Makayla Sims

Knee replacement is a routine surgery performed on more than 600,000 people

worldwide each year. More than 90% of people who have had a total knee replacement

experience an improvement in knee pain and function. 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. To

diagnose your condition, an orthopedic surgeon will perform a thorough examination of your

knee, analyze X-rays, and conduct physical tests. You will be asked to describe your pain, if you

suffer from other joint pain, and if you have endured past injuries that may have affected your

current knee condition. It may be helpful to keep a record of your knee pain to share with your

doctor. Your knee joints will then be tested for strength and range of motion through a series of

activities, which include bending and walking. X-rays of your knee joint will indicate any change

in size or shape, or any unusual circumstances. Signs that it may be time for a knee replacement

include pain persisting or reoccurring over time, knee aches during and after exercise,

medication and using a cane are not delivering enough relief, pain prevents you from sleeping,

your knees are stiff or swollen, You feel a “grating” of your joint, and you experience morning

stiffness that typically lasts less than 30 minutes.

There are four basic steps to a knee replacement procedure. The damaged cartilage

surfaces at the ends of the femur and tibia are removed along with a small amount of underlying

bone. The removed cartilage and bone is replaced with metal components that recreate the

surface of the joint. These metal parts may be cemented or "press-fit" into the bone. Lastly, the

undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. Some surgeons
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do not resurface the patella, depending upon the case. A medical-grade plastic spacer is inserted

between the metal components to create a smooth gliding surface. When the decision is made to

have surgery, the patient may be asked to do some things in preparation. Two weeks before

surgery, a patient may be asked to stop taking certain medications, such as Aspirin, non-steroidal

anti-inflammatory drugs and other medications that make it more difficult for blood to clot. In

addition, the patient may be asked to stop Steroids and other medications that suppress the

immune system and therefore can increase the chance of post-surgical infection, and Opioid pain

medication to help decrease tolerance to pain medication and improve postoperative pain level.

A patient may be told to eliminate or cut down on smoking or other tobacco use. Nicotine

impedes healing and increases the risk of post-surgical infection or deep vein thrombosis, a

potentially deadly blood clot in a deep vein. Patients who have other medical conditions, such as

diabetes or heart disease, may be required to consult specialists in those areas to make sure they

are able to undergo surgery. Patients who have more than 1 or 2 alcoholic drinks per day should

tell their doctors, as heavy alcohol use influence the effects of anesthesia. Patients who get sick

(cold, flu, fever, herpes breakout, etc.) in the days preceding a surgery should report it to their

doctors.

While in the observation area, I witnessed the circulating nurse do many things. As a

patient advocate, the circulating nurse interacted with the patient before surgery and served as a

patient protector during surgery. Assessing the patient right before surgery was critical to making

sure that all required prep was completed. Serving as a patient advocate and safety monitor, the

circulating nurse observed the surgery and ensured that no aspect of patient care is missed. I also

got to see the scrub nurse in action. The scrub nurse works in the sanitized area of the surgery.
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He is "scrubbed in," putting on sterile masks and clothing before approaching the surgical

station. The scrub nurse hands the surgical tools and other supplies to the doctor performing the

operation. A scrub nurse maintains the sanitation of the operating area, making sure everything

stays sterile to reduce the likelihood of contamination. Another key person I witnessed in the

surgical setting, was the nurse anesthetist. Nurse anesthetists provide anesthesia and related care

before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide

pain management and emergency services, such as airway management. I witnessed this nurse

administer spinal anesthesia to the patient. I felt that the communication between all these roles

and the surgeon was productive and sometimes went without words.

Before the surgery, the nurse did a preoperative assessment and discharge planning. She

also went through the patients medications, and looked at risk factors. The preoperative

assessment is very important, because if the patient goes to surgery with good pulses, then comes

back with an absent pedal pulse or confusion and disturbed level of consciousness then there is a

problem. During surgery, the nurse made sure the patient was constantly monitored. Her vitals

were constantly monitored along with constant observation of her heart and airways. The patient

was also strapped down for safety. After surgery a postoperative assessment was conducted to

make sure the patient returns to their back to baseline and does not show any signs of malignant

hyperthermia. This is all done to ensure no harm is done to the patient, and that they have a

positive outcome.