How to support elderly parent after knee operation

[TheNaughtyDaughter]

My elderly parent (90) who lives alone is having a knee operation in a few weeks. They had another minor operation a few months ago and suffered a fair bit afterwards so I’m trying to prepare for this one.

I live 300 miles away, so this is going to be difficult, but I do have a sibling nearby to them and we will both stay over for as long as we can.

Can you please help with the following questions:

1. Following surgery, do they normally keep the patient in for a few nights?

2. I’m concerned how my dad will go up the stairs to bed, the bathroom etc. We are there to help but not sure how this is going to work? Would I be better off taking him to a hotel? Or how could I set it all up downstairs?

3. Will he need dressings removed or changed? A bed bath? Is there anyone I get get help with?

4. Are there any resources in the community I can access to come out to his house?

5. I’m concerned I can only stay about 5 days (work, kids etc.) but my sibling can stay too. We can do stints. I could then bring him to my house but that is 300 miles away, but he’d be on one floor and well looked after.

As you can see I’ve no clue, and trying to get in front of this as last time, even though it was a minor op, he was in a bad state afterwards with low blood pressure and he couldn’t sleep (and I nearly had a nervous breakdown with the stress).

From my DM's experience after a shoulder surgery - you should be told whether they need to stay in, roughly how long and how mobile they will be afterwards eg stairs or not.

The elective ortho ward was a very slick operation with a lot of OT and physio input. Almost all the patients are elderly so they have loads of experience in knowing who is safe to go home and what adjustments they need, if they need a care package etc. My DM also has low BP and I was impressed how they dealt with it, she spent 24 hours in recovery before being allowed on to the ward due to her BP.

We were given clear instructions what to do with dressings - in our case not to touch it under any circumstances until her follow up appointment.

I stayed with my DM for a week after surgery after which she told me I was surplus to requirements and to go home. My main role was ferrying her to appointments, making meals and buying random shit off Amazon that we suddenly realised she needed. In the first few days the Amazon driver was basically a permanent fixture.

We considered taking her to my house but quickly realised this was a non starter as there was a lot of physio and outpatient follow up and she wouldn't have been near it.

What sort of operation? My mum had a total knee replacement. Was in hospital for only 3 nights, walking and doing the stairs the day after.

Last time my mum (82) had a lower limb issue, the hospital arranged a hospital bed to be provided and set up downstairs so she did not have to navigate stairs for a few weeks. They also provided a commode and a care package 4x a day. Hers was more reactive than proactive though. On another occasion, when she was admitted to hospital via A&E, the first person she saw was an over-75 assessor, whose job was to establish what discharge would require, so they could start preparing things if needed.

Can you or your sibling attend any of the pre-op assessments with him and ask some of the questions then?

what operation is he planning to have? Given the difficulty he had after the 'minor' operation, it is definitely worth exploring how much benefit they think this next procedure is likely to give him vs the risk of proceeding. For something major like a knee replacement or revision, it would perhaps be worth exploring whether an anaesthetic pre-assessment clinic appointment might be helpful as a way to a) ensure he's as medically and nutritionally optimised as possible and b) go through some of the risks that go with surgery at that age factoring any other medical problems he has too. While a lot of patients have considered the possibility of dying and think that's worth the risk, many haven't considered some of the 'softer' stuff that goes with major surgery including cognitive deterioration, reduced mobility, the need to move to rehab/nursing placement either temporarily or permanently even if everything goes really well. There are some risk prediction tools that we use that, while they aren't perfect for any particular group, can help predict how things are likely to go post-op for this procedure and it's perhaps worth exploring in detail whether this is a proposed operation because there is an operation they can do, or one that is going to bring him meaningful benefit. They can also begin to explore in clinic what anaesthetic would be most appropriate for him (spinal is often better than GA) and whether he'd benefit from staying on the HDU post-op (particularly if BP was a problem last time). Lots of hospitals run hip/knee 'schools' for patients having joint replacements (if that's what he's having) to give them an idea of what to expect in terms of support post op and what is expected of them in terms of optimising their own recovery - sounds like it'd be a good idea for someone to attend with him as two brains may be better than one in remembering what's said/thinking of questions. He should be having OT input pre-op re. any adaptations he may need at home (or indeed whether home is the right environment for him post op) - again, may be a good idea for someone to join him. Increasingly major hip/knee surgery is done as day case procedures or a 24-hour turn around and it is worth being very clear at the start whether that's what they're planning - it does seem to work well for a lot of customers, but less so for frail nonagenarians who've struggled with minor procedures recently. HTH.

