 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.
 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,
• 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 O pe rati on

4.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. Pl acin g the tib ial co mp onen t (met al 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. P lacin g th e Tib ia l co mp onen t (pl as ti c sp acer )
- 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. Pl aci ng the Pa te lla r co mp onen t

- The patellar button is usually cemented into place behind the
patella.
 Co mpl icati ons Of Total Knee Rep laceme nt

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.
Acti vit ies t o av oi d a fter TKR
 Our patient, used to have pain and sw ell in g, due to
the fresh surgical wound.

 Diag nosi s

Risk for pain & swelling related to surgical wound.

 Pati ent
Asses sment prob lems / Nurs ing Evalu ati on
Goals Inte rv enti on

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 Terminal Knee subsided.
that pain and
onset, duration, Extension, Knee
frequency and swelling will be
Flexion, Straight leg
intensity of pain lessen. raising.
and swelling.
b) Patient will be
able to
move/walk
slowly.
 Patient
Ass essment prob lems / Nurs ing Evalu ati on
Goa ls Inte rv enti on
c) Assess nutrition c) Patient will be c) Adequate meal with c) Patient well
& appetite need of able to maintain Iron & protein nourished.
patient. adequate supplement, is
nutrition for given to promote - Wound
tissue healing. proper tissue healing healing in
and restore muscle good
strength. progress.

d) Patient
d) Assess patient’s d) Patient will be d) Educate the patient understood
knowledge about
the after care of able to perform regarding the exercises
TKR at home. exercises as self-care measures at and carry out
taught for fast home and exercises. on daily basis
healing. for proper
Wound
healing.
 Heal th Educ at ion fo r T ota l Knee
Repla cemen t pa ti ent s

 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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