Normal Knee Anatomy American Academy of Orthopaedic Surgeons

Normal Knee Anatomy American Academy of Orthopaedic Surgeons : AAOS, 2015

Osteoarthritis of Knee American Academy of Orthopaedic Surgeons : AAOS, 2015

Total Knee Arthroplasty American Academy of Orthopaedic Surgeons : AAOS, 2015

DVT, PE Blood clots form in one of the deep veins of the body most commonly form in the veins of the pelvis, calf, or thigh.

DVT, PE Warning signs of blood clots in leg !! • Increasing pain in calf • Tenderness or redness above or below knee • New or increasing swelling in calf, ankle, and foot

DVT, PE Warning signs of pulmonary embolism !! • Sudden shortness of breath • Sudden onset of chest pain • Localized chest pain with coughing

fat embolism Schonfeld’s criteria • Petechiae • Chest X-ray changes (diffuse alveolar infiltrates) • Hypoxaemia (Pao 2 < 9. 3 k. Pa) • Fever (>38°C) • Tachycardia (>120 beats min) • Tachypnoea (>30 bpm) 5 4 3 1 1 1 Cumulative score >5 required for diagnosis

Infection It may happen while in the hospital or after go home or anywhere from weeks to years after the surgery

Infection Warning signs of infection !! • fever • chills • Increasing redness, tenderness, or swelling of the knee wound • Drainage from the knee wound • Increasing knee pain with both activity and rest

Goals of Joint Replacement Surgery • Relieve pain !! • Restore function, mobility (knee movement, alignment) • Increase activity • Improve quality of life

pre-admit Preparing for Surgery • Medical Evaluation • Film : CXR, Knee AP/lat • EKG • Laboratory work up : CBC, U/A, FBS, BUN, Cr, Electolyte, G/M

วน Admit • Possible infection – Ask specifically about colds, dental problems, urinary tract infections, infections within 2 weeks • G/M PRC 2 -4 Unit • สอน early ambulation, AROM Knee

Pre-op • Pre visit scrub nurse • Pre visit anasth nurse • Consult Med / Pre medicine / Protocal DM • Hygiene care อาบนำ สระผม • Skin )Hibiscrub ฟอก 2 times( • Ice therapy เตรยม Cryo cuff

operation day • Routine Pre op )NPO, IV, V/S, Prep skin, Retained cath, G/M( • Consent form + Identify Pt, Knee Lt/Rt/Both • Pre-med • Antibiotic 1 -½hr/พอดกบลงมด (ward, OR( Cloxacillin, Cefazolin, Fosfomicin • Timing operation 2 -3 hrs

ระยะผาตด (operation day( Risks of Surgery Blood loss • Tourniquets are used during surgery. • There may be some bleeding into the knee • • after surgery. use a drain in the knee clamp/no clamp Hct at ward / at 18. 00 Transamine 500 mg IV q 6 hr If patient have symptoms from a low blood count, patient may need a blood transfusion.

กลบ ward • Close skin )silk, staple, sterile strip( • Radivac drain )clamp, off clamp, suture, work( • Cryo cuff, John bandage

หลงผาตด 24 ชวโมงแรก • Monitor Vital sign • การจดทานอน หามงอ เขา หรอ ใชหมอนรองใตเขาเพอ flexion contracture • • • Wound assessments Neurovascular assessments ประเมน Active bleeding Pain relief Infection prevention Promote early ambulation ปองกน knee

Position in bed

Equipment as order เครองปองกน DVT

Equipment as order Continuous passive motion (CPM)

Equipment as order Cryocuff

AROM: Active Range of Motion