By Whitley Hall-Marcott, Rebecca Horn, Andi Kempf, Janll Matheis
University of Southern Indiana
Many older adults experience problems with their joints which may eventually require a total joint replacement for joints such as hips, knees, and shoulders. After total knee replacement surgery 37%-55% of people do not experience their desired level of improvement which may result from pain, lack of therapy, or noncompliance with surgeons’ recommendations (Liao, Liou, Huang, & Huang, 2013). The purpose of this article is to describe the general principles and care requirements of total knee replacement based upon current research.
What does the research say about life before knee replacement?
Those who decide to have total knee replacement have problems with movement and completing their daily activities. Some people report pain scores of 8 and above on a 0 to 10 pain scale with stiffness, feelings of depression, and an overall reduction in the quality of life (Papakostidou et al., 2012). They may be at an increased risk of falling due to the pain and lack of balance from degenerative joint disease, which causes wear and tear on the joints (Liao et al., 2013). Older adults are at a higher risk for osteoarthritis which is one of the main reasons to have this surgery (Papakostidou et al.). A meeting with a doctor should be set up before the surgery to discuss the procedure and any specific risks that this procedure may have on the client’s health.
What is this surgery going to include?
The doctor will provide specific details to each individual on what the surgery will entail. The information listed below is a general overview of knee replacements surgery.
Many different types of sedation are available for this procedure depending on the person’s individual health, the facility policy, and the doctor’s preference. The doctor will make a small opening in the knee in order to remove the damaged joint and replace it with an artificial device made out of various materials (Liao et al., 2013). Even though the actual joint has been removed, the artificial device is made to function like a natural joint. After the procedure, the client will likely be admitted and stay a few nights in the hospital to ensure a safe recovery. While hospitalized the client will participate in physical therapy where he or she will learn exercises that will need to be continued after returning home. These exercises help maintain the strength of the joint and ensure that it can be moved properly. When leaving the hospital, instructions will be provided that will explain approved movements and home based therapies.
What does research say about after surgery?
According to Papakostidou et al. (2012), 95% of people have a better quality of life as early as three months after knee replacement surgery. Most clients who have knee replacement surgery will be participating in some form of rehabilitation afterwards. The focus of this rehabilitation is to strengthen the new joint through functional and resistance training exercises (Liao et al., 2013). The therapists will help the client relearn how to do daily activities so that he or she can return to their former level of functioning. Examples of the functional and resistance training exercises are as follows:
- Bending and extending of the lower limbs (3 minutes)
- Stretching of the quadriceps and hamstrings (10 each side)
- Standing up and sitting down (15 times)
- Climbing on a platform or a flight of stairs (30 times)
- Walking on a treadmill or sidewalk (10 minutes)
Recent research by Liao et al. (2013) on knee replacement patients demonstrates that balance exercises are beneficial in encouraging mobility and efficient daily functioning. Results of this research found improvement in the following tests: forward reach, time balancing on one leg, time involved to sit and then stand, time required to climb stairs, time required to walk ten meters (Liao et al., 2013).
Examples of balance training exercises are as follows:
- Side stepping (5 minutes)
- Cross-over steps (5 minutes)
- Balance beam forward and backward walk (10 minutes)
When arriving back at home there are specific instructions to follow in order to ensure safety. It is recommended that a caregiver (spouse, child, grandchild, or other trusted adult) is available to help complete daily activities that may be difficult. However, the client should try to do as many as possible of these activities on their own in order to gain independence (US National Library of Medicine, 2014). He or she may require assistive devices such as a long-handled retriever, sock-aid, shower chair, or raised toilet seat to make these activities easier.
The following activities should not be done until approval is given by a physician:
- Do not do excessive bending or twisting at the knee level
- Do not put a pillow under the knee when lying down
- Do not carry anything over 5-10 pounds
The following activities are encouraged:
- Keep your incision clean and dry
- Remove rugs and extended rugs that may be tripping hazards
- Get up and move around every 45 minutes
A total knee replacement is a procedure that should be thoroughly discussed with a doctor. Many older adults find themselves needing joint replacements because of limited mobility and pain due to damaged joints. During this surgery an artificial device will replace the worn out natural joint. The rules and exercises provided are important to follow to ensure an optimal recovery after the procedure. Such recommendations will be provided on an individual basis. According to Papakostidou et al. (2012), clients who follow the guidelines for rehabilitation and home safety report decreased pain scores, a notable improvement in function, and a decrease in depressive symptoms.
Whitley Hall-Marcott, BSN Student
Rebecca Horn, BSN Student
Andi Kempf, BSN Student
Janell Matheis, BSN Student
Jean Hunt, MSN, AG CNS-BC, CVRN
Charlotte Connerton, EdD, RN, CNE- BC
University of Southern Indiana College of Nursing and Health Professions
Liao, C., Liou, T., Huang, Y., & Huang, Y. (2013). Effects of balance training on functional
outcome after total knee replacement in patients with knee osteoarthritis: A randomized
controlled trial. Clinical Rehabilitation, 27(8), 697-709. http://dx.doi.org/10.1177/0269215513476722
Papakostidou, I., Dailiana, Z. H., Papapolychroniou, T., Liaropoulos, L., Zintzaras, E.,
Karachalios, T. S., & Malizos, K. N. (2012). Factors affecting the quality of life after
total knee arthroplasties: A prospective study. BMC Musculoskeletal Disorders, 13, 116.
U.S. National Library of Medicine. (2014, November). Knee joint replacement-discharge.
Retrieved from https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/