Please confirm topic selection

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

Updated: Jul 22 2022

TKA Postoperative Inpatient Management

4.3

  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon
  • star icon star icon star icon

(13)

Images
https://upload.orthobullets.com/topic/422740/images/9fb46a46-3908-433f-a455-4f506bbcf8de_oral_multimodal..jpg
  • 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)
              opioids
              • 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
Card
1 of 2
Question
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