[rntoon]

why can't a pillow be placed under the knee while asleep for a patient that had a total knee replacement?

[Marie_LPN]

It can allow the knee to get 'lazy,' and possibly remain with a slight bend.

[catjolpn]

There is risk of contracture when pillow is placed under knee after TKR. This causes a shortening or distortion of muscular or connective tissue which can result in deformity of the joint. Also make sure when they are sitting in recliners to place something under recliner bottom so that it doesn't fall downwards. Place rolled towels under heels. Hope this helps.

Ortho, Neuro, general Surgery LPN for 3 years

Catjo

[rntoon]

thanks for the advice...well appreciated!

[Grace Oz]

Added to the above advice ....... a pillow under the knee can cause pressure and increase the risk of DVT

[TracyB,RN]

ditto to the above posts, but why would you want to wake up a patient that is sleeping? If VS are scheduled Q4h, then do re-positioning, but not with a pillow under the knee.
Waking up a peacefully sleeping post TKR is just as bad as waking up someone to give them a pain pill. They're asleep for a reason.... finally comfy enough to sleep, which is what the pt needs.

[NJNursing]

Additionally, bending the knee can actually be stressful to the incision site, especially the first couple of days post-op. The skin isn't fully approximated yet.

[JaredCNA]

While they are sleeping, don't you have them in a CPM (continuous passive motion) machine? We always do.

[november551]

Putting a pillow directly under the knee can make the new knee "go bad"

Mainly, what Catjo posted. It's fine to put a pillow or preferably a rolled up towel under the operative leg's ankle though.

NJ: It's important to get that knee bending as soon as possible. It's a proven fact that the patient will recover faster to their pre-op level of functioning. I don't think approximation is a big deal if the skin is stapled together. (So far) I've never seen or heard of an incision splitting open due to ROM exercises in the immediate postoperative period. We usually start at 65 degrees flexion on the day of surgery and often get the patient up to 90 degrees flexion by day 2 or 3. If it is a young patient they can usually get to 90 even faster.

Jared: I'm usually cool with letting the patient take their CPM off if it is really bugging them (I work the night shift). It's really a matter of pain tolerance. Some patients say they really like the CPM. Some of them can't tolerate it at all, even if I practically snow them with narcotics. Like I said, if I have a patient complaining of pain I'll give them a break from it for a while (sometimes almost my entire shift). It is usually females in the 50+ age range that have problems with the CPM for some reason. I just document the situation and move on. Not really that big of a deal. Most of the surgeons are pretty understanding if a patient has a low pain tolerance (it's usually pretty apparent when they round). But the surgeons will get ****** if we don't at least make an effort to get a patient to use it.

[JaredCNA]

Originally Posted by november551

Putting a pillow directly under the knee can make the new knee "go bad"

Mainly, what Catjo posted. It's fine to put a pillow or preferably a rolled up towel under the operative leg's ankle though.

NJ: It's important to get that knee bending as soon as possible. It's a proven fact that the patient will recover faster to their pre-op level of functioning. I don't think approximation is a big deal if the skin is stapled together. (So far) I've never seen or heard of an incision splitting open due to ROM exercises in the immediate postoperative period. We usually start at 65 degrees flexion on the day of surgery and often get the patient up to 90 degrees flexion by day 2 or 3. If it is a young patient they can usually get to 90 even faster.

Jared: I'm usually cool with letting the patient take their CPM off if it is really bugging them (I work the night shift). It's really a matter of pain tolerance. Some patients say they really like the CPM. Some of them can't tolerate it at all, even if I practically snow them with narcotics. Like I said, if I have a patient complaining of pain I'll give them a break from it for a while (sometimes almost my entire shift). It is usually females in the 50+ age range that have problems with the CPM for some reason. I just document the situation and move on. Not really that big of a deal. Most of the surgeons are pretty understanding if a patient has a low pain tolerance (it's usually pretty apparent when they round). But the surgeons will get ****** if we don't at least make an effort to get a patient to use it.

I understand what you mean. I work nights too and I am the CNA that takes care of all the joints on our floor and I have been for a while. I think I was going on a very, very small amount of sleep at this time.

On a side note, why aren't the joint replacement patients ever prescribed anti-inflammatory meds like Toradol? POD #2 all of our joints have their PCA removed and get Vicodin 5/500 PO q4h. I don't know if Vicodin would even take the edge off my pain if I was in that situation.