Contact Details

Queen Elizabeth University Hospital main switchboard – 0141 211 1100

Queen Elizabeth University Hospital Fracture Clinic – 0141 452 3210 (Monday – Friday, 09:00 – 16:00)

Victoria ACH Fracture Clinic – 0141 347 8754 (Monday – Friday, 09:00 – 16:00)

Appointments booking office – 0141 347 8347 (Monday – Friday, 08:00 – 20:00)

Physiotherapy – 0141 452 3713 (Monday – Friday 8.30- 1600)

MSK Physiotherapy Self Referral https://www.nhsggc.org.uk/your-health/health-services/msk-physiotherapy/ 

Further information is available at:

https://www.nhs.uk/conditions/broken-leg/
https://orthoinfo.aaos.org/en/diseases–conditions/tibia-shinbone-shaft-fractures
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Introduction

This webpage will provide you with some information and exercises for you to follow after your shoulder surgery. This page is for rehabilitation following surgeries that do not involve immobilisation which means you will not have your arm in a sling for longer than one day. These include:

  • Subacromial decompression
  • Capsular release
  • Acromio-clavicular joint resection

If you have been told after surgery you will be in a sling for a longer than one day then this is not the correct information and you should refer to the Shoulder Surgery: immobilised information .

What Surgery Involves

Your keyhole surgery (arthroscopy) involves the surgeon making small incisions around your shoulder and using a tiny camera to look inside your shoulder joint. They will look for any areas of possible damage and undertake any necessary treatment. Sometimes the treatment required can be more or less than anticipated prior to surgery. 

You will have a general anaesthetic which means you will be asleep. In some cases, we may use a nerve block to numb the area.

After surgery your arm may be in a sling. This is for initial support, as after your procedure there will be little to no movement in the arm and hand. This should not last for longer than 24 hours.  Once you have regained full sensation and movement of your arm it is safe to take the sling off and discard it. You will probably get home on the day of your surgery or on the day after. 

The ward physiotherapist will see you on the ward after your surgery to provide advice and complete exercises with you. They will refer you for further physiotherapy as an outpatient. You will be contacted with an appointment by telephone or letter with your outpatient physiotherapy appointment.

Post Operative Advice

Pain:

There will be some pain and discomfort after your surgery. You should take painkillers as prescribed, do not wait for your pain to worsen prior to taking pain relief.

Wound:

You will go home from the ward with a dressing over your wound. The nursing staff will give you dressings to use at home and tell you about when and where to get your stitches out. This is usually about ten days after your surgery. However, you will be left with small scars around the shoulder

Sleeping:

We advise you to sleep in any comfortable position. However, sleeping on your operated shoulder will probably increase your pain.

Washing and dressing:

Avoid getting your wound dressing very wet.

When dressing your upper body place your operated arm into your clothes first for comfort. When undressing remove your operated arm last.

Are there things I should avoid after my surgery?

There are no movements of the shoulder that you need to avoid unless we tell you otherwise. You can expect your arm to be uncomfortable when moving. Do not be frightened to start moving your arm and start the exercises.

We recommend you start light activities when you feel able this should be in the days following surgery. Do not lift anything heavy with your operated arm for at least 6 weeks.

If your arm is painful on certain movements then it is best not to force or push these movements and speak with your physiotherapist.

When can I start to drive again?

You should not drive for 2 weeks after your surgery. Do not drive until you have regained full control and movement of your arm. Before driving sit in your car and try using all of your controls to make sure you are able to do so comfortably. When you return to driving, start with a short journey to ensure you are comfortable and in control.

We also recommend that you speak with your insurance company before you start to drive. The law states you should be in complete control of a car to drive.

When Can I Return to Work?

This depends on your occupation, most people can return to work within 6 weeks of their surgery. If your job involves only small movements of your operated arm you may be able to return to work within 1 week.

Please discuss this with your surgeon, doctor or physiotherapist.

When Can I Return to Hobbies and Sport?

This depends on your pain, shoulder movement and strength. Pain would be a sign that you are not ready to return to a specific activity.

Your physiotherapist will guide your return to heavy activities and sport. We normally recommend that you avoid specific sporting activities that involve the operated arm, such as golf and racquet sports for 3 months.

Physiotherapy

The exercises included in this booklet are safe to start once you have the feeling back in your arm, normally the same day or the day after your surgery. It is important that you attempt to do these exercises as instructed to regain the movement and strength of your shoulder.

You will be referred for physiotherapy by the ward physiotherapist – this will usually be within a few weeks of your surgery. You will need to attend physiotherapy to continue your rehabilitation.

