Desun Today : February 2016 - JOINT REPLACEMENT

THINGS TO CONSIDER IN JOINT REPLACEMENT

• Initially conservative management with medicines is administered
• At home, assistance is required for basic life activities
• Lifestyle modification is necessary as prescribed by physician

WHEN JOINT REPLACEMENT MAY NOT BE OF MUCH HELP ?

INFECTION : If there is any existing infection in the body

OBESITY :If the patient is overweight

NEUROPATHY : In case of any nerve damage

PRE-OPERATIVE MEDICAL EVALUATION OF THE PATIENT

Medical evaluation - Good cardiopulmonary function can withstand anesthesia and to cope with a blood loss of 1000-1500 ml

X-RAYS

• Standing Anterior-Posterior (AP) View
• Lateral View
• Patellofemoral (skyline) View
• Long leg Radiographs (for assessmal-alignment)
• Standing Radiographs with the knee in extension or in 45 degrees of flexion (Rosenberg view)

PATHOLOGY

• Complete Blood Count (CBC)
• Erythrocyte Sedimentation Rate (ESR)
• Serum Electrolytes l Renal Function Studies
• Prothrombin Time and Activated Partial Thromboplastin Time (PT/APTT)
• Urinalysis
• Urine Culture

Antibiotics and antithromboembolic Devices

Antibiotics and antithrombotic prophylaxis are administered approximately 30 minutes before the incision is made.

Mechanical anti-thromboembolic devices like struva, stockings and foot pumps are used intra-operatively to prevent thrombosis.

Other symptoms that can occur with CAD include:

• Shortness of breath
• Palpitations
• Weakness or dizziness

SURGICAL POST-OPERATIVE CARE

Adequate Hydration & Analgesia : The patient undergoes recovery & is usually observed for a 24-hours period in a High-Dependency Unit. Adequate hydration and analgesia are essential at this time of high physical stress. Analgesia is provided through continuation of the intraoperative epidural, patient-controlled intravenous analgesia or oral analgesia. Cryotherapy is used to reduce post-operative swelling and pain.

Beginning of Knee Movement : At this early stage, the patient begins knee movement, sometimes using a Continuous Passive Motion (CPM), machine & exercises. These are continued under the supervision of a physiotherapist until discharge. Drains are usually removed within 24 hours, and the patient is encouraged to walk on the 2nd postoperative day. Continual improvement is generally observed & discharge occurs in 5-14 days depending on speed of recovery.

Discharge : Discharge is recommended only once wound healing is satisfactory, knee flexion of 90 degrees has been achieved, the patient is considered to be safe and supported in the home environment & no complications are present. Thromboembolism prophylaxis is often continued at home for a period of time. The first outpatient review generally is in 6 weeks to 3 months