skin breakdown after total knee

[Tsatalstrana]

Nurses on the ortho unit! I don't have much experience with ortho but have a question. If a patient has TKA, can the patient be repositioned after the surgery? My mom just had TKA in Canada. I got a report from a family member that her coccyx looks like beginning of stage I. They are not repositioning her. Is it b/c you have to stay on your back, or it is not allowed by surgeon? If one is to be repositioned after TKA, then how do you do this with the operative knee? I know with total hip you would log roll on the non-operative side to change positions. Anyway, some input please.

[vanburbian]

total knees are up ambulating the day after surgery at latest. She can reposition herself as pain allows most likely, but you would have to ask her surgeon if she has any unusual restrictions.

I don't even really see TKA patients stay longer than 2 days in the hospital anymore unless there is some complication.

[xtxrn, ASN, RN]

I was up that night (within 4 hours). Is there something else going on?

We can't give advice, but would ask the nurses for rationale.

[Jenni811, RN]

Amputees sometimes can't move right away or there are specific restrictions.

are you sure it was knee and not amputee?

[bsnanat2]

I am sure someone will post a TOS comment about seeking medical advice, so I will speak in generalities......

Unless there is some comorbidity, I don't understand why anyone has to move her or help her reposition. A TKA or THA (even bilaterals) should be up on day of surgery for PT/OT eval and up with walker for PT the next. None of our TKA/THA are in bed long enough to suffer skin breakdown. No need to logroll either as they can use their hands and their "good leg" to move themselves in bed. We do not even have bedpans as all are expected to get OOB to use the bathroom as a part of their therapy. Rarely, we will use a bedside toilet. So there is no reason inherent to TKA/THA surgery that would require one to stay in bed, be repositioned by someone else or stay in bed long enough to suffer skin breakdown. Safety equipment such as walkers, gait belts and immobilizers are used. There must be some misunderstanding or some piece of info missing here.

[Jenni811, RN]

I am sure someone will post a TOS comment about seeking medical advice, so I will speak in generalities......

Unless there is some comorbidity, I don't understand why anyone has to move her or help her reposition. A TKA or THA (even bilaterals) should be up on day of surgery for PT/OT eval and up with walker for PT the next. None of our TKA/THA are in bed long enough to suffer skin breakdown. No need to logroll either as they can use their hands and their "good leg" to move themselves in bed. We do not even have bedpans as all are expected to get OOB to use the bathroom as a part of their therapy. Rarely, we will use a bedside toilet. So there is no reason inherent to TKA/THA surgery that would require one to stay in bed, be repositioned by someone else or stay in bed long enough to suffer skin breakdown. Safety equipment such as walkers, gait belts and immobilizers are used. There must be some misunderstanding or some piece of info missing here.

which is why im thinking this might be a case of amputee instead. Don't they often have activity and positioning restrictions? I'm cardio, so please forgive me!

[xtxrn, ASN, RN]

I am sure someone will post a TOS comment about seeking medical advice, so I will speak in generalities......

Unless there is some comorbidity, I don't understand why anyone has to move her or help her reposition. A TKA or THA (even bilaterals) should be up on day of surgery for PT/OT eval and up with walker for PT the next. None of our TKA/THA are in bed long enough to suffer skin breakdown. No need to logroll either as they can use their hands and their "good leg" to move themselves in bed. We do not even have bedpans as all are expected to get OOB to use the bathroom as a part of their therapy. Rarely, we will use a bedside toilet. So there is no reason inherent to TKA/THA surgery that would require one to stay in bed, be repositioned by someone else or stay in bed long enough to suffer skin breakdown. Safety equipment such as walkers, gait belts and immobilizers are used. There must be some misunderstanding or some piece of info missing here.

Uh. I hear what you're saying- but the pain involved was enough to require someone to help EVERY TKR transfer- either to the BSC or up to the BR w/walker. Help with repositioning pillows also needs some assistance. The pain is no joke. PCAs aren't ordered for minimally painful surgeries. JME... For safety reasons, the nurses I worked with always got another co-worker or myself to move the TKRs and THRs, and any ORIF of a LE.

[noyesno, MSN, APRN, NP]

Activity orders are usually: "dangle tonight for dinner" (this is the day of surgery), then, "ambulate with assist" and "out of bed in chair for all meals" for post-op day 1 and on.

No turning restrictions for TKR's.

[LouisVRN, RN]

none of our orthos have activity limitations for tkr provided they were ambulatory pre-op. Most of ours must dangle dos at minimum and are wbat. Our tkr usually have a lot of equipment though cpn, vascutherm, scds so they often will need assistance with getting out of bed. Only exception is on dos with some of our patients who have had epidurals/spinals then activity is per anesthesia until it wears off

[Esme12, ASN, BSN, RN]

Sometimes even with the best of care there can be skin breakdown. Sometimes even when being repositioned there is redness when you change positioned. Possibly your relatives did not know of a pre-existing Stage 1 due to the immobility of the patient due to pain.... Without knowing all the details it's impossible to give advice or thoughts as to the problem. TKR are really up and about pretty quick these days as in the night of surgery as everyone has already mentioned.

[canesdukegirl, BSN, RN]

Consider that a TKA takes anywhere from 2 hours to 4 hours. When a pt is positioned for this procedure, the operative leg is oftentimes extended and flexed to ensure that the implant is seated correctly. Although the OR bed should be adequately padded, the coccyx area takes most of the pressure. Sometimes our surgeons will ask for extra padding in this area, but only certain ones do this.

If your Mom is only POD#1 or 2, it may take some time for her backside to return to normal. Usually takes a few days. Encourage her to ambulate as much as possible to get the blood flowing.

[vald96]

you have to call the DON of that hospital and find out their protocol or guidelines in taking care of s/p TKA.I'm pretty sure its not the surgeon's order.Having skin breakdown at the hospital is common now a days because lack of care.