Exercises

It is normal to feel aching, discomfort or stretching sensations when doing your exercises. We recommend that you do each exercise 15 – 20 times and repeat this three times per day with at least 2 – 3 hours in between.

  • Pendular: Allow your operated arm to hang by your side and allow it to swing gently forward and backward.
  • Posture: It is important not to slump or have round shoulder posture after your operation. You should practise correct posture regularly.
  • Shoulder Raising: Hold a stick in both hands and slowly raise this upwards, your non-operated arm should help assist movement of your operated arm.
  • Shoulder Side Movements: Hold a stick in both arms at waist level. Gently push your operated arm up and outwards, using your operated arm to assist the movement.
  • Shoulder Rotation: Hold a stick in both hands with your elbows at waist height. Push your operated arm out to the side using your non operated arm to help. You should keep your elbows at your waist, only your hand should move out.
  •  Wall slide: Place your hand flat on wall in front of you at waist or chest height, which ever you are comfortable with. Slide your operated arm up the wall. As your arm raises you may need to step closer to the wall.
  • Table Flexion: place your hands onto flat surface or table. Slowly step backwards keeping your hands on the table bringing your head and shoulders forward into flexion.
Follow Up

All patients will attend follow up appointment but trauma and elective patients will be seen at different clinic types and at different timescales post-operatively.

You will be given your first return appointment by the nursing staff prior to discharge from the ward.

If you have any concerns following surgery please contact your follow up clinic, your GP or physiotherapist for advice.

If you have any urgent concerns please call NHS 24 on 111.

What is an Ilizarov frame and why is it used?

Illzarov is a circular frame used to hold bones in place; this is a type of external fixation. The frame holds broken bones in place to allow healing through the use of rings and wires. The metal rings will go fully or partly round your leg with the metal wires going through your bone and attaching to the rings. The tension between the rings and wires hold the bones to allow healing, this can take some time and your frame will be on for 6 to 18 months.

Frames are used for:

  • Bone breaks
  • Correcting deformities
  • Leg lengthening
  • Infection of metalwork
  • Non-union of bone internal fixation

Next: Rehabilitation

Rehabilitation

Rehabilitation is a large part of your recovery once your frame is applied. The physiotherapists and occupational therapists will work with you on the ward from the first day after your surgery until you are fit for discharge home; this will include mobility and other daily tasks such as washing and dressing. It is very important that you work with the physiotherapist and occupational therapists; this is your recovery and your progression relies upon your willingness and co-operation to work with the team looking after you.

If your frame is on the lower half of your leg you will be provided with footwear to fit below the frame and a band will be fitted around the shoe and to your frame to help maintain your ankle movement. See picture below.

Next: Exercises

Exercises

Once your frame has been applied, you will be expected to learn and perform exercises that will be explained to you by your physiotherapist. It is important to exercise the joints and muscles around the frame to prevent any other problems that would slow your recovery and to promote new bone formation. The main aim of these exercises is to maintain muscle length and strength. Try to repeat these exercises 3 times per day.

Toes

  • Bend and straighten your toes. Repeat 10 times.

OR

  • If you find this is difficult and your toes remain in a bent position try to gently straighten them out with your hands – hold this stretch for 30 seconds and repeat 3-5 times.

Ankle

  • Lying on your back or sitting. Bend and straighten your ankles briskly. If you keep your knees straight during the exercise you will stretch your calf muscles.
  • You can do this against the elastic band that is attached to your frame to make this exercise more difficult.

OR

  • A towel looped around the bottom of your foot can help pull your foot into a stretch – you should feel this up the back of your calf. Hold for 30 seconds and repeat 3-5 times.

Knee

1. Knee bend

  • Either sitting or lying on your back. Bend and straighten your hip and knee by sliding your foot up and down.
  •  Repeat this 10 times.
  • If you are struggling with this then you can use a towel to assist with this as shown.

2. Knee Strength:

  • Lying on your back with legs straight. Bend your ankles up and push your knees down firmly against the bed. Hold secs.5- relax. Repeat 10 times. 
  • Inner range Quads: Place a roll underneath your knee. Point your toes to the ceiling, rest the back of the knee against the roll and lift your heel off the bed while straightening your knee. Hold for 3-5 seconds then relax. Repeat 10 times.
  • Straight leg raise: Lying on your back with one leg straight and the other leg bent. Exercise your straight leg by pulling the toes up, straightening the knee and lifting the leg 20 cm off the bed. Hold approx 5 secs. – slowly relax. Repeat 10times.

Knee Stretch:

In sitting or lying. Rest your ankle on a stool or a rolled up towel. Stay in this position for 5-10 minutes to stretch the back of your knee.

