 This study provides an overview

of Total Knee Replacement (TKR)

topic including: TKR risk factors,
how knee diseases develops,
grows, and spreads, and types of
TKR and nursing care that we will
be giving to patients with TKR.
 A knee x-ray shows density in the central
portion of her both knee caps and valgus
deformities, which concluded
osteoarthritis in both her knee joints.
 She was admitted immediately to
perform Bilateral Total Knee Replacement
(TKR).
 What is Total Knee
Replacement?
 If your knee is severely damaged by arthritis or
injury, it may be hard for you to perform simple
activities such as walking or climbing stairs. You
may even begin to feel pain while you are sitting or
lying down.

 If medications, changing your activity level, and

using walking supports are no longer helpful, you
may want to consider total knee replacement
surgery.

 By resurfacing the damaged and worn surfaces of

the knee can relieve pain, correct leg deformity and
help resume normal activities.
• The most common cause of chronic knee pain
and disability is arthritis. Osteoarthritis,
rheumatoid arthritis, and traumatic arthritis
are the most common forms.

• Osteoarthritis - The cartilage that cushions

the bones of the knee softens and wears
away. The bones then rub against one
another, causing knee pain and stiffness.
• Reasons that you may benefit from total knee
replacement commonly include:
 Severe knee pain that limits your everyday activities,
including walking, climbing stairs, and getting in and
out of chairs.
 Moderate or severe knee pain while resting, either
day or night.
 Chronic knee inflammation and swelling that does
not improve with rest or medications.
 Knee deformity: a bowing in or out of your knee.
 Knee stiffness: inability to bend and straighten your
knee.
 Surgery – Total Knee Replacement
 There are two main types of artificial knee replacements:

 Cemented Prosthesis
 Uncemented Prosthesis

 A cemented prosthesis is held in place using an epoxy type

cement that attaches the metal to the bone.
 An uncemented prosthesis has a fine mesh of holes on the
surface that allows the bone to grow into the mesh and
attaches the prosthesis to the bone.
 Each prosthesis has four parts:
 The tibial component replaces the end of the tibia. The
tibia is commonly called the shinbone.
 The femoral component replaces the end of the femur, the
groove where the kneecap slides. The femur is commonly
called the thighbone. It is the largest bone in the body.
 The patellar component replaces the surface on bottom of
the patella. The "top" of the kneecap is the part you can
feel through your skin. The "bottom" is the on the other
side, and slides up and down in the femoral groove
whenever you bend or straighten your leg.
 The Operation

1.Shaping the distal femoral bone

- Once the knee joint is entered, a special cutting tool is

placed on the end of the femur. This special tool
ensures that the bone is cut keeping the proper
alignment to the leg's original angles - even if the
arthritis has made you bowlegged or knock-kneed.
Several pieces of diseased bone are cut away from the
end of the femur so that the artificial knee can be
attached.
2. Preparing the tibial bone
- Then, the top of the tibia is cut using another cutting tool that also ensures
proper alignment.

3. Preparing the patella

- The undersurface of the kneecap is removed.

4. Placing the femoral component

- The femoral component is then fitted on the femur. In the uncemented type of
femoral component, the prosthesis is held on the end of the bone because the
end of bone has a taperd cut.
- The metal prosthesis is made to almost exactly match the taperd cut of
the bone. Fitting the femoral component onto the end of the bone
holds the component in place by friction. In the cemented component,
an epoxy cement is used to attach the metal prosthesis to the bone.

5. Placing the tibial component (metal tray)

- The metal tray that holds the plastic spacer is attached to the end of
the tibia. The metal tray is either cemented into place, or held in place
with screws if the component is the uncemented type. The screws hold
the tray in place until the bone grows into the porous coating. The
screws are left in the bone and are not removed.
 6. Placing the Tibial component (plastic spacer)
- The plastic spacer is attached to the metal tray of the tibial component. If the
plastic spacer wears out it can be replaced if the rest of the prosthesis is in good
condition - a so called retread.

