How prepared are you for rehab at home?

This Primer runs through the practical things you need to take care of before your knee surgery


Page updated August 2023 by Dr Sheila Strover (Clinical Editor)

 

This section of 'How prepared are you for rehab at home?' is all about anaesthetic options that may affect your immediate mobility after surgery.

It may be assumed that you are happy to have pain-numbing blocks and infiltrations - and you may be - but ask your surgeon if you are likely to to be given these to help with pain after surgery. It is really helpful that you know exactly what the surgeon and anaesthetist plan to do in this respect, and exactly what it will mean for you in managing your pain after the op.

Going to hospital for knee surgery can be a difficult time in general, and of course you will have to cope also with a change in your mobility. Although your surgeon has probably explained the surgical procedure in some depth, you need to have a clear idea of how mobile you are going to be on your return and what kind of walking aids, shower aids and toilet aids you might need.

The tendency these days is for the hospital to send you home as quickly as possible, for both financial reasons and to minimise the potential for a hospital-acquired infection. Make a telephone appointment to ask your surgeon how many days you will be in hospital, supported by the staff there and on what day post-op you can expect to be sent home.

If you are going to be sent home within the first 24 hours, then the issue of whether or not any local anaesthetic block will still be working. Such a block will provide good pain relief for the first night, but then if you are sent home and the block wears off you may be plunged into acute pain without the support you had in hospital. Even if having a general anaesthetic and being put to sleep for the procedure, it often happens that the anaesthetist adds what is called a regional block while you are asleep, and possibly a long-acting local infiltration into the wound as well, so you may wake up comfortable but unaware that this is because of the local anaesthesia.

 

Regional nerve block

Femoral nerve block, popliteal sciatic nerve blocks and local infiltration analgesia will block pain for many hours after knee surgery so you may set off home without pain. However your leg may be weak and unpredictable when you stand on it, and the weakness can take quite some time to wear off. These blocks may become very relevant once you get home - as well as initial trouble with mobility, you may have trouble with increasing pain once the blocks wear off and you need to be prepared for this.

 

Spinal and epidural anaesthesia

Spinal and epidural analgesia - which you are less likely to receive - may cause similar problems, but in addition may give problems with urine retention. However you will almost certainly be made very aware if you have had these procedures - but this may not apply to individual nerve blocks and local infiltration which may be performed as a matter of routine.

Knee immobiliser

The next question to ask the surgeon relates to bracing of the knee after surgery. You should have some idea if you will go home with a ‘leg immobiliser’ or a knee brace fixed in extension, because you will need to be sure that you can easily fit into the vehicle that will take you home.

 

Resources

Checklist to download and print of things to remember to do before your knee surgery.

Common patient questions about nerve blocks

A video example of a knee immobiliser

Car transfer after hip and knee surgery​

 


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