Total Knee

Replacement
Brawa Tama

Advisor: Dr. dr. Adrian Khu, Sp. OT, FICS,

AIFO-K
Patient’s status
 Room number : A905
 Day/date of admission : 5th September 2019
 Medical record number : 07.73.15
Patient’s identity
 Name : Mrs. H.T.O.
 Sex : Female
 Date of birth : 14th March 1950
 Age: 69 years old
 Nationality : Indonesia
 Religion : Buddhist
History taking
 Presenting complaint: pain on both knee joints
 History of presenting complaint :
 Patient came to Royal Prima ER on 5th September 2019 with
the complaints of stiffness and pain on both of her knees for
at least the last 2 months. She claimed to feel worse pain
on her right knee. History of trauma (-).
 Past history : -
 Drug history : -
 Family history : -
Physical examination
 Vital sign
 BP : 126/85 mmHg
 RR : 22x/i
 HR : 74x/i
 T : 37o C
 GCS : 15
 O2 saturation : 99%
Physical examination
 Head : Normocephalus
 Eyes : Pupil Isokor, Icteric Sclera (- / -), Anemic Conjunctiva
(- / -), Light Reflex (+ / +)
 Ears : normal
 Nose : normal
 Mouth : normal
 Neck : Lymph Node Enlargement (-)
Physical examination
 Thorax :
 Anterior
 Inspection : symmetrical fusiform
 Palpation : symmetrical
 Percussion : resonance
 Auscultation : vesicular, normal breath sound
 Posterior
 Inspection : symmetrical fusiform
 Palpation : symmetrical
 Percussion : resonance
 Auscultation : vesicular, normal breath sound
 Heart :
 Inspection : ictus cordis not visible
 Palpation : ictus cordis not palpable
 Percussion : normal
 Auscultation : normal S1, S2, murmur (-), gallop (-)
Physical examination
 Abdomen
 Inspection : symmetry, spider nevi (-), ascites(-)
 Auscultation : normal peristaltic sound
 Palpation : normal, no tenderness
 Percussion : tympanic

 CNS
 Consciousness : compos mentis
 GCS : 15
 CN functions : normal

 Genitalia : not examined

Physical examination
 Extremities
 Upper extremities
 Look : normal
 Feel : normal
 Move : normal

 Lower extremities :
 Look : both right and left knee joint looks a bit swollen
 Feel : tenderness felt on both knee joints
 Move : stiffness of both right and left knee joints, limited ROM, reduced
flexibility
Diagnosis
 Temporary diagnosis :
 Knee OA dextra Grade IV
 Further investigation :
 X-ray (right knee AP & lateral view) & thorax
 BUN, Creatinine
 CBC
 Liver function test
 ECG
Kellgren & Lawrence OA grading
Kellgren & Lawrence OA grading
Kellgren & Lawrence OA grading
Laboratory Result
Liver Function Test
No. Test Result Unit Normal range
1 SGOT 17 U/L 0 – 31
2 SGPT 29.5 U/L 14 – 59

Renal Function Test

No. Test Result Unit Normal Range
1 BUN 49 mg/dL 15 – 38
2 Cr 0.74 mg/dL 0.55 – 1.30
Laboratory Result
Hematology
No. Test Result Unit Normal Range
1 Hemoglobin 12.7 g/dL 13.5 – 15.5
2 Leukocyte 8.10 103/μL 5 – 11
3 Platelets 201 103/μL 150 – 450
4 Hct 37.3 % 30.5 – 45.0
5 Erythrocyte 4.06 106/mm3 4.5 – 6.5
6 MCV 91.9 μm3 75.0 – 95.0
7 MCH 31.3 pg/cell 27.0 – 31.0
8 MCHC 34.1 g/dL 32.0 - 34.0
Laboratory Result
Hematology
No. Test Result Unit Normal Range
9 RDW 12.7 % 11.50 – 14.50
10 PDW 61.6 fL 12.0 – 55.0
11 MPV 9.4 fL 6.50 – 9.50
12 PCT 0.19 % 0.10 – 0.50
13 Eusinophil 3.6 % 1–3
14 Basophil 0.5 % 0–1
15 Monocyte 5.5 % 2–8
16 Neutrophil 61.7 % 50 – 70
17 Lymphocyte 27.7 % 20 – 40
18 LUC 1.1 % 0-4
Imaging (pre-operative) 20/8/2019
Treatment
 Plan : Posterior stabilized total knee arthroplasty of the Right
Knee (5/9/19)
 Actions :
 Patient placed in supine position
 Anaesthetic procedure (spinal)
 Disinfection & draping
 Incision in knee areas
 Femur & tibia replacement component identification
 Total Knee Replacement procedure (posterior stabilization)
 Wound washing, drainage placement
 Wound closure
Imaging (post-operative) 5/9/2019
Post-operative assessment
 Definite diagnosis
 Knee OA dextra Grade IV

 Treatment
 Viccyline
 Ketorolac
 Ranitidine

 Education
 Preventing post-operative infection
 Wound hygiene control
 Changing wet bandages
 Early ambulation & physiotherapy
Post-operative
 Complications :
assessment
 Postoperative bleeding  Dislocation
 Failure of wound healing
 Implant loosening
 Implant fracture
 Instability & malalignment
 Revision
 Stiffness
 Thromboembolic disease (blood
 Superficial or deep clots)
periprosthetic joint infection  Neural deficit (sensory or motor)
 Periprosthetic fracture  Intraoperative Death
(distal femur, proximal
tibia, or patella)