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Please download and read the 'Patient's Guide' book containing all the aspects regarding patient's experience before, during and after knee replacement surgery. This book has been written with patient's experience in mind and contains all the information required for the patient to have the an enjoyable and smooth surgical journey.  


Please read carefully the information provided below. It is essential that you are familiar with all the steps of your treatment. This will ensure the greatest satisfaction and best possible result of the proposed treatment. The information provided is specific to Mr Vioreanu's practice. All the aspects below will be discussed in depth during the consultation.
 
First Consultation
During first Consultation you will meet Mr. Vioreanu to discuss your knee problem. He will determine what, if any, surgery is required.

The consultation will last as long as necessary, depending on the complexity of your knee problem. Mr. Vioreanu will perform a physical examination and will review all your imaging studies.

There is a fee payable for the consultation. Remember to bring the referral letter from the GP or medical specialist.

Appointments are realistically scheduled for all patients, mindful and respectful of time. The nature of medicine and surgery is not always predictable and delays might happen. Your understanding is appreciated during such circumstances.

Appointments are confirmed with an SMS alert the day prior. A cancellation fee is not charged, however a return phone call of inability to attend is appreciated.
Do I Need Surgery?
The right time to have knee replacement surgery is when the pain you experience is affecting your quality of life and you really want something done about it. Some people decide to have surgery because they are no longer able to work and this surgery can make a significant difference to their lives. Some can not walk around the golf course and cannot bear the thought of being unable to play. Others will put up with pain and wait a long time, choosing only have surgery when they can no longer walk from the bed to the bathroom. It is a personal and very subjective decision. I always advise patients to take their time, really think it over and have surgery when it suits them.
There are two treatment options.

Conservative Treatment

Please see the 2013 American Academy of Orthopedic Surgeons Guidelines for conservative treatment of Osteoarthritis.

It is always worth to try with conservative treatment before deciding for surgery.


Surgical Treatment

It should be stressed that this surgery is designed to allow patients to walk without discomfort, not to return them to sporting activities. A total knee replacement replaces these surfaces with plastic and metal. The femoral replacement is a smooth metal component, which fits snugly over the end of the bone. The tibial replacement is in two parts, a metal base sitting on the bone and a plastic insert, which sits between the metal base on the tibial and femoral component. If necessary the patellar surface (under the knee cap) is replaced with a plastic button, which glides over the metal surface of the femoral replacement.

To be able to replace the surface of the knee joint a 20cm incision is made down the front of the knee and the joint opened. The bony overgrowth, which commonly occurs in arthritis of the knee, is trimmed away and the joint surfaces removed. This involves some shaping of the bone so that the joint replacement components sit firmly on the bone. In the replacements now being used the bone then grows into the roughened surfaces of the replacement, anchoring it down. In addition, bone cement is used to hold the components in place.
Risks for Surgery
There are always risks when having surgery, and you need to be fully aware of those risks before making your decision to proceed with surgery. Do not hesitate to ask questions of your surgeon, anaesthetist or of other medical specialists who are managing your health in the lead up to your surgery.

The vast majority of people get through the surgery with no problems at all and will be surprised at how good they feel so soon afterwards. Some will experience minor issues and occasionally there may be more serious complications. These problems are rare and most can be treated quickly and effectively. Below is a list that covers the major risks and complications with Arthroscopic surgery. Additionally, there may be other risks, particularly if you have a complex medical history or particular conditions which need to be managed by a medical specialist.

General Complications Related to Surgery.