Hip strength:

  • Lying on your front. Squeeze buttocks firmly together. Hold approx. 5 secs.Relax. Repeat 10 times
  •  Sidelying on your non frame side. Keep the leg on the bed bent and the upper leg straight. Lift the upper leg straight up with ankle flexed and the heel leading the movement. Repeat 10 times.
  •  Sidelying on your non frame side. Keep the leg on the bed bent and the upper leg straight. Lift the upper leg up 10cm then keeping the ankle flexed and the heel leading the movement take the leg behind you and back. Repeat 10 times.

Hip Strength in Standing:

  • Hip Extension: While standing, hold onto a steady object (e.g. the back of a chair). Keep your trunk still in an upright position and bring your leg backwards. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier). Repeat 10 times.
  • Hip Abduction: While standing, hold onto a steady object (e.g. the back of a chair). Keep your trunk still in an upright position and lift your leg out to the side. Hold for 3-5 seconds then relax (you can hold for longer as the exercise gets easier) Repeat 10 times.

 Next: Exercises Programme Videos

Mobility

After frame application you can fully weight bear on your leg, you will receive pain killers from nursing staff at regular intervals in the day to allow you to participate in your rehabilitation.

Your physiotherapist will provide walking aids to allow you to mobilise from the first day after your operation, the aid used will vary depending how much support you require. It is advisable that you have pain relief prior to therapy input as this will allow you to get the most out of your time with the therapist.

Walking with a frame:

  • Place walking frame out in front.
  • Step your frame leg first then weight bear down through your arms and step your non-operated leg in to meet it then repeat.
  • With therapy input you should move to walking one foot past the other, this encourages heel contact and weight bearing on your frame leg which is important.

Walking with elbow crutches:

  • You will be progressed to elbow crutches if able
  • Place both elbow crutches out in front
  • Step your frame leg first followed by your non operated leg.
  • When able start to walk one foot past the other again to encourage heel contact and weight bearing on frame leg.

Next: stairs

Stairs

If a handrail is available then always use it as well as one crutch. Your physiotherapist will teach you how to carry your other crutch up and down the stairs as you will need it when you get to the top/bottom. 

Going up stairs:

Instructions for climbing upstairs are:

  • Place your un-operated leg up onto the step
  • Bring your frame leg up to the same step
  • Bring the crutch up onto the same step

See videos below

Going down stairs

Instructions for climbing downstairs are:

  • Place your crutch down onto the step below
  • Step down with your frame leg
  • Bring your un-operated leg down to the same step

See videos below

Next: Transfers

Transfers

Your Occupational Therapist and Physiotherapist will likely ask you to demonstrate your ‘transfers’, i.e. how you move from one surface to another. This includes getting in/out of your bed, and on/off your toilet and chair. You will need to demonstrate that you can safely do these transfers before going home. Your rehab team will offer you advice on techniques, and may recommend specialist equipment to help. Some general tips for transfers are as follows:

Bed:

  • Sit-down high up the bed to minimise the need to adjust your position later.
  • Shifting your weight over each hip in turn can help you shuffle further on/off the bed.
  • Lift your leg high to avoid catching your frame or ripping your sheets/mattress. You may have to change which side you sleep on depending on which leg you find easiest to lead with.
  • The frame can be very heavy, so your Occupational Therapist may provide equipment to make getting in and out of bed easier.

Toilet:

  • Your Occupational Therapist will assess your ability to sit down and stand up from the toilet based on information provided about your home
  • Do not sit down until the backs of both knees are touching the toilet.
  • To sit/stand, stick your affected leg out in front, and bending forward at the hips to put your weight through your unaffected leg.
  • To control your movement, your Occupational Therapist may provide you with equipment which gives a sturdy hand-hold, or you can place your hands on the toilet bowl itself for support.      

Chair/sofa:

  • It is important to choose a chair that is high enough for you to get off easily. Your occupational therapist may provide equipment to raise your chair heights if required.
  • A chair with armrests on both sides can be useful to push up from.
  • You may wish to elevate your leg for comfort on a stool. Be careful with recliner footrests as your pins may get caught.

 Next: Washing and Dressing

Washing and Dressing

Dressing:

You will find wearing loose fit trousers, shorts, dresses, skirts or t-shirts ideal for getting on/off over your frame. You may find wearing a bigger size of clothing helps when dressing. When taking clothes on / off over your Ilizarov frame you will be required to be careful of the wires and pin sites You may even wish to cut trousers/ leggings / t-shirt arms above the external fixator. During your hospital stay, your Occupational Therapist will look at you getting dressed to provide further information and equipment to make getting dressed easier if required.

