Total Knee Replacement
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This study provides an overview of Total Knee Replacement (TKR) topic including: TKR risk factors, how knee diseases develops, grows, and spreads, and types of TKR and nursing care that we will be giving to patients with TKR.
A knee x-ray shows density in the central portion of her both knee caps and valgus deformities, which concluded osteoarthritis in both her knee joints. She was admitted immediately to perform Bilateral Total Knee Replacement (TKR).
What is Total Knee Replacement?
If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If medications, changing your activity level, and using walking supports are no longer helpful, you may want to consider total knee replacement surgery.
By resurfacing the damaged and worn surfaces of the knee can relieve pain, correct leg deformity and help resume normal activities.
•
The most common cause of chronic knee pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms.
•
Osteoarthritis - The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
•
Reasons that you may benefit from total knee replacement commonly include: Severe knee pain that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. Moderate or severe knee pain while resting, either day or night. Chronic knee inflammation and swelling that does not improve with rest or medications. Knee deformity: a bowing in or out of your knee. Knee stiffness: inability to bend and straighten your knee.
Surgery – Total Knee Replacement There are two main types of artificial knee replacements: Cemented Prosthesis Uncemented Prosthesis A cemented prosthesis is held in place using an epoxy type cement that attaches the metal to the bone. An uncemented prosthesis has a fine mesh of holes on the surface that allows the bone to grow into the mesh and attaches the prosthesis to the bone.
Each prosthesis has four parts: The tibial component replaces the end of the tibia. The tibia is commonly called the shinbone. The femoral component replaces the end of the femur, the groove where the kneecap slides. The femur is commonly called the thighbone. It is the largest bone in the body. The patellar component replaces the surface on bottom of the patella. The "top" of the kneecap is the part you can feel through your skin. The "bottom" is the on the other side, and slides up and down in the femoral groove whenever you bend or straighten your leg.
The Operation 1.Shaping the distal femoral bone - Once the knee joint is entered, a special cutting tool is placed on the end of the femur. This special tool ensures that the bone is cut keeping the proper alignment to the leg's original angles - even if the arthritis has made you bowlegged or knock-kneed. Several pieces of diseased bone are cut away from the end of the femur so that the artificial knee can be attached.
2. Preparing the tibial bone - Then, the top of the tibia is cut using another cutting tool that also ensures proper alignment. 3. Preparing the patella - The undersurface of the kneecap is removed. 4. Placing the femoral component - The femoral component is then fitted on the femur. In the uncemented type of femoral component, the prosthesis is held on the end of the bone because the end of bone has a taperd cut.
-
The metal prosthesis is made to almost exactly match the taperd cut of the bone. Fitting the femoral component onto the end of the bone holds the component in place by friction. In the cemented component, an epoxy cement is used to attach the metal prosthesis to the bone.
5. Placing the tibial component (metal tray) - The metal tray that holds the plastic spacer is attached to the end of the tibia. The metal tray is either cemented into place, or held in place with screws if the component is the uncemented type. The screws hold the tray in place until the bone grows into the porous coating. The screws are left in the bone and are not removed.
-
6. Placing the Tibial component (plastic spacer) The plastic spacer is attached to the metal tray of the tibial component. If the plastic spacer wears out it can be replaced if the rest of the prosthesis is in good condition - a so called retread.
7. Placing the Patellar component - The patellar button is usually cemented into place behind the patella.
Complications Of Total Knee Replacement The most common complications following knee replacement are:
Thrombophlebitis (DVT)
Infection in the joint
Stiffness of the joint
Loosening of the joint
Exercises after surgery
Quadriceps Setting
Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.
Terminal Knee Extension
This exercise helps strengthen the quadriceps muscle. It is done by straightening your knee joint. Lie on your back with a blanket roll under your involved knee so that the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times.
Knee Flexion
Each day you will bend your knee. The physical therapist will help you find the best method to increase the bending (flexion) of your knee. Every day you should be able to flex it a little further. Your therapist will measure the amount of bending and send a daily report to your doctor.
Straight Leg Raising
Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times. Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags) at the ankle to further strengthen the muscles. The amount of weight is increased in one pound increments.
Activities to avoid after TKR
Our patient, used to have pain and swelling, due to the fresh surgical wound.
Diagnosis Risk for pain & swelling related to surgical wound.