7. Placing the Patellar component

- The patellar button is usually cemented into place behind the patella.
 Complications Of Total Knee Replacement

The most common complications following knee replacement

are:

 Thrombophlebitis (DVT)

 Infection in the joint

 Stiffness of the joint

 Loosening of the joint

 Exercises after surgery

 Quadriceps Setting

 Lie on your back with legs straight, together, and flat on the
bed, arms by your side. Perform this exercise one leg at a time.
Tighten the muscles on the top of one of your thighs. At the
same time, push the back of your knee downward into the bed.
The result should be straightening of your leg. Hold for 5
seconds, relax 5 seconds; repeat 10 times for each leg.
 Terminal Knee Extension

This exercise helps strengthen the quadriceps muscle. It is done

by straightening your knee joint.
 Lie on your back with a blanket roll under your involved knee so
that the knee bends about 30-40 degrees. Tighten your
quadriceps and straighten your knee by lifting your heel off the
bed. Hold 5 seconds, then slowly your heel to the bed. You may
repeat 10-20 times.
 Knee Flexion

 Each day you will bend your knee. The physical therapist will
help you find the best method to increase the bending (flexion)
of your knee. Every day you should be able to flex it a little
further. Your therapist will measure the amount of bending and
send a daily report to your doctor.
 Straight Leg Raising

 Bend the uninvolved leg by raising the knee and keeping the
foot flat on the bed. Keeping your involved leg straight, raise the
straight leg about 6 to 10 inches. Hold for 5 seconds. Lower the
leg slowly to the bed and repeat 10-20 times.
 Once you can do 20 repetitions without any problems, you can
add resistance (ie. sand bags) at the ankle to further strengthen
the muscles. The amount of weight is increased in one pound
increments.
Activities to avoid after TKR
 Our patient, used to have pain and swelling,
due to the fresh surgical wound.

 Diagnosis

Risk for pain & swelling related to surgical

wound.
 Patient
Assessment problems / Nursing Evaluation
Goals Intervention

a) Assess factors a)The potential a)Teach simple a) Pain has

which may cause problem of pain exercises, such as : lessen.
pain and swelling. and swelling
indicates a goal Quadriceps Setting, b) Swelling
b) Assess the subsided.
that pain and Terminal Knee
onset, duration,
frequency and swelling will be Extension, Knee
Flexion, Straight leg
intensity of pain lessen. raising.
and swelling.
b) Patient will
be
able to
move/walk
slowly.
 Patient
Assessment problems / Nursing Evaluation
Goals Intervention
c) Assess nutrition c) Patient will c) Adequate meal withc) Patient well
& appetite need be Iron & protein nourished.
of patient. able to supplement, is
maintain given to promote - Wound
adequate proper tissue healing healing in
nutrition for and restore muscle good
tissue healing. strength. progress.

d) Patient
d) Assess d) Educate the understood
patient’s patient
knowledge about d) Patient will the exercises
the after care of regarding and carry out
be
TKR at home. self-care measures at on daily basis
able to perform home and exercises.
for proper
exercises as
Wound
taught for fast
healing.
Health Education for Total Knee Replacement patients

 Warning signs of possible blood clots in your leg include:

 Increasing pain in your calf

 Tenderness or redness above or below your knee
 Increasing swelling in your calf, ankle, and foot
 Warning signs that a blood clot has traveled to your lung include:
 Sudden increased shortness of breath
 Sudden onset of chest pain
 Localized chest pain with coughing
 Participate in regular light exercise programs to maintain proper
strength and mobility of your new knee.

 Take special precautions to avoid falls and injuries. Individuals who

have undergone total knee replacement surgery and experience a
fracture may require more surgery.

 Notify your dentist that you had a knee replacement. You should be
given antibiotics before all dental surgery for the rest of your life.

 See orthopaedic surgeon periodically for a routine follow-up

examination and x-rays (radiographs), usually once a year.
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