"Clinical procedures for knee replacement patients"

My story began when I had my left knee replaced in Ninewells hospital by Mr Love. My surgery went very well, as did my experience on the ward. Once home however, my pain got out of control and it was almost impossible to redress this situation.

I was therefore determined to do everything in my power to ensure that my second knee replacement on my right knee went as smoothly as possible. 

So I phoned ward 8 in PRI and asked for the booklet of exercises for knee replacements to be posted out to me so that I could do them in advance of my surgery in order to strengthen my leg as much as possible prior to surgery.

Point 1: The booklet I was sent out was the same one I was given in 2016 (a yellow booklet entitled Your Knee Replacement Information for Patients'). When I used this booklet  it was clear that the order in which the exercises were set out was very challenging for the patient, with the most difficult exercise first. 

I had re-ordered them in 2016 myself at home  in the booklet from easy to difficult and I did the same again this time.

Suggestion 1: That the order of the exercises in the yellow booklet is changed so that they go from easiest to most difficult and that it is re-printed immediately. (If patients are asked to do the hardest exercise first they are more likely to give up). 

Point 2: In due course I received another booklet in the post entitled The NHS Tayside Orthopaedic Knee Advanced Recovery Programme. This booklet was A4 size. I found that it  contained exactly the same exercises as the yellow booklet - also with the most difficult exercise first. 

Finally, on arrival in the ward prior to my operation I was given a third set of knee exercises - a single sheet of A4 entitled simply Knee Exercises. These exercises are in a more patient-friendly order. However, the print quality is poor and the illustration and explanation for the Quads contraction needs to be clearer. 

Suggestion 2: That all three of these documents are revised to make the exercise content identical,  and - where necessary - clearer. Also, the exercises need to be numbered 1-7.

Point 3: As a result of having done my knee exercises repeatedly before surgery this time, my leg muscles were much stronger and I was able to mobilise easily on return to the ward. It made a huge difference. Not just to me, but also to the staff. I needed less physio and less help from the ward staff. I could use the toilet and shower independently almost immediately. Better still, I could do even the most difficult exercises with ease. My hope is that this will considerably improve my overall recovery time.

Suggestion 3: That doing these exercises (and recording when they are going to be done) now becomes part of the preparation for surgery for every patient. That is, during the Pre-assessment Appointment the patient is issued with:

1) The single sheet of Knee Exercises which is currently issued on arrival in the ward 

2) A second sheet with a table which they will be asked to complete showing the dates and times when they will do their knee exercises prior to coming for their surgery (with some small improvements this Record Sheet might fit on the back of the Knee Exercises sheet).

This means, of course, that the nurse carrying out the Pre-assessment Appointment will now have two additional tasks: to explain the exercises to the patient and also get them (as part of the appointment) to fill in the dates and times they plan to do the exercises. I appreciate that this is an additional task for this particular member of staff, but if it is even partially successful, it should save time at the back end of the process for ward and physio staff. 

The  table to be completed by the patient on the Record Sheet might involve identifying dates (say the 10 days immediately prior to their operation) and times (say just after breakfast and just after lunch - so 10am and 2pm) which the patient can enter in to their table during the Pre-assessment Appointment with the nurse, with the patient then having to put in the number of repetitions for each exercise at home.

The hope is that since patients begin this part of the process with a medical practitioner they will be more likely to see it as an integral part of the process and keep it up at home. They could, of course, be asked to bring their Record Sheet to the ward with them when they arrive for their surgery. 

I am taking the time to submit this feedback as my way of saying Thank You to all the dedicated NHS staff who have helped and supported me through both knee replacements in the hope that it might make your working lives a tiny bit better.