Assessment
Patient problems / Goals
Nursing Intervention
Evaluation
a) Assess factors a)The potential a)Teach simple which may cause problem of pain exercises, such as : pain and swelling. and swelling
a) Pain has lessen.
indicates a goal Quadriceps Setting, that pain and Terminal Knee swelling will be Extension, Knee Flexion, Straight leg lessen. raising.
b) Swelling subsided.
b) Assess the onset, duration, frequency and intensity of pain and swelling.
b) Patient will be able to move/walk slowly.
Assessment
Patient problems / Goals
c) Assess nutrition c) Patient will & appetite need be of patient. able to maintain adequate nutrition for tissue healing.
Nursing Intervention
Evaluation
c) Adequate meal withc) Patient well Iron & protein nourished. supplement, is given to promote - Wound proper tissue healing healing in and restore muscle good strength. progress.
d) Patient d) Assess d) Educate the understood patient’s patient the exercises knowledge about d) Patient will regarding and carry out the after care of be self-care measures at on daily basis TKR at home. able to perform home and exercises. for proper exercises as Wound taught for fast healing.
Health Education for Total Knee Replacement patients
Warning signs of possible blood clots in your leg include:
Increasing pain in your calf Tenderness or redness above or below your knee Increasing swelling in your calf, ankle, and foot Warning signs that a blood clot has traveled to your lung include: Sudden increased shortness of breath Sudden onset of chest pain
Localized chest pain with coughing
Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
Take special precautions to avoid falls and injuries. Individuals who have undergone total knee replacement surgery and experience a fracture may require more surgery.
Notify your dentist that you had a knee replacement. You should be given antibiotics before all dental surgery for the rest of your life.
See orthopaedic surgeon periodically for a routine follow-up examination and x-rays (radiographs), usually once a year.
1.
2.
3.
4.
5.
6.
7.
This study provides an overview of Total Knee Replacement (TKR) topic including: TKR risk factors, how knee diseases develops, grows, and spreads, and types of TKR and nursing care that we will be giving to patients with TKR.
A knee x-ray shows density in the central portion of her both knee caps and valgus deformities, which concluded osteoarthritis in both her knee joints. She was admitted immediately to perform Bilateral Total Knee Replacement (TKR).
What is Total Knee Replacement?
If your knee is severely damaged by arthritis or injury, it may be hard for you to perform simple activities such as walking or climbing stairs. You may even begin to feel pain while you are sitting or lying down.
If medications, changing your activity level, and using walking supports are no longer helpful, you may want to consider total knee replacement surgery.
By resurfacing the damaged and worn surfaces of the knee can relieve pain, correct leg deformity and help resume normal activities.
•
The most common cause of chronic knee pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms.
•
Osteoarthritis - The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness.
•
Reasons that you may benefit from total knee replacement commonly include: Severe knee pain that limits your everyday activities, including walking, climbing stairs, and getting in and out of chairs. Moderate or severe knee pain while resting, either day or night. Chronic knee inflammation and swelling that does not improve with rest or medications. Knee deformity: a bowing in or out of your knee. Knee stiffness: inability to bend and straighten your knee.
Surgery – Total Knee Replacement There are two main types of artificial knee replacements: Cemented Prosthesis Uncemented Prosthesis A cemented prosthesis is held in place using an epoxy type cement that attaches the metal to the bone. An uncemented prosthesis has a fine mesh of holes on the surface that allows the bone to grow into the mesh and attaches the prosthesis to the bone.
Each prosthesis has four parts: The tibial component replaces the end of the tibia. The tibia is commonly called the shinbone. The femoral component replaces the end of the femur, the groove where the kneecap slides. The femur is commonly called the thighbone. It is the largest bone in the body. The patellar component replaces the surface on bottom of the patella. The "top" of the kneecap is the part you can feel through your skin. The "bottom" is the on the other side, and slides up and down in the femoral groove whenever you bend or straighten your leg.
The Operation 1.Shaping the distal femoral bone - Once the knee joint is entered, a special cutting tool is placed on the end of the femur. This special tool ensures that the bone is cut keeping the proper alignment to the leg's original angles - even if the arthritis has made you bowlegged or knock-kneed. Several pieces of diseased bone are cut away from the end of the femur so that the artificial knee can be attached.
2. Preparing the tibial bone - Then, the top of the tibia is cut using another cutting tool that also ensures proper alignment. 3. Preparing the patella - The undersurface of the kneecap is removed. 4. Placing the femoral component - The femoral component is then fitted on the femur. In the uncemented type of femoral component, the prosthesis is held on the end of the bone because the end of bone has a taperd cut.
