Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Jul 22 2022

TKA Postoperative Inpatient Management

  • Introduction
    • Rehabilitation requires coordinated effort from
      • orthopaedic surgeon
      • physical therapist
      • occupational therapist
      • case manager
      • nursing staff
      • patient and patient's family
    • Care can be broken down into different phases including
      • Inpatient management
      • post-operative anemia 
  • Inpatient Management
    • Pain management
      • preoperative
        • NSAIDS and opioids given immediately before procedure reduce postoperative pain
      • intraoperative
        • regional anesthesia (spinal and/or epidural)
          • preferred over general anesthesia
        • peripheral nerve blocks
          • useful adjuvant to decrease postoperative pain
        • periarticular multimodal drug injection
          • decrease postoperative pain with minimal risks
      • postoperative
        • multimodal oral drug therapy
          • gold standard and includes
            • NSAIDs: Inhibit COX-1 and COX-2 ? inhibition of inflammatory mediators ( PGs, TXA, AA)
              • Mu agonist leading to neuron hyperpolarization and reduced excitability
            • NSAIDs
              • inhibit COX-1 and COX-2
              • inhibition of inflammatory
              • mediators (PGs, TXA, AA)
            • selective COX-2 inhibitors
              • inhibits transformation of AA to PG precursors
              • minimizes GI effects
              • may inhibit bone healing
            • gabapentin/pregabalin
              • reduce hyper-excitability of voltage dependent Ca2+ channels in activated neurons.
              • pregabalin= better oral bioavailability.
            • SNRIs
              • inhibition of serotonin and noradrenergic reuptake in the CNS
    • Physical therapy
      • therapy should start on the day of surgery
        • reduces length of hospital stay
        • reduced pain and improves function
    • Range of motion
      • requirements
        • swing phase of gait
          • 65° of flexion
        • activities of daily living
          • 90° of flexion
        • stairs
          • 95° of flexion
        • rise from a chair
          • 105° of flexion
    • Continuous passive motion (CPM) machine
      • improve early knee flexion
      • has not been shown to have a long-term benefit
    • Drain Placement
      • has not demonstrated any difference in complications or outcomes
    • Discharge home criteria
      • medically stable
      • 80-90° AROM knee flexion
      • ambulate 75-100 feet
      • ascend or descend stairs
  • Post-Operative Anemia
    • Intra-operative
      • less intraoperative blood loss with the use of tourniquet
    • Earlier discharge to rehab from hospital associated with improved outcomes
    • Discharge criteria to home similar to those in hospital
1 of 2
1 of 6
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options