Reducing Risks in Knee Surgery

Discussing risks during a consultation. Nick Howells Specialist Knee Surgeon. Bristol, Bath, Cotswolds

All surgery carries some risk, although for most knee procedures the risks are low.

Mr Howells will discuss in detail the risks specific to any procedure that is planned, but here is some general advice to help reduce the likelihood of complications occurring. Further information is provided on the specific surgical procedure pages.

  • If you have any pre-existing medical problems that are not under control, be sure to have these checked by your GP well before the date for surgery.

  • Before the procedure, you will have a ‘pre-operative assessment’ to judge your fitness for surgery. Problems picked up at this stage may need to be sorted out beforehand and surgery may need to be delayed.

  • Swabs looking for MRSA are done before any major operation and if you test positive for the disease this will be treated before surgery.

  • Elective knee surgery cannot proceed if you have any active source of infection e.g. you must finish treatment for any chest, urine or dental infection before proceeding. If you have any open wounds, ulcers, cellulitis, thrombophlebitis or severe sunburn affecting the legs, surgery will be postponed.

  • Diabetics and patients on immunosuppressive drugs have increased infection risk and should ensure these conditions are optimised and stable prior to surgery.

  • If you are due to have a knee replacement, do not have a steroid injection in the knee in the preceding 6 months.

  • Ensure your muscles are as strong as possible before surgery to aid more rapid post-operative rehabilitation. Strong muscles also help to reduce stiffness and the risk of clots.

  • We operate in Ultra-clean Air (UCA) laminar flow theatres to reduce infection rates. It is important that every person who comes into contact with you on the ward (including staff and family/visitors) uses the alcohol hand gel provided.

  • Wound dressings are disturbed as little as possible in the first 48 hours to allow the wounds to ‘seal’.

  • Post-operatively, you must keep the wounds dry until they are sealed and the stitches or clips have been removed. The nurses can advise you on how to achieve this whilst still maintaining general personal hygiene.

  • Following surgery, you should immediately contact the hospital or surgeon if there is any concern about ongoing bleeding or oozing from the wound, infection or severe swelling.

  • The risk of clots is highest in patients with specific risk factors, which include: previous clots, family history of clots, obesity, age, prolonged immobility, and cancer. Your individual risk will be assessed and your type of surgery taken into account. The key to reducing clots is early mobilisation, but you may also require:  foot pumps and tablets or injections to thin the blood. This medication will usually start once we are happy there is no severe bleeding risk, and may continue after discharge.

  • Long-haul air travel carries a risk of clots. You should avoid long-haul flights for four weeks before and after major joint replacement. If this is not possible, additional scans for clots may be required before surgery or before flying.

  • Good nutrition helps with recovery after surgery as it aids the healing of your wounds and enables you to cope with energetic physiotherapy. If you have any nutritional problems, these should be addressed prior to major surgery. If you have any unusual dietary requirements, let the hospital know before you are admitted.

  • There is good evidence that outcome is better and the risks are lower in hospitals and with surgeons performing high volumes of knee surgery.

  • We follow the WHO Safer Patient Initiative guidelines, which involve a safety briefing at the start of each operating list and each case. This ensures the whole team have checked the side of the operation, whether the patient has any medical problems, and the availability of all the kit needed to carry out the operation.