Recovering from Surgery

+ What do I do if I have a problem after my operation?

If you are concerned about anything during your recovery, please get in touch: Rivers Hospital, Sawbridgeworth:

• Clinical issue - please call Orchard Ward on 01279 602662. They will be able to liaise with Mr Kosuge.

• Administrative issue - please contact Mr Kosuge's secretary Frances Hicks on 01279 602718.

The Princess Alexandra Hospital, Harlow:

• Clinical issue - please call Henry-Moore Ward on 01279 827125.
• Administrative issue - please contact Mr Kosuge's secretary Helen Hind on 01279 827672.

+ How long do I need to keep a dressing to cover my wound?

Mr Kosuge covers your incision with a dressing and asks that you do not remove this dressing for 14 days. Minor staining of the dressing from beneath is acceptable. Mr Kosuge asks that you do not get the dressing wet for the 14 day duration and to avoid touching it unnecessarily. Please contact the ward immediately if you notice any of the following:

• Severe staining or leaking through dressing.
• Redness and increasing pain.
• Persistent fever.
• If dressing starts to peel off.

+ When will my stitches need to be removed?

Mr Kosuge uses either absorbable sutures (no need for removal) or skin staples (removal required at 14 days). He will let you know what he used before you are discharged from the hospital. A wound review at 14 days is required for both and you will be invited back to the nurse-led wound dressing clinic.

+ When can I sleep on my side?

Hip Replacement - Mr Kosuge recommends you avoid lying on the operated side until the wound has healed completely and to do so only when it is comfortable for you. Lying on the non-operated side should be avoided for 4 weeks. Knee Replacement - Mr Kosuge is happy for you to lie on your side immediately after the operation but would recommend you put a pillow between your knees to cushion the operated knee.

+ When can I shower?

Mr Kosuge recommends showering only after the wound has healed completely (normally after 2 weeks), unless you are able to shower without getting the dressing wet. Once the wound is healed, Mr Kosuge recommends massaging of Bio-Oil onto and around the wound.

+ Should I use ice or heat?

Mr Kosuge recommends use of ice-packs to help with swelling around the wound. This is probably more useful for knee replacements compared to hip replacements. In the first week, Mr Kosuge recommmends using ice-packs three to four times daily with each episode lasting 20 minutes or so.

+ How long will I be on a blood thinning medication?

Typically, Mr Kosuge will prescribe Aspirin 150mg to be taken once daily for two (knee replacements) or four (hip replacements) weeks from the day after your operation. In addition, Mr Kosuge will prescribe anti-embolism stockings for you to wear for a duration of six weeks. Exercising and keeping hydrated can also help with reducing risks of a blood clot (deep vein thrombosis/pulmonary embolism). If you are normally on blood thinning medication, Mr Kosuge will discuss alternative options to the above. The stronger your blood thinning medication, the greater the risks of bleeding complications such as persistent wound oozing which, in turn, can lead to infection.

+ Are there any precautions I need to take in terms of movement?

Hip Replacement - Mr Kosuge would like you to be mindful of movements that lead to excessive bending of your hip (knees towards chest) and twisting of your hip such that your toes are pointing inwards:

• Bending down to pick items up from floor.
• Sitting on low chairs or low toilet seats.
• Turning your upper body by twisting at your hip. Preferably keep your knees apart when sat down, and if you must reach for the floor, keep the knees wide apart when doing so. The above advice is to minimise risk of dislocation of your artificial hip. Mr Kosuge recommends being mindful for upto 3 months after the operation.

Knee Replacement - None in particular but Mr Kosuge stresses the importance of knee exercises in order to minimise risk of permanent stiffness.

+ Can I kneel?

Mr Kosuge recommends you attempt kneeling no earlier than 2 months after your operation. Hip Replacement - you should not attempt to kneel earlier than 3 months after your operation. To kneel, touch down with the knee of your operated leg first. To arise from kneeling, use your non-operated leg first. If gardening, consider purchasing a kneeler with arm supports. Knee Replacement - you should not attempt kneeling earlier than 2 months after your operation. Although uncomfortable, you will not damage your artificial knee by kneeling. Majority of patients will struggle to kneel after this operation and a knee pad may be useful.

+ What exercises should I do?

You will be instructed by your physiotherapist on appropriate exercises and given a patient information booklet containing lists of exercises to follow. It is imperative that you are compliant as not only does exercising help your recovery but it can reduce the risk of you getting a blood clot (deep vein thrombosis/pulmonary embolus). Mr Kosuge recommends you get into a habit of performing these exercises indefinitely. Swimming and stationary cycles are exercises Mr Kosuge supports and you will be guided by your physiotherapist in regards to appropriate time to commence this.

+ When can I drive?

As a general rule, six weeks is the time-scale Mr Kosuge quotes. You must make sure that you can sit comfortably in your vehicle and that maneuvering the pedals does not cause pain that will distract you whilst driving. Mr Kosuge recommends you start with short-distance driving initially and gradually build this up over time. For hip replacements, getting into and out of your vehicle can encourage you to put your hip in an extreme position, risking dislocation of your artificial hip. Please take your time and perform in the way you would have been shown by your physiotherapist. Low car seats should be raised with a cushion.

+ When can I return to work?

This is very dependent on your job. With sedentary jobs, it is possible to return between four to six weeks after your operation. With manual intensive jobs, it may take up to three months. The above should only serve as a guide given return to work is hugely variable due to patient differences in how they recover following surgery.

+ When can I fly?

Mr Kosuge does not recommend you travel in the first 6 weeks and would always suggest that the longer you can wait, the better. The effect of pressure changes and immobility may induce pain and swelling. In addition, the risk of a blood clot (deep vein thrombosis or pulmonary embolus) reduces as more time passes following your operation. If you must travel, Mr Kosuge recommends regular breaks to allow a stretch or walk and for you to drink plenty of water.

+ When can I dance?

Mr Kosuge recommends avoiding dancing of any kind for a period of 3 months following your operation. Movements that involve twisting and bending excessively may injure your artifical joint.

+ Do I need to take any precautions when having dental work?

Yes. For the first six weeks, avoid any dental procedures if possible. It is therefore best that any dental issues are treated before you have your joint replacement. After your artifical joint replacement, Mr Kosuge advises use of antibiotics for any invasive dental procedures you have. This is to minimise risk of bacteria from your gums seeding into the artifical joint replacement through the bloodstream. Please ask your dentist to prescribe this for you.