@TheNaughtyDaughter

I’ve had both knees done ten years apart. From that you might deduce I am not young.

This is a window on my experience but different hospitals may differ in their approach. Pick up any leaflets you can find at surgery or hospital, or Google for after care advice. Dad should also be given a leaflet by his surgical team.

As soon as the physios are happy that he can manage stairs, he is likely to be discharged.
This might be as quick as just 2 nights in hospital.

They should offer him gel ice packs & possibly a toilet seat raise thingy. Lowering onto and standing up from the toilet can be excruciating.

They might also provide a waterproof cover for his leg so he can shower. No bed baths OP!
He must get up and move around. He’s not going to be an invalid!

IF there is any issue these items might not be provided, buy on Amazon in advance. Gel Ice packs reduce swelling and pain so are an absolute god-send. Use them regularly especially after moving around on crutches. He must keep mobile. No lying about for too long.

The wound will be dressed. There shouldn’t be any bleeding. The dressing will be changed after a week or ten days. Keep it dry!! Clips or stitches out (ouch) after ten days by nurse at surgery.

Exercises! This is of the upmost importance.

Your dad must do the prescribed exercises. He absolute must because if he does not it will be a total waste of NHS money and upheaval and pain for him. The exercises are excruciating. The worst pain ever but must done regularly several times every day. The metal joint is not compromised but the surrounding soft tissues are pulled & stretched so it’s those which cause the extreme pain but they absolutely must be kept mobilised and stretchy or he’ll suffer later.

I was offered and accepted 6 weeks post-operative physio at the NHS gym. It was supervised by my physio and was a godsend. It was often uncomfortable but I persevered and am so glad I did attend once a week. Ask about post operative physio.

if your dad is brave and perseveres with the prescribed exercises which are absolutely key to full mobility, he will be pain free and walking normally very soon after his op. Mind over matter. Good luck to him.

OK, so I need a bit more help please.

My dad has had his knee operation. It is now day 4 post op and he is still in hospital. Days one and 2 looked a bit slow, but on day 3 he was walking around the ward with a frame, then crutches and apparently the physio has had him doing a lot today.

I have had to return home as I have to go back to work. Upon discharge my dad would be very much on his own in his house, and so he has agreed to come stay with me. It is quite a journey (3-4 hours!) but the physio and doctors agree it is his best case scenario and that he would be taken well care of.

They said I would have to get him temporarily registered at the doctors. Not sure if there is enough time to do this? But I can also consider private?

Also, he needs his stitches removed (staples) in 10 days. That would mean my driving him back home to do this, or is this something simple that I could get a local hospital or doctor to do?

Obviously this all seems a big faff for my poor dad, but staying at mine he would have lots of people looking after him, whereas staying at his own means being mostly alone, sleeping downstairs on the sofa or struggling up really steep stairs on crutches.

Can you pop into your GP on monday and register him as a temporary patient? It is usually just a form to fill in.

Once he is registered then he can have his staples removed on day 10 at your GP surgery- this is commonly done by practice nurses.

Whatever you do make sure he has be physio straight after - push hard for it. My mum (85) had her knee replacement done and caught a bug from the hospital and was very poorly for about 6 weeks and didn’t get the physio. Now her leg won’t straighten (a year on) and it sounds horrific when she walks.

The only issue you may have with him coming to you is the post op physio is often provided by the hospital and you may find your local gp physio service or local hospital won't provide it. I have similar issues as my surgery is undertaken many miles from where I live. Can he afford a private physio every week or so while he is recovering at your home - as otherwise you will be driving him a long way for appointments.

In my experience it is worth trying to get NHS or private physio appointments as otherwise once he is at home with you his recovery may stall.

I had a private physio who came to the house ( cost £70 per session) as that was the cheapest option rather than trying to get back to the long distance hospital.

I’m fine to sort out a private physio and even private GP and to remove stitches.

Between my siblings we can share it.

The only thing I need to sort is the logistics of it.

Just get your Dad registered with your GP and ensure that the hospital send a letter to the GP with all his requirements.
Hopefully he will recover very soon.