Knee Arthroplasty

(Total Knee Replacement)

What is it?
During knee replacement, a surgeon cuts away damaged bone and cartilage from femur, tibia and kneecap and
replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.
Why it’s done?
It is most commonly done to repair joint damage caused by osteoarthritis and rheumatoid arthritis.
You may be a candidate for knee replacement if:
Your pain is disabling- People who need knee replacement surgery usually have problems walking, climbing
stairs, and getting in and out of chairs. They also may experience moderate or severe knee pain at rest.
Other treatments haven't helped- More conservative treatments include weight loss, physical therapy, a cane
or other walking aid, medications, and braces.
You're 55 or older- Knee replacement is typically performed in older adults, but it may be considered for
adults of all ages.
Risks:
Infection, Knee stiffness, blood clots, nerve damage. An infected knee replacement usually requires surgery to
remove the artificial parts and antibiotics are necessary to kill the bacteria. After the infection is cleared, another
surgery is performed to install a new knee.
Risks of serious complications are rare. According to the American Association of Orthopedic Surgeons, fewer
than 2 percent of people undergoing knee replacement surgery experience serious complications.
Pre-Op
Before the procedure, the surgeon takes medical history and performs a physical examination to assess knee's
range of motion, stability and strength. He or she also orders an X-ray exam to determine the extent of knee
damage. A full medical exam is performed, including blood tests, an electrocardiogram and a urine test, before
surgery. Patient is NPO after midnight.
Knee replacement surgery requires anesthesia. Patient’s input and personal preference helps the team decide
whether to use general anesthesia, spinal or epidural anesthesia.
Intra-Op
During the procedure, the knee is in a bent position so that all surfaces of the joint are fully exposed. After
making an incision about 8 to 10 inches (20 to 25 centimeters) in length, your surgeon moves aside your
kneecap and cuts away the damaged joint surfaces. After the joint surfaces are prepared, the surgeon inserts and
attaches the pieces of the artificial joint. Before closing the incision, he or she bends and rotates your knee,
testing and balancing it to ensure that it functions properly. The surgery lasts about two hours.
Post-Op
 Advance clear liquid diet as tolerated
 Monitor VS
 Monitor and Manage Pain Level
 Monitor labs for infection
 Monitor and Manage Wound Site
 Establish Voiding and Bowel Elimination Pattern
 Patient/Family Education on Reporting Complications
 Encourage pt. to move feet and ankles, which increases blood flow to leg muscles and helps prevent
swelling and blood clots. Doctor may order blood thinners or compression boots to further protect against
swelling and clotting. Patient is usually discharged by 3rd day post-op.
Nursing Diagnosis
 Acute pain r/t TKR, AEB eight inches (20 cm) long incision.
 Altered Mobility r/t TKR, AEB use of wheelchair
 Risk for Infection r/t incision.