Sankt Marien-Hospital Buer
Knee-joint-replacement operation
Before checking in
After arranging an appointment for the implantation of your knee joint, you should take into account the following recommenda-tions: 1. Please inform your family doctor and all other treating practitioners about your upcoming knee-joint-replacement operation. They might prepare you for your operation, Dear Patients,
especially if you suffer from one the following chronical diseases: You are suffering from distinctive arthritis by which we mean strong joint wear out. Even after trying all non-operative methods your doctor has decided that your life-quality is severely limited through pain and loss of function. Therefore the responsible doctors have come to the conclusion to perform a In order to ensure a safe and smooth running of the upcoming procedures, we would like you to thoroughly read the following It is important to be well prepared, to minimise all risks! 2. Part of the preparation should be to reduce massive 3. If there are any known allergies to any sort of metal, it is necessary to test the replacement joint material.
Two weeks before the operation you will be invited for a final check up. Please remember to bring along all necessary diagnostic findings of your treating practitioners (i.e. X-Rays, cardiograms, etc.). During this appointment you will be informed about all operational risks. Furthermore the anaesthetist will help you decide which aesthetic method to choose.
Important Medical Information
Blood Bottles
Please read the attached information concerning anaesthetics We are able to provide you with a modern bloodtransfusion and operational risks carefully, in order to be able to ask all technique, where we can restore the blood you have lost during the operation. This implies that the probability of an alien blood transfusion is significantly minimised but it cannot completely be ruled out. Therefore we offer the possibility of an own-blood-donation, which can be executed four weeks in advance at your local GP or blood bank.
Useful Clothing
Please bring walking shoes such as trainers, when you arrive for your stationary treatment. This will enable you to take first steps soon after the operation. If you already have crutches, If you consume any blood-diluting medication such as ASS®, please feel free to bring them along. It is also advisable to bring Aspirin®, Colfarit®, Iscover®, Miniasal®, Nootrop®, Plavix®, a rucksack so that you can comfortably carry any personal Persantin forte®, Rocornal®, Thomaphyrin®, Tiklyd® you have to discontinue this 10 -12 days before your operation after consul-ting your doctor. Occasionally treatment can continue by means of Heparin injections. This is also applicable for Marcamur®- Preparation of Rehabilitation
patients. If you are diabetic, please remember that due to an increased aesthetic risk you should refrain from the medication In good time to your operation you should have decided whether with Biocos®, Diabesin®, Diabetase®, Glucobon biome®, Gluco- you prefer a three week stationary rehabilitation to an ambulant phage®, Mediabet®, Meglucon®, Mescorit®, Met®, Metforim®, one. It is possible to arrange transport from our hospital to a Siofor®, Thiabet® three days before the operation. If you do not rehabilitation centre directly after your hospital stay. Otherwise follow these instructions, the operation will be postponed. you will be released to your home three days before you start your rehabilitation treatment. The standard treatment in hospi-tal is usually about 10-12 days. In order to prepare the rehabilitation make sure you bring your insurance numbers.
Your stay with us
The operation day
After you finished all preparation, you can check in a day prior to On the day of the operation you will be woken up at 06:30 and the knee joint replacement. A doctor will do a final check-up in have enough time to prepare yourself for the operation. Please which he will also gather information about your medical history. do not use lotions or skin creams on your knee anymore. Take It would be helpful to bring a portfolio of your prior medical off your jewellery, glasses and watches. Do not wear nail polish treatment including your drug history. The doctor will ask you or make-up. Leave valuable with the nurses. whether you want stationary or ambulant rehabilitation and which insurance company will cover for you. During the day you will be taken to operation theatre, where you will receive your anaesthetic. To minimise the pain you will Please arrive at 12:30 at the ATZ (Ambulantes Therapiezentrum, receive a catheter in the groin area during the operation. This Ambulant Therapy Centre) on the ground floor. You will be gree- catheter allows us to dispense narcotics in the least painful way ted by our physiotherapist, who will immediately introduce you possible, ensuring your well-being after the operation. Through to walk on crutches to avoid dispensable encumbrance. the catheter analgesics will be injected twice or three times a day to relief the pain and avoid drowsiness. Unfortunately due On the same day you will meet the doctor in charge, who will to the nature of the anaesthetic you might not be able to move discuss the upcoming procedures will answer all your ques- your foot properly; we would like to advise you to take good care tions. Then the nurses will mark and depilate the concerned leg. when trying to walk directly after the operation it is not advisab- Please refrain from eating, drinking and smoking after midnight. le to get up by yourself as your freshly operated knee will not The nurses will give you a tranquillizer, in order to assure a be able to support your weight. Trained staff will help you to get As long as you’re unable to move your foot properly you will receive joint ankle support in order to avoid thrombosis. This will help you move your feet. Once you gain move your foot independently, you should do so regularly and intensively. Even though we supply you with best available medication you must not underestimate the risk of thrombosis. In order to prevent thrombosis it is essential to get active as soon as possible. This also includes the provided muscle activity programme. During the operation the operating doctor will remove parts of your cartilage and as little as possible of your bone mass, to reduce the chance of a later bone building treatment. You will Your bed will be put in a slightly upwards angling position to usually receive a so called surface-reimbursement-knee-joint- avoid thrombosis and swellings in your leg. Please make sure replacement. According to the age and indeed the state your that you stretch your leg fully, even though it might hurt a little bones are in the knee joint will either be attached with suppor- ting glue mass or it will simply be fitted in, without the help of any artificial elements. Hereby the leg axis will be straightened Two