After knee surgery

This resource is about how to care for your child after knee surgery at Sheffield Children’s NHS foundation Trust.

If you have any more questions or concerns, please contact the doctor or speak with the nurse caring for your child.

When can we go home?

Your child may be able to go home the same day as their surgery but this depends things such as the time of day of their surgery and how well they are recovering. Your child can go home when:

• their pain is well managed (this does not mean pain free)

• they can eat and drink as normal

• they are not feeling sick or being sick

• are behaving as they usually do

• when they can safely mobilise and do stair transfers (if applicable) safely

Who do we need to see before we go home?

Often the surgeon, physiotherapist or nurse will check your child:

• feels good and normal in their leg

• has appropriate movement

• is a good and normal colour

• has warmth in their treated leg

The physiotherapist will also review your child.

The surgeon and physiotherapist will advise you of how much weight your child can put through their leg. This can be none weight-bearing, partial-weight bearing or full weight-bearing.

This depends on the operation type as well as by how well your child copes with crutches and any pain they may be in. Your child will be taught to use crutches or a frame depending on their ability and how they feel after the operation.

Will we be given anything to take home?

You will be given crutches or a frame to take home, and may also be given a brace to wear. This is to limit the range of motion at the knee in accordance with the surgeon’s advice.

Depending on your pre-operation questionnaire, you will be given a bath board if needed to help with bathing.

The brace must stay on at all times including bathing. It will need covering at bathtime, such as with a cast cover or a plastic bag.

How should we travel home?

If you travel by car, it is important that your child gets in the front passenger seat (if they are tall enough). The best way to do this is by sliding the seat fully back and reclining it so they can get in easily, then return to seat to normal.

You can pack your bags in the footwell to give them a foot rest which may be more comfortable.

If you are travelling a longer distance to get home, be sure you stop for regular breaks to allow them to change their position

Managing your child’s pain at home

You child will likely be given a nerve block during their procedure. This does mean that the leg can be numb for a number of hours, and can impact on their ability to move. It is important to be sure your child can move their limb before going home.

Most of the time, nerve blocks will wear off completely overnight. If it does not, please contact the hospital.

As the medicine wears off, it is normal for your child to feel a change in post-operative pain. The best way to help manage changes in post-operative pain will be to give your child regular pain medication upon return home. You will be given a short supply of pain medication, and you can get more either from a prescribing pharmacist or your GP.

To begin with, the leg will likely swell up post-surgery. The best way to help manage this is with raising the leg regularly, that will help reduce swelling and pain.

My child has a brace on – do I need to adjust it?

After your child’s surgery they may have a brace on. However, your child’s leg will swell up and change through the recovery period which this means the brace may slide down often and need readjusting regularly to put it back in place.

To do this, release the Velcro, unclip the brace, slide it back up to the correct place (so the hinges are at the knee joint) and then tighten the straps again.

The brace will limit the range of motion through the knee. We will show you how to change the brace range if necessary, but it will most likely be adjusted by your local therapist as well as your return visits to clinic at Sheffield Children’s NHS Foundation Trust. If you need to trim the Velcro attachments at home you can do so, usually we will show you how during your hospital visits.

How long will the brace be on for?

How long the brace needs to stay on for depends on the type of surgery your child has. It is often around 6 to 8 weeks, and sometimes it will be locked out straight for 2 weeks and adjusted when you return to clinic.

How long will it take for the wounds to heal?

After surgery, your child has one or more incisions. The scars around the knee will depend on the procedure your child has had.  The typical timescale for the healing process is as follows:

• You should have a return visit to hospital planned for around 2 weeks post surgery. Around that time wounds should have started to heal

• Scar formation can be unpredictable at times and it is important to care for the scars once healed. Usually we advise E45 or Aveeno to be applied once the scabs and stitches has fallen off.

• Sometimes scars can become raised or bumpy and even expand beyond the boundaries of the original wounds. If you have concerns, please get in touch and we can arrange review with our scar service. Please note scars may take up to 2 years to fully mature.

• With time, some scars may blend in with the natural skin Other scars may stay lighter or darker than your child’s natural skin tone.

How do I manage my child’s wound?

Often orthopaedic wounds are covered with dressings that stay in place for up to 14 days after surgery. Dressings need to be kept dry until their wound has been checked, usually around 2 weeks after surgery in the hospital.

If you are out of area it may be possible to get the wounds checked by your local practice GP nurse.

We use dissolvable stitches during your child’s procedure. These usually dissolve or fall out by themselves and do not usually need to be removed. However, sometimes they can take longer to dissolve under the skin and cause irritation. If you have any concerns please raise them when you attend hospital, or discuss with your GP or practice nurse

Is there anything specific I need to look out for?

You can contact the Emergency Department, the ward, your GP surgery or Minor Injury Unit (MIU) if your child has any of the following:

• increased redness or purple skin changes around the wound and surrounding area

• changes in swelling around the wound or limb that may feel hot to touch (the knee will be swollen post-surgery anyway)

• increasing unmanageable pain

• has a foul smell from the wound or dressing

• wound begins to open up

• pus or watery fluid (discharge) from the wound, or showing through the dressing

• has a high temperature (fever)

• is feeling sick or being sick

• develops a very sore, swollen red calf

How do I care for my child following surgery?

The dressings used to cover the wound are not waterproof. It is important to keep the dressings clean and dry until removal 10 to 14 days after surgery. Keep a bag over the operated leg for showering, and the remaining leg can then be flannel washed around the dressings.

Should I change the dressing?

If the dressings or unhealed wounds get wet or dirty, we run the risk of infection and not healing. This may cause the wound to reopen. It is important to prevent reopening and the possible introduction of infection into the open wound. It can lead to deep infections of bone, metalwork or soft tissue. If you have concerns, please contact the department urgently.

We will give you an extra dressing in case the edges of the dressing start to come loose.

When can my child return to school following surgery?

It is usual to need a period of time off to recuperate following surgery, usually around 2 weeks off school. Once your hcild goes back to school, we recommend they have a pass to leave class early, to avoid busy times and being knocked over in the corridors when changing between lessons. If necessary, they will also need a lift pass.

It should be noted they should not return to PE without authorization from your treating physiotherapist or the consultant looking after your child.

Your child will need to use crutches and potentially a wheelchair when out for longer walks or for school. This will need to be rented from red cross and will need to have a “leg extender” to support the operated leg.

When will my child be reviewed after their surgery?

After being discharged from the hospital you will have appointments booked for around 2 weeks and 6 weeks post-surgery. If you do not receive an appointment within that rough timescale, please contact the surgeon’s secretary who can arrange the appointments for you. It is very important that your child is brought to all follow-up appointments and any physiotherapy sessions until they are discharged.

Wheelchair form

Sheffield, Rotherham, Barnsley or Doncaster:

Collection address: Monday to Friday 10am till 4pm
10 Acres Hill Lane
Parkway
Sheffield
S9 4LR

To arrange loaning a wheelchair please call 0300 456 1914 and select option 2. This is an answer phone service. Please leave a message and someone will return your call.

The British Red Cross charge £22.00 per week, including any elevating leg rests.

If you are unable to collect a wheelchair, the British Red Cross will deliver and collect for a £25 (£12.50 delivery & £12.50 collection).

Please make arrangements for your wheelchair and leg rests (if required) to be collected or delivered and brought to the hospital prior to any planned admissions. Your therapist may recommend a specific type of wheelchair appropriate to your child.

  Adult wheelchair

  Children’s wheelchair

  Left elevating leg rest

  Right elevating leg rest

  Stump board