Arthroplasty or knee joint replacement surgery is a type of surgical procedure that is performed to repair a damaged part of the joint or replace it with an artificial joint. Arthroplasty is performed in cases where the destruction and damage to the knee joint is such that it cannot be improved by non-surgical methods and the knee surgeon prefers to use knee joint replacement to improve the patient's condition.
To treat knee joint problems, a specialist doctor will first prescribe non-surgical treatment measures, such as medication, physiotherapy, exercise and the use of assistive devices such as braces, and if the patient's condition cannot be improved with these methods; he will proceed with knee joint replacement.
Arthritis is one of the most common diseases, and among the joints of the body, the knee is the most common. Knee joint osteoarthritis is characterized by pain and deformity of the knee in the form of a brace or cross-shaped knee. This disease usually occurs in older people, but it may also occur at younger ages in those who have a history of joint damage.
Joint dryness and swelling are other symptoms of this disease. Factors predisposing to this disease include weight gain, a history of knee injuries, especially meniscus, ligaments, and articular cartilage injuries, as well as a person's genetic predisposition. Treatment of this disease in the early stages includes physiotherapy, weight loss, hydrotherapy, and painkillers. As time passes and the disease becomes more severe, surgery is helpful.
Knee Arthritis Surgery
Knee arthritis surgery in the advanced stages of the disease involves knee joint replacement. In this surgery, the damaged joint surfaces are removed and replaced with a prosthesis. The prosthesis consists of two metal parts that cover the joint surfaces of the femur and tibia, and a compact and strong plastic called polyethylene that forms the joint space. The metal parts are attached to the bone with special orthopedic cement. Knee joint replacement surgery is a very precise surgery, and the smallest error in performing the surgery may cause treatment failure.
With this surgery, the knee deformity is corrected and after the surgery, the patient can walk with full weight on his legs and with the help of a cane. Physiotherapy is very important after the surgery, because strengthening the surrounding muscles and gaining knee movement depends on physiotherapy and good cooperation of the patient.
Patient education items:
The patient's feet should be placed away from the body, which is established by a pillow placed between the legs. For a long time, the patient should be taught not to cross his legs.
The head of the patient's bed should not be raised more than 45 degrees so that the joint does not bend.
When changing the dressing, any signs of redness, swelling, foul-smelling discharge, etc. should be reported. The patient's diet should not be constipating or bulky.
Use protein and vitamin-rich foods, fresh vegetables and fruits.
48 hours after surgery, an ice pack helps reduce pain and swelling, but it has no effect from the third day onwards. The hemovac helps drain secretions at the wound site and remains in place for up to 48 hours, then remove it. Physiotherapy and exercise to strengthen the shoulder and chest muscles and perform isometric and isotonic exercises. The patient should get out of bed and walk on the second day after surgery with a walker or crutches.
After getting out of bed, the hip joint is placed in full extension. Climbing stairs and bending are prohibited in the first 3 months after surgery.
Use a walker or crutches and do not put maximum body weight on the operated joint and put it on the hands. Use a high chair for sitting and avoid sitting for more than 30 minutes.
Hip arthroplasty
Hip joint replacement is usually performed in elderly people due to femoral neck fracture and osteoporosis. This procedure is performed in two forms: complete, in which the femoral head and acetabulum cavity are replaced, and incomplete, in which only the femoral head is replaced.
Required nursing care:
Postoperative pain:
1- In the first 24-48 hours, narcotics are used, and if necessary, a narcotic infusion pump.
Start taking oral painkillers from 48 hours onwards
3. Briefly move the patient to reduce pressure on the bony prominences
4. Inform the doctor if there is pain that is not relieved by narcotic painkillers.
Risk of prosthesis dislocation:
1. Place the patient's legs in the abduction position (place a pillow between the legs so that they are far apart)
2. Do not bend the hip joint more than 90 degrees (the head of the bed should not be higher than 60 degrees)
3. Provide the patient and companions with the necessary training to prevent joint dislocation during movement
4. Emphasize to the patient about movement restrictions for up to 4 months
5. Check for symptoms of joint dislocation and immediately inform the treating physician (severe pain in the operation area - shortening of the leg - severe groin pain - inability to move the leg)
6. Avoid putting weight on the operated leg for up to 6 months
7. Use assistive devices such as a walker or crutches to start moving
8. The nurse should teach the patient how to get out of bed, sit down, and walk.
Possibility of DVT and embolism:
1- The highest risk of DVT is 5-7 days after surgery.
2. Check for DVT symptoms: redness - pain and swelling in the calf and a positive Homans sign: If the knee is straight, if the foot is in a flexed position (the sole of the foot is facing backwards), severe pain will occur in the calf. Necessary precautions to prevent thrombosis include:
* Getting up as soon as possible after the patient recovers
* Using varicose stockings
* Performing active & passive leg movements in bed
* Emphasis on physical therapy of the limbs
* Taking the prescribed anticoagulant Enoxaparine
* Encouraging adequate fluid intake
Risk of postoperative bleeding:
1- Monitoring the surgical site for bleeding or hematoma and draining the patient after surgery
2. More normal rate