Total knee replacement surgery aims to relieve pain and restore mobility and function. It involves replacing damaged cartilage and bone in the knee joint with prosthetic components. Pre-operative evaluation assesses a patient's medical history, physical exam, labs, and risk factors. Post-operatively, patients undergo physical therapy including range of motion exercises to regain mobility while avoiding high-impact activities. Nursing care focuses on wound monitoring, pain management, and early ambulation to aid recovery.

1. TOTAL KNEE
REPLACEMENT
- NURSING MANAGEMENT
DR. RAJESH T EAPEN
ATLAS HOSPITAL
MUSCAT

3. Q&A

4. Goals of Joint Replacement Surgery
• Relieve pain!!!
• Restore function,
mobility

5. Evaluation Of Patient Before Surgery
• A Complete Medical History
• Thorough Physical Examination
• Laboratory Work-up
• Anesthesia Assessment

6. Preoperative Evaluation
• Soft tissue defects around the knee.
• Vascular status to the limb.
• Extensor mechanism.
• Preoperative range of motion.
• Standing (AP) view, a lateral view of the knee, and a
skyline view of the patella.

7. • Extreme pain
• Limited range of motion
• Previous surgeries to the knee
• Muscle atrophy
• Locking/catching within knee
• Chronic inflammation
• Deformity
• Unable to kneel down
• Lack of function
• Limiting activities of daily living and/or hobbies
PREEXISTING FACTORS LEADING TO
TOTAL KNEE REPLACEMENTS (TKR)

8. CONTRAINDICATIONS TO TKR
• Infection
• Severe vascular disease
• Neuropathic joint
• Obesity
• Skin diseases

9. Preparing for Joint
Replacement Surgery
• Ease anxiety by mentally preparing with:
– Breathing exercises
– Meditation
– Talking with friends and family
• Learn more about knee replacement surgery:
– Brochures
– Handouts
– Websites
– Videos

10. The Night Before Surgery
• Avoid medications, such as “blood thinners”
(aspirin, ibuprofen, etc.).
• Do not consume any food or liquid after
midnight.
• Make sure you have everything you’ll need at
the hospital.
• Ask any questions you may have before
surgery.

11. Nursing Process: The Care of the Patient
Undergoing Orthopedic Surgery—
Assessment, Preoperative
• Routine preoperative assessment
• Hydration status
• Medication history
• Possible infection
– Ask specifically about colds, dental problems,
urinary tract infections, infections within 2 weeks
• Knowledge
• Support and coping

12. Surgical Preparation
• Administer a dose of a 1st
generation
cephalosporin (or
vancomycin,
clindamycin)
• Avoid pressure on
peripheral nerves.

13. Pre-op Care
• Educating Patient
• Discharge planning
• Evaluating patient risks

14. BEFORE & AFTER SURGERY
• Before surgery:
• Begin rehabilitation to build up muscle and stability
• Knowing the exercises before hand will aid in a speedy recovery
• After surgery:
• Adhere to limitations set by doctor
• Attend and stick with rehab!!!
• Gradually begin light, low impact activities to tolerance
• Walking, swimming
• Avoid high impact activities
• Long-distance running, basketball, downhill skiing, impact aerobics

15. Procedure

16. Procedure

17. Procedure

18. Procedure

19. Procedure

20. Procedure

25. Postoperative Management

26. Post-op Care
• Monitor VS
• Wound assessments
• Neurovascular assessments
• Monitor wound drainage
• Pain relief
• Infection/Osteomyelitis prevention
• Promote early ambulation
• Ensure physiotherapy is consulted

27. After Surgery
• Movement of knee determined by doctor.
• Physical therapy is very important to regain
mobility and strength.

28. Post Operative Rehabilitation
– Rapid post-operative mobilization
• Range of motion exercises started
• CPM
• Passive extension by placing pillow under foot
• Flexion- by dangling the legs over the side of
bed
• Muscle strengthening exercises
• Weight bearing is allowed on first post op day

29. Post-op Nursing Interventions
• Observe dressing for bleeding/drainage
• Ice as ordered
• Neurovascular checks
• Pain meds as ordered
• Active flexion of foot q1h while awake
• Observe CAC in wound suction drainage
• Continuous passive motion (CPM) device
• Early ambulation with knee immobilizer
• Physical therapy as ordered

30. Collaborative Problems/Potential
Complications—Postoperative
• Hypovolemic shock
• Atelectasis
• Pneumonia
• Urinary retention
• Infection
• Thromboembolism—DVT or PE
• Constipation or fecal impaction

31. Position in bed
• A towel roll should be placed at the ankle to
promote knee extension when patients are
supine in bed.
• Nothing should be placed behind the
operative knee, to promote maximal knee
extension and prevent knee flexion
contracture.

32. Nursing Considerations
Total Knee Replacement
• Compression bandage & ice may
be applied
•Active ROM of the foot q1h while
patient is awake.
•Wound suction drain – 200-400
mL in first 24 hours is considered
normal
•Continuous passive motion (CPM)
device may be used
•Nurse assists patients in
ambulating evening of or day after
surgery
•Elevate knee while patient sits

33. Q&A
1. What Activities should I avoid after surgery?
- Activities that require stop-start, twisting, or high impact
loading
- Excessive or repetitive bending or squatting
- Heavy lifting
2. Will my new knee replacement set off a metal detector?
- It is unlikely that your implant will set off a a metal detector.
However, if it does, notify the security guard and they will pass a
hand-held unit over your knee to verify.
DOUBTS OF PATIENTS

34. Hospital Discharge
• You will be released from the hospital as soon as you
can:
– Get in and out of bed safely.
– Walk up to 75 feet with your crutches or walker.
– Get up and down flight of stairs.
– Access the bathroom.
– Demonstrate good muscle contraction of the upper thigh
muscle.
• Hospital stay usually lasts 3 to 4 days.
• May continue physical therapy at a rehabilitation center
or at home.

35. Thank You!!!