Knee Arthroplasty Postprocedure Care
Knee arthroplasty involves surgical replacement of all or part of the knee joint. In partial knee replacement, either the medial or lateral compartment of the knee joint is replaced. Total knee replacement is commonly used to treat severe pain, joint contractures, and deterioration of joint surfaces, conditions that prohibit full extension or flexion.
Arthroplasty postprocedure care includes maintaining alignment of the affected joint, assisting with exercises, and providing routine postoperative care. Nursing responsibilities include teaching, safe mobility, home care, and exercises that may continue for several years.
Equipment
Incentive spirometer ▪ continuous passive motion (CPM) machine ▪ compression stockings or sequential compression device ▪ sterile gloves ▪ gloves ▪ sterile dressings ▪ hypoallergenic tape ▪ ice bag ▪ skin lotion ▪ warm water ▪ crutches or walker ▪ pain medications ▪ closed-wound drainage system ▪ IV antibiotics ▪ pillow.
After total knee replacement, a knee immobilizer may be applied in the operating room, or the leg may be placed in CPM.
Implementation
Confirm the doctor’s orders.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.1
Explain all the procedures.
Check vital signs every 15 minutes until stable, then every 30 minutes twice, then every 2 to 4 hours, and then routinely thereafter, according to facility policy. Report any changes in vital signs because they may indicate infection, hemorrhage, or postoperative complications.
Encourage the patient to perform deep-breathing and coughing exercises. Assist with incentive spirometry to prevent postprocedure pneumonia.
Perform a bilateral neurovascular assessment every 2 hours for the first 48 hours and then every 4 hours or according to your facility’s policy for signs of complications. Check the affected leg for color, temperature, toe movement, sensation, edema, capillary filling, and pedal pulse. Investigate any complaints of pain, burning, numbness, or tingling.
Apply the compression stockings or sequential compression device, as ordered, to promote venous return and prevent venous thromboembolism. Once every 8 hours, remove the stockings or compression device, inspect the legs—especially the heels—for pressure ulcers, and reapply the stockings or device.
Assess the patient’s pain and administer pain medications, as ordered, following safe medication administration practices.5,6
Administer anticoagulant therapy, as ordered, to minimize the risk of venous thromboembolism. If a continuous infusion of heparin is prescribed, administer it using a programmable pump (preferably a smart pump with dose-range alerts) to provide consistent and accurate dosing.9 Observe for bleeding and for signs and symptoms of phlebitis, such as warmth, swelling, tenderness, and redness. Monitor laboratory results, such as complete blood count, prothrombin time, International Normalized Ratio, and partial thromboplastin time.7
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