  • Pneumonia: Patients with a viral respiratory tract infection (common cold or flu) should inform us as soon as possible and will have their surgery postponed until their chest is clear. Patients with a history of asthma should bring their inhalers to hospital.
  • Deep vein thrombosis and pulmonary embolus: Although this complication is rare following arthroscopic surgery, a combination of knee injury, prolonged transport and immobilisation of the limb, smoking and the oral contraceptive pill or hormonal replacement therapy all multiply to increase the risk. Any past history of thrombosis should be brought to the attention of the Surgeon prior to your operation. The oral contraceptive pill, hormonal replacement therapy and smoking should cease one week prior to surgery to minimise the risks.
  • Excessive bleeding resulting in a haematoma is known to occur with patients taking Aspirin or Non-steroidal Anti-Inflammatory Drugs - such as Voltaren, Arcoxia, Mobic, Naprosyn or Indocid. They should be stopped at least one week prior to surgery.
  • Infection. Surgery is carried out under strict germ free condition. Antibiotics are administered intravenously at the time of your surgery. Any allergy to known antibiotics should be brought our attention. With these measures there is a less than 2% chance of developing an infection within the joint. Most commonly these are superficial wound infections that resolve with a course of antibiotics. More serious infections may require further hospitalisation and surgery with prolonged antibiotic therapy.
  • Dissatisfaction is reported more commonly in young patients (less than 65) having a knee replacement, according to International Joint Registries. This is not because the operation is performed wrongly or there are technical problems with the surgery. It is because generally younger people are more active and their expectations from a knee replacement far exceeds the actual performance of a knee replacement in any individual. It is crucial that you discuss in depth your expectations with Mr. Vioreanu during the consultation and you familiarize yourself with the performance of a knee replacement in general population.
Before Surgery

Choosing a date for surgery

After the consultation, in conjunction with Mr. Vioreanu's Personal Assistant, you should decide on the time frame and a date that is most suitable to you. You will walk with crutches for around 4-6 weeks after the surgery and may need to take as much time off work. This should be taken into account when planning for a suitable date for surgery.

Forms to be completed and signed.

You will receive an information package containing your admission, consent and questionnaire forms, which you will need to complete and send back to us.

Mr. Vioreanu collects information about each surgery for the purposes of patient management, but also uses information for research. You will be given a consent form, which is to be completed and given back to Mr. Vioreanu’s office.

Let us know.

You should inform us of any medical conditions or previous medical treatment as this may affect your operation.
It is extremely important that there are no cuts, scratches, pimples or ulcers on your lower limb as this greatly increases the risk of infection. Your surgery will be postponed until the skin lesions have healed.
You should not to tape, shave or wax your legs for one week prior to surgery.
Please use HIBISCRUB solution (Chlorexidine 4%) to wash your knee ONCE daily for 5 days prior to surgery. Wash the skin gently and do no scrub the area. You can find HIBISCRUB solution at a retail Pharmacy. 


Pre-operative testing.

You will need to have a chest x-ray, ECG and blood tests done prior to surgery. These are standard tests for all patients. These are usually done 2 weeks prior to your pre-admission appointment. If it is convenient for you, all these tests can easily be arranged at the SSC. Results need to be back in time for your pre-admission appointment.

Pre-admission clinic at SSC.

The hospital will contact you some time prior to your surgery to make an appointment for you at the pre-admission clinic. At this appointment, you will be fully assessed and given all the information you need about your hospital stay and procedure. Test results from your chest x-ray, ECG and blood pathology will be discussed with you and your anaesthetist may come see you at the pre-admission appointment.

Managing your Medications.

Prior to your surgery we will discuss your medications with you. You will be given important instructions about what you should and should not take prior to surgery. Please do not hesitate to contact our office if you are unsure about these instructions.

Also, some patients with complex medical conditions will need appointments with other medical specialists to ensure that it is safe to proceed with surgery.
We will let you know if this is something you need to do.

Your Teeth

Tooth decay and mouth infections can be a cause of infection in joint replacement. It is very important you talk to your dentist to address abscess and tooth decay prior to having surgery, as infections in the mouth can cause infections in other parts of the body. Even years after you have surgery, it is important to ensure you are vigilant about dealing with decay in your mouth, or any small infections on other parts of your body.

The night before surgery.

Please do not eat and drink after mid-night and try and have a good night sleep.
During Hospital Stay

Admission to SSC.

