TOTAL HIP AND KNEE

REPLACEMENTS
JULY 2009
 At UAH total # of Joints waiting for surgery: 276
 Total Hip Replacements waiting: 31
 Total Knee Replacements waiting: 39
 Average Length of Stay (ALOS) had decreased
from past years
THR ALOS at UAH 5.8 days
TKR ALOS at UAH 5.7 days
 Total Hip Replacements
Causes of THR:
1) Osteoarthritis – wear and tear arthritis
2) Rheumatoid Arthritis
3) Avascular Necrosis
4) Congenital Hip Disorders - Ganz Osteotomy
Ceramic Hip
Hip Resurfacing
 Post-operative Care
 Follow Care Path
 Total Hip Precautions need to be maintained and
reinforced
 No straight leg raises
 No flexion > 90 degrees
 No adduction past neutral
 No internal rotation
 No forced external rotation
 No extension past neutral
 Monitor vital signs and neurovascular assessment
 Systems assessment
 Hemovac/foley drainage
 Dressing
 Analgesics
 Progressive ambulation (anticoagulation)
 Progressive diet
 OT and PT consults
 Total Hip Precautions

Rule 1: Do not
bend past 90
degrees
Rule 2: Do
not cross
your legs
Rule 3: Do not
twist your body-do
not turn your leg
inward or outward
Rule 4: Do not forcibly extend your leg behind your body
Rule 5: Follow your weight
bearing order and use your
walking aid (walker or
crutches)
 Complications of THR
1) Thrombophlebitis
2) Infection
3) Dislocation
4) Loosening of Prosthesis
5) Inflammatory reaction
6) Heterotrophic Bone Growth
 Total Knee Replacements
Causes of TKR:
1) Osteoarthritis
2) Rheumatoid Arthritis
3) Traumatic Arthritis

Unicondylar Knee
 Post-operative Care
 Follow Care Path
 Total Knee Precautions
 Assessment! (system/vital signs/neurovascular)
 Drains (hemovac and foley).
 Dressing/splints
 Pain control
 Assist with mobility (TKR’s require hard work on the
part of the patient)
Continuous Passive Motion
Different brands of
CPM
 Patient controlled

Able to set flexion

and extension
 Using CPM
 Analgesics! Analgesics! Analgesics!
 Start slow and increase flexion as patient tolerates
 The more they use it the better
 Often off at night
 When starting the next day, decrease flexion and
work up again….knee will be stiff
Total Knee Movements to Avoid

Rule 1: Do not twist

your knee
Rule 2: No
extreme knee
bending
Rule 3: Follow your
weight bearing order
and use your walking
aid (walker or crutches)
Rule 4: Do not lift
or move heavy
objects
 Complications
 Blood Loss (1st couple of days Post-Op)
 Thrombophlebitis
 Infection
 Stiffness – minimum flexion wanted is 90 0
Optimum is > 110o
 Component Loosening
 ABBREVIATED: PATIENT CARE ORDERS
PRIMARY TOTAL HIP/KNEE ARTHROPLASTY
(MEDICATIONS ORDERS WILL BE FOUND IN UNIT MARS BOOKLETS)
 Day 0 POST OP:__________
 Routine post-operative vital signs and extremity
 neurovascular assessment
 O2 sat q shift and PRN, may titrate O2 to keep sats
 >92% or preop baseline.
 Keep O2 on overnight until POD 2 (may DC during the day)
 Deep Breathing and Coughing q1h
 IV Normal Saline at ________cc/hr
 In and out q shift
 HgB if symptomatic
 Empty and Reprime hemovac Q 8hr & when full
 Regular high fiber diet
 Day 1 POST OP: _________
 CBC, lytes, creatinine
 Saline Lock IV if drinking well
 Remove Foley catheter early am ______
 Dressing Change q day and PRN
 Ice to limb PRN (max 20 mins at a time)
 DC hemovac if drainage < 75 cc in 12 hrs _ _____
 D/C hemovac if drainage < 75 cc in 12 hrs _ _____
 Teach patient to self administer fragmin injection _____
 Reinforce movement precautions
 Assist patient to maintain logbook
 Confirm discharge plan to home/rural/subacute facility;
 and fax forms to rural or subacute __ ______
 Day 2 POST OP: ________
 CBC
 Post op X rays “Pilot” (hip or knee) ______
 Arrange discharge prescriptions ______
 Day 3 POST OP: ________
 CBC, lytes, creatinine
 Discharge patient home
 Transfer patient to rural/ subacute facility ______
 Provide patient with discharge teaching (medications,
 movement precautions, follow-up appointments, total joint card) __
_____
 Arrange for home care and/or home collections ______
 Draw platelets POD 5 or prior to discharge