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Anatomy of the Knee

Made up of
three bones:
Femur (thigh
bone)
Tibia (lower leg
bone)
Patella (knee
cap)
KNEE RANGE OF MOVEMENTS
ROM :
0 to 140 degrees of
flexion.

In osteoarthritis ROM
decreases.

By TKR we need to
increase the ROM.
OSTEOARTHRITIS
Knee Joint
Healthy knee joint


Arthritic knee joint
Clinical examination
Swelling
Joint line tenderness
Crepitus on ROM.
Decreased ROM
Deformity of knee


Skin condition & leg
vascularity.






PRE OPERATIVE EVALUATION
Previous medication:
Stop blood thinners

Surgical profile:
CBP Hb%
-- TWBC
-- Platelet count
Blood urea & serum
creatinine.
PT & INR
Serum electrolytes



Pre operative care

Look for any infection in
body.
IV access.
Blood reserve.
Pre operative
medication.
Blood sugar levels.
Foleys catheterisation

Pre operative preparation
Shaving of leg from mid thigh to mid leg.

Betadine scrubbing 2 times at 10 pm and 6 am
under aseptic conditions.


Total Knee Replacement Components
Femoral- replaces arthritic
portion of thigh bone
Tibial- replaces arthritic
portion of shin bone
Tibial insert- replaces
cartilage and acts as shock
absorber
Patella- replaces knee cap
TKR

In recovery room
Vitals

IV fluids

Elevation of limb

Suction drain
Post op pain management
IV/IM/Oral analgesics.

Epidural anesthesia.

Local anesthesia

Nerve blocks.

Transdermal patches








Post operative antibiotics
IV CEPHALOSPORINS
FOR 2 DAYS.

THEN CONTINUE ORAL
CEPHALOSPORINS FOR
10 MORE DAYS.
DVT PROPHYLAXIS
S/C LOW MOLECULAR
WEIGHT HEPARINS (EX:
CLEXANE) FOR 5 DAYS.

THEN ORAL
ANTICOAGULANTS.
1
ST
POST OPERATIVE DAY
Pain management

Repeat Hb%.

Urine out put

Fever

Drain collection

Wound soakage


POST OPERATIVE PROTOCOL
The patients knee was immobilized in a Jones compressive
bandage and a knee immobilizer immediately post operatively.
The patients were started on IV antibiotics and DVT prophylaxis
in the form of subcutaneous low molecular weight heparin.

1st post op day, patient was taught static quadriceps exercises.

2nd post op day, the dressing was debulked and wound
inspected. Patient was made to walk full weight bearing within
the limits of pain with the knee immobilizer and advised to
continue static quadriceps exercises.


POST OP PROTOCOL
4 th post op day, knee flexion was started and patient was
taught dynamic quadriceps exercises.


IV antibiotics were given for the first 48 hours post op and
the switched over to oral antibiotics for the next five days.

DVT prophylaxis was given for the first five days post
operatively.

12th post op day, sutures were removed and patient was
advised to continue regular physiotherapy.
ICE PACK APPLICATION
Physiotherapy
Static quadrices
exercises
Ankle pumps
Static knee
extension
Knee bending



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