days after the operation the Continues Passive Motion out if it had been deformed, and it will be taken care of a full (CPM) will be inserted and the drainages will be removed. Both and sound movement of the new joint. After the operation doctors and physiotherapist will encourage you to move your two drainages will be put into the knee joint. After closing the new joint angling 110 to 120 degrees. Depending on your gene- wound layer wise the knee joint will be bend in a 110 up to 130 ral condition it might take up to four days before you can start degrees to test the stability and flexibility of the joint and the the treatment at the ambulant therapy centre (ATZ), where you stitches. The usual operation time is estimated between 60 and will be treated once or twice a day. Please note down the name of our physiotherapist so that you can arrange appointments for the following day. If necessary you can take a painkiller before the physiotherapy treatment. If you are suffering from severe pain we recommend you to notify us as soon as possible so that we can give you a painkiller. Once the pain grows it is more After the operation:
After the operation you will be brought to an anaesthetic recove- Please be assured that we will never extend the maximum ry room where you will be looked after for a few hours. After that doses of drugs you receive. You should be able to move your new joint nearly painless after a week of intensive training. Your new knee-joint should now be able to support parts of your If your doctor considers you to be a special need patient, (if, bodyweight, which means that you can walk with relative ease for example, you have been suffering from a heart attack or a stroke before) you might well be taken to intensive care for a few days, to make sure your recovery goes as planned. This special treatment might also be possible if you are suffering from circulation problems. You will be slowly mobilized on the day after your operation and your physiotherapist will teach you the first muscle tensing exercises. If you feel strong enough you will be allowed, in guidance of a nurse, to go to the bathroom. It is our aim to get you moving on crutches as soon as possible, usually no later than two days after the operation. The release and the time after the operation
to put your full weight on the operated knee two weeks after the operation; however you should walk on crutches for a further 10 to 14 days after the treatment the skin brackets will be four weeks or up until your physiotherapist acknowledges your removed and an x-ray of your “new” knee-joint will be taken. You will be able to keep a copy of these x-rays to take home to your general practitioner or physiotherapist, but as the pictures Rehabilitation:
are your property make sure you keep hold of them. If you have chosen to participate in an ambulant physiotherapy Depending on the stability of your health you will be able to we would be more than happy to offer you our qualified, expe- leave the hospital ten to twelve days after the operation to take rienced medical help in our Ambulant-Therapy-Centre (ATZ). part in your physiotherapy treatment. If you haven’t received your x-ray pictures, your prostheses-identity-card, redundancy letter and your physiotherapy treatment plan by then a nurse or If the wound has healed nicely your Physiotherapist might a doctor will provide you with of these. You are usually allowed decide that the best treatment would take place in a movement pool. Many patients enjoy this treatment as the water eases the pain and helps relaxing the body. Please make sure to arrange an appointment for a follow up treatment after the Physiotherapy or three months after the operation with our ambulant-surgery-centre. Please call 0049-209-364-3330.
After the Physiotherapy:
If you suffer from any complications or have any open questions after the operation do not hesitate to call Bianca Staubach, personal assistant of Dr. Ruhnau (Nr: 0049-209-364-3310).
She can put you in touch with the operating doctor, or will arrange for the doctor to ring you back as soon as possible.
We would like to remind you that it is possible to do the post-operative check ups in our hospital. These should take place on Premises to exercise after the operation
It is generally possible to participate in sporting activities after the operation if you follow these guidelines:> The operation took part three to six months ago> A stable heart circulation> No weight or resting pain in the joint> The joint is flexible and stabile (at least 100° degrees aspect > A stable backside and leg musculature a yearly basis, so that we can assure a long endurance of the > No signs for a slackening of the knee-joint implant knee joint replacement, as well as discovering and treating any > Age and body weight allow activity> You know the risks of the sport you are participating in Aim of the operation
You must not participate in any sports if you are or have been suffering of a joint infection or if the prosthesis is unstable. It The aim of the operation is to enable you to live a painless life is also forbidden if your musculature is too weak or you are with your operated knee. As far as you are not disabled through chronically overweight. You shall not do any fighting or ball other diseases, like heart or other joint diseases, you should be sports, as they are too risky. Naturally, competitive tournaments able to walk longer distances and move your knee independent- ly. We have to mention that chronicle overweight, as well as the carrying of heavy duty, adds an extra risk to the knee-joint and The ideal sport for knee prostheses patients is cycling, swim- might well shorten the life expectancy of the replacement. The ming and walking. Hiking can also be advisable, if you make average life expectancy is between ten and twenty years.
sure to wear the right kit. It is always important that you stop and rest once you are in pain and that you inform your doctor Infections, especially on a bacterial basis with a temperature, about any problems. Golfing is only advisable if you are techni- toothpus or inflammation of hand or body parts can infect the cally advanced, so that you don’t put too much pressure on your knee joint replacement through a blood stream. The risk is knee or hips. Skiing on the other hand can only be recommen- exceptionally high within the first year of the procedure. It is ded, if you can stretch your knee to its full extend therefore important to inform your general practitioner about the (a 120 degrees) and have a high fitness level.
replacement operation so that he can treat you with antibiotics to rule out the risk of an infection.
MD. Klaus Ruhnau - Senior resident
www.marienhospital-buer.de info@marienhospital-buer.de

Source: http://www.marienhospital-buer.de/fileadmin/images/ech/downloads/KnieTEP_engl.pdf

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