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Anatomy of the Knee
Made up of
three bones:
Femur (thighbone)
Tibia (lower leg
bone)
Patella (knee
cap)
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KNEE RANGE OF MOVEMENTS
ROM :
0 to 140 degrees of
flexion.
In osteoarthritis ROM
decreases.
By TKR we need to
increase the ROM.
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OSTEOARTHRITIS
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Knee Joint
Healthy knee joint Arthritic knee joint
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Clinical examination
Swelling
Joint line tenderness
Crepitus on ROM.
Decreased ROM Deformity of knee
Skin condition & legvascularity.
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PRE OPERATIVE EVALUATION
Previous medication:
Stop blood thinners
Surgical profile:
CBP
Hb%-- TWBC
-- Platelet count
Blood urea & serumcreatinine.
PT & INR
Serum electrolytes
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Pre operative care
Look for any infection in
body.
IV access.
Blood reserve.
Pre operative
medication. Blood sugar levels.
Foleys catheterisation
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Pre operative preparation
Shaving of leg from mid thigh to mid leg.
Betadine scrubbing 2 times at 10 pm and 6 amunder aseptic conditions.
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TKR
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In recovery room
Vitals
IV fluids
Elevation of limb
Suction drain
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Post op pain management
IV/IM/Oral analgesics.
Epidural anesthesia.
Local anesthesia
Nerve blocks.
Transdermal patches
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Post operative antibiotics
IV CEPHALOSPORINS
FOR 2 DAYS.
THEN CONTINUE ORALCEPHALOSPORINS FOR
10 MORE DAYS.
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DVT PROPHYLAXIS
S/C LOW MOLECULAR
WEIGHT HEPARINS (EX:
CLEXANE) FOR 5 DAYS.
THEN ORAL
ANTICOAGULANTS.
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1STPOST OPERATIVE DAY
Pain management
Repeat Hb%.
Urine out put
Fever
Drain collection
Wound soakage
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POST OPERATIVE PROTOCOL
The patients knee was immobilized in a Jones compressive
bandage and a knee immobilizer immediately post operatively.The patients were started on IV antibiotics and DVT prophylaxis
in the form of subcutaneous low molecular weight heparin.
1st post op day, patient was taught static quadriceps exercises.
2nd post op day, the dressingwas debulked and wound
inspected. Patient was made to walk full weight bearing within
the limits of pain with the knee immobilizer and advised tocontinue static quadriceps exercises.
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POST OP PROTOCOL
4 th post op day, knee flexion was started and patient wastaught dynamic quadriceps exercises.
IV antibiotics were given for the first 48 hours post op andthe switched over to oral antibiotics for the next five days.
DVT prophylaxis was given for the first five days postoperatively.
12th post op day, sutures were removed and patient wasadvised to continue regular physiotherapy.
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ICE PACK APPLICATION
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Physiotherapy
Static quadrices
exercises Ankle pumps
Static knee
extension
Knee bending
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THANK U
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