Purpose of the surgery:
Total knee replacement surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components that are shaped to allow continued motion of the knee, reduce joint pain, and improve quality of life.
 
Preparation before surgery:
  1. The preoperative examination includes electrocardiography, chest x-rays, and blood tests.
  2. The doctor will explain the process and the purpose of the operation to the patient and family. The patient will sign an operation consent form, anesthesia consent form, blood transfusion consent form, and self-pay consent form, etc.
  3. In order to observe the patient’s skin color during anesthesia, prior to operation, nail polish and lipstick must be removed.
  4. To avoid anesthesia side effect, the patient can not eat or drink anything for at least eight hours before surgery. After patient returns to the ward, the eating instructions must be followed.
  5.  On the morning of surgery, the patient will change into a surgical gown and will be required to remove dentures, watches, and jewelry. An intravenous catheter will be inserted by the nurse.
     
Post-operative care:
  1. The patient must keep his/her knees straight. If the leg swelling is severe, pillows can be used to elevate the calf. Do not place pillows under the knees (popliteal fossa).
  2. In order to avoid sputum accumulation, the patient should take deeps breath and cough frequently.
  3. To prevent pressure injury, the patient should change position at least every two hours.
  4. Rehabilitation:
    1. Ankle pumping: This exercise will help reduce swelling and increase circulation. Lie flat on bed. Point toes toward the foot of the bed. Point toes toward knee. Move each foot in a circular motion. Repeat 10 times (Figure 1).
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    2. Quadriceps sets: This exercise will strengthen the thigh muscles. Lie on back with legs straight. Tighten the thigh muscles by pushing the back of the knee down into the bed. Hold the contraction for five seconds and then release. Repeat 10 times (Figure 2).
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    3. Knee flexion and stretch exercise.
      • Lie down and flex the operated leg, then slowly stretch it out as much as possible (Figure 3).
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      • Use a continuous passive motion (CPM) machine twice a day for about 15-30 minutes per session. Applying an ice pack and pressure on the affected leg may relieve the pain and swelling (Figure 4).
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      • Sitting on the edge of a bed or chair, place the good limb in front of the operated leg at the ankle, and apply downward pressure for five seconds. Next, raise the operated leg and stretch for five seconds, then slowly put it down (Figure 5).
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  5. The day after surgery, get out of bed and move around. The nurse will assist and teach the proper use of crutches or a walker.
 
Self-care at home:
  1. Keep the wound clean and dry. Dressing is not necessary if there are no secretions, and the patient can take a shower after the stitches are removed.
  2. Continue rehabilitation, especially knee flexion and stretch exercises.
  3. The pain will reduce gradually; painkillers can be taken as prescribed or ice packs can be used.
  4. Keep using walker until the next out-patient clinic appointment.
  5. Avoid jumping, running, mountain climbing, kneeling and carrying heavy objects during the first one to three months.
  6. Control weight and eat a balanced diet.
  7. If visiting the dentist or having additional surgery, the doctor must be informed of the artificial knee joint, especially when taking prescription antibiotics.
  8. Skin diseases (such as wounds or athlete’s foot) should be treated immediately.
  9. After surgery, it is typically normal for joints to be swollen for three months and feel warm for six months. If fever, wound secretions, or increased pain are experienced, the patient must return to the hospital immediately.
 
Reference
  1. Davila Castrodad, I. M., Recai, T. M., Abraham, M. M., Etcheson, J. I., Mohamed, N. S., Edalatpour, A., & Delanois, R. E. (2019). Rehabilitation protocols following total knee arthroplasty: a review of study designs and outcome measures. Annals of Translational Medicine, 7(Suppl 7), S255. doi:10.21037/atm.2019.08.15
  2. Justine, M., & Ibrahim, A. (2019). Physiotherapy Approach in Improving Knee Function Following Total Knee Replacement: A Case Report. Indian Journal of Physiotherapy & Occupational Therapy, 13(2), 90-94. doi:10.5958/0973-5674.2019.00052.2
  3. Rutherford, R. W., Jennings, J. M., & Dennis, D. A. (2017). Enhancing Recovery After Total Knee Arthroplasty. Orthopedic Clinics of North America, 48(4), 391-400. doi:10.1016/j.ocl.2017.05.002
  4. Wang, K. Y., Chen, S., & Lin, L. H. (2018). Musculoskeletal disorder and nursing. In K. Y. Wang (Ed.), Medical surgical nursing (5th ed., pp. 55-62). Taipei City, Taiwan, ROC: Yeongda.
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