Personal care:

You will be advised to try keeping your frame and pin sites dry. It is recommended in between pin site cleans to have a strip wash while sitting on a chair being careful to avoid your pin sites. On the day you are completing pin site clean you can shower beforehand.

Sleeping:

When sleeping, you may find it more comfortable sleeping on your back. The metalwork around the frame may cause ripping to your bed sheets, to limit this wrap a pillow case around the External Fixation to protect your bed sheets. Do not place pillows under your frame, this can cause your knee to bend and over time this can limit your ability to fully straighten your knee.

Next: Going home and activity levels

Going home and activity levels

You will be involved in your own discharge planning throughout your rehabilitation including any ongoing needs you may have such as rehabilitation and care package.

Depending on your level of mobility and mobility aid, there are lots of things you will still be able to do for yourself. However, for the more robust activities, it is important to plan, and consider what support you have available to assist you.

Housework:

You may still be able to complete basic tasks, for example washing & drying the dishes. In order to make this task easier, consider storing your frequently used dishes and utensils in an easily accessible place at waist height, for example, on the work top, or, an easily reachable cupboard at eye level.

For more robust tasks such as hoovering or changing the bedding, you may want to arrange help. Speak to friends and family about this, or if you are able, privately arrange a cleaner.

Shopping:

Your ability to go to the shops will depend on your level of mobility. Being able to attend the shop for groceries should be a goal of yours if you were able to do this before. Initially for convenience, you may wish to speak to friends or family about arranging assistance.

If you have access to the internet, you can also arrange a delivery with a local grocer or supermarket.

Kitchen activity & meal prep:

There are many ways you can retain your independence in the kitchen. Your Occupational Therapist will discuss these with you during your assessment.

If there is an able bodied person at home with you, they may be asked to assist you with your meal preparation, and carrying items.

If you live alone, your Occupational Therapist will discuss your kitchen environment, how you will safely transfer items, and may assess you with appropriate equipment depending on your level of mobility at discharge.

Exercises and Mobility:

Try not to sit for long periods when at home, go for short walks regularly and keep using your walking aid(s) as instructed by your physiotherapist. Build up your walking distance gradually from short distances around the house to getting out and about.

Continue with your exercises at home 3 times a day.

You will be referred to your local physiotherapy department for ongoing progression of exercises and mobility; they will contact you with appointment once you are at home.

Next: Returning to work

Returning to work

If you are of a working age, and currently in employment, either the Doctor on your ward, or your own GP, can provide you with a sick line as required.

When returning to work, you should speak to your employer’s Occupational Health department. If your employer does not have an Occupational Health department, speak to your GP.

Either your GP or your Occupational Health department can provide advice and guidance with regard to a phased return to work.

Next: Driving

Driving

You cannot drive with an ilizarov frame. If you drive you must wait until your frame is removed before returning to driving.

Next: Mental Wellbeing

Mental Wellbeing

Having an External frame fitted can require a big adjustment to you (and your families) life. Following the application of your External Fixation you may find you have emotional ‘ups and downs’. Some frame users have described feelings of:

  • Fearfulness
  • Loss of identity
  • Feeling useless
  • Feeling like a burden
  • Fear for the future
  • Concern regarding pain/infection/your own ability

Prior to surgery you may find it beneficial to think of ways of coping and identifying people whom you could speak to when you feel frustrated and low. Your GP, consultant, nurse and AHP staff are also there to support you, providing advice and/or referring you onto other relevant services in your local area. Very often challenges can be overcome by finding ways to adapt to, or overcome, the situation. You may also benefit from speaking with other frame wearers at the weekly clinic to share experiences and advice. It is important to remember that every frame-wearer will have a different experience, and it is impossible to predict how you will feel, or what challenges you may come across. 

Useful resources:

Exercise Programme Videos

Exercise videos below:

1. Ankle pumps: Repeat 10 times 3 times per day

2. Ankle strength: start this exercise when exercise 1 becomes too easy.

Repeat 10 times 3 times per day

3. Knee stretch: hold position for 10mins repeat every 1-2hours

4. Knee flexion: Repeat 10 times 3 times per day

5. Inner Range Quads: Repeat 10 times 3 times per day

6. Straight Leg Raise: lift and hold for 10seconds.

Repeat 10 times 3 times per day

7. Hip Abduction in lying: Repeat 10 times 3 times per day

8. Hip Extension in lying: Repeat 10 times 3 times per day

9. Hip Extension Standing: can be done as alternative to exercise 8.

Repeat 10 times 3 times per day

10. Hip Abduction: can be done as alternative to exercise 7.

Repeat 10 times 3 times per day

Next: Mobility