You will be admitted on the morning of the surgery. Mr. Vioreanu's Personal Assisstant will inform you of the exact time and place to go for your admission.
Do not forget to bring all your relevant imaging studies (Xray’s , MRI’s etc.) and relevant medical letters and tests.

Mr. Vioreanu works closely with a small number of expert anaesthetists to optimise the pain relief and recovery after the surgery. The anaesthetist for your surgery will depend on which day your surgery is scheduled. The anaesthetist will usually contact you to discuss your anaesthetic beforehand. You should discuss with the Anesthesist preference and benefits of spinal versus general anaesthesia.

Immediately after surgery.

You will wake up in the recovery ward and will have a bandage on the operated knee. You will be given regular pain relief by the nursing staff in the form of an injection or tablet as required.

Mr. Vioreanu will come and discuss the surgery performed. You will then be transferred to the ward. A physiotherapist will visit you in the afternoon of your surgery, or the following day. They will show you some exercises for your leg and will get you up for a walk. Once you are able to safely mobilise and care for yourself you will be discharged from hospital, usually 3-4 days after your surgery.

SSC In-hospital Handbook SSC In-hospital Handbook (1451 KB)


After Surgery
You will receive instructions and a prescription for pain-killers from our nursing staff prior to being discharged from hospital.

The next few days.

If you have any concerns about your post-operative recovery please do not hesitate to contact our office. Mr. Vioreanu will call you back at a suitable time to discuss all your concerns.

Swelling.

The swelling in your operated leg may take up as much as 4-6 months to fully resolve. To facilitate this we advise to place 2-3 pillows under your bed mattress to keep the leg elevated at night time.

Bruising.

Bruising of the lower leg, calf and sometimes the thigh is not uncommon after Knee Replacement Surgery. It will take 1-2 weeks to resolve.

Crutches.

You will walk with crutches for 4-6 weeks after surgery.

Driving.

Driving an automatic car is possible as soon as you can walk comfortably after surgery. You will not be fit to drive a car for at least 6 weeks after surgery.

Return to work.

Sedentary and office workers may return to work approximately 4-6 weeks following surgery.
Follow-up Appointments
Mr. Vioreanu will see you 6-8 weeks after knee replacement with new X-Rays. The following appointments will be at 6 months and 9-12 months after surgery respectively. You do need to contact our office to make these appointments.. You do not need a referral letter for these appointments.
Enhanced Recovery After Knee Replacement

The enhanced recovery program is about improving patient comfort & outcomes and speeding up a patient’s recovery after surgery. 


The program focuses on making sure that patients are active participants in their own recovery process. It also aims to ensure that patients always receive the right evidence based (proven) care at the right time. 

This new approach aims to accelerate all aspects of a patient’s recovery process. This includes accelerating their physical, mental and physiological recovery following surgery. 

Physical recovery includes restoring a patient’s level of function, strength and range of movement. 

Mental recovery includes the elimination of concerns, and the return of self-confidence and the state of feeling balanced and whole. 

Physiological recovery takes all the major body systems into account and aims to avoid insult on the cardiovascular, respiratory, renal, gastro-intestinal and haematological systems during your surgery.

After the operation the program focuses on getting patients out of bed and starting to move their joint as soon as possible with the support of good pain management.   This results in patients making a quicker recovery than average and being able to return to active life as soon as possible.

Enhanced recovery surgery: 


 - Allows patients to recover faster and more comfortably from major surgery 

 - Allows greater patient involvement in the early stages of recovery 

 - Gives better patient outcomes 

 - Reduces hospital stay 


Patients never leave the hospital until they are ready and comfortable to walk independently.


All patients will leave the hospital with the ‘Exercise Guide to Knee or Hip Replacement’ book that clearly outlines the expectations and provide specific exercises and advice for each week after surgery. 

When at home, all patients can contact our office directly by phone or email if they have any concerns regarding their progress or recovery and they will be attended promptly. 



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