Once considered a high risk, joint replacements are now very common. It is termed as ‘a life-changing procedure’.
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
Standing Anterior-Posterior (AP) 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)
Complete Blood Count (CBC)
Erythrocyte Sedimentation Rate (ESR)
Serum Electrolytes l Renal Function Studies
Prothrombin Time and Activated Partial Thromboplastin Time (PT/APTT)
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.
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