-
The metal prosthesis is made to almost exactly match the taperd cut of the bone. Fitting the femoral component onto the end of the bone holds the component in place by friction. In the cemented component, an epoxy cement is used to attach the metal prosthesis to the bone.
5. Placing the tibial component (metal tray) - The metal tray that holds the plastic spacer is attached to the end of the tibia. The metal tray is either cemented into place, or held in place with screws if the component is the uncemented type. The screws hold the tray in place until the bone grows into the porous coating. The screws are left in the bone and are not removed.
-
6. Placing the Tibial component (plastic spacer) The plastic spacer is attached to the metal tray of the tibial component. If the plastic spacer wears out it can be replaced if the rest of the prosthesis is in good condition - a so called retread.
7. Placing the Patellar component - The patellar button is usually cemented into place behind the patella.
Complications Of Total Knee Replacement The most common complications following knee replacement are:
Thrombophlebitis (DVT)
Infection in the joint
Stiffness of the joint
Loosening of the joint
Exercises after surgery
Quadriceps Setting
Lie on your back with legs straight, together, and flat on the bed, arms by your side. Perform this exercise one leg at a time. Tighten the muscles on the top of one of your thighs. At the same time, push the back of your knee downward into the bed. The result should be straightening of your leg. Hold for 5 seconds, relax 5 seconds; repeat 10 times for each leg.
Terminal Knee Extension
This exercise helps strengthen the quadriceps muscle. It is done by straightening your knee joint. Lie on your back with a blanket roll under your involved knee so that the knee bends about 30-40 degrees. Tighten your quadriceps and straighten your knee by lifting your heel off the bed. Hold 5 seconds, then slowly your heel to the bed. You may repeat 10-20 times.
Knee Flexion
Each day you will bend your knee. The physical therapist will help you find the best method to increase the bending (flexion) of your knee. Every day you should be able to flex it a little further. Your therapist will measure the amount of bending and send a daily report to your doctor.
Straight Leg Raising
Bend the uninvolved leg by raising the knee and keeping the foot flat on the bed. Keeping your involved leg straight, raise the straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the leg slowly to the bed and repeat 10-20 times. Once you can do 20 repetitions without any problems, you can add resistance (ie. sand bags) at the ankle to further strengthen the muscles. The amount of weight is increased in one pound increments.
Activities to avoid after TKR
Our patient, used to have pain and swelling, due to the fresh surgical wound.
Diagnosis Risk for pain & swelling related to surgical wound.
Assessment
Patient problems / Goals
Nursing Intervention
Evaluation
a) Assess factors a)The potential a)Teach simple which may cause problem of pain exercises, such as : pain and swelling. and swelling
a) Pain has lessen.
indicates a goal Quadriceps Setting, that pain and Terminal Knee swelling will be Extension, Knee Flexion, Straight leg lessen. raising.
b) Swelling subsided.
b) Assess the onset, duration, frequency and intensity of pain and swelling.
b) Patient will be able to move/walk slowly.
Assessment
Patient problems / Goals
c) Assess nutrition c) Patient will & appetite need be of patient. able to maintain adequate nutrition for tissue healing.
Nursing Intervention
Evaluation
c) Adequate meal withc) Patient well Iron & protein nourished. supplement, is given to promote - Wound proper tissue healing healing in and restore muscle good strength. progress.
d) Patient d) Assess d) Educate the understood patient’s patient the exercises knowledge about d) Patient will regarding and carry out the after care of be self-care measures at on daily basis TKR at home. able to perform home and exercises. for proper exercises as Wound taught for fast healing.
Health Education for Total Knee Replacement patients
Warning signs of possible blood clots in your leg include:
Increasing pain in your calf Tenderness or redness above or below your knee Increasing swelling in your calf, ankle, and foot Warning signs that a blood clot has traveled to your lung include: Sudden increased shortness of breath Sudden onset of chest pain
Localized chest pain with coughing
Participate in regular light exercise programs to maintain proper strength and mobility of your new knee.
Take special precautions to avoid falls and injuries. Individuals who have undergone total knee replacement surgery and experience a fracture may require more surgery.
Notify your dentist that you had a knee replacement. You should be given antibiotics before all dental surgery for the rest of your life.
See orthopaedic surgeon periodically for a routine follow-up examination and x-rays (radiographs), usually once a year.
1.
2.
3.
4.
5.
6.
7.
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