TKR question

Marie_LPN, RN, LPN, RN · Feb 6, 2007

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

catjolpn · Feb 6, 2007

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 · Feb 6, 2007

thanks for the advice...well appreciated!

Grace Oz · Feb 8, 2007

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

TracyB,RN, RN · Jul 9, 2007

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, ASN, RN · Aug 27, 2007

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, CNA · Nov 6, 2007

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

november17, ASN, RN · Nov 10, 2007

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 pissed if we don't at least make an effort to get a patient to use it.

JaredCNA, CNA · Nov 17, 2007

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 pissed 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.

P_RN, ADN, RN · Nov 20, 2007

http://www.medicalnewstoday.com/articles/40103.php

This is an older article without some of the more recent info on the COX-2s. But some good info here.

Nonsteroidal anti-inflammatory drugs (NSAIDs), including over-the-counter aspirin and ibuprofen, are the most prescribed medications to relieve pain and reduce inflammation post-surgery. A lesser prescribed -- and more potent -- set of pain relievers are COX-2 inhibitors, a special category of NSAIDs. Unlike COX-2 inhibitors, NSAIDs prevent blood from clotting, so patients are required to stop taking these medications one to two weeks prior to surgery to prevent excessive bleeding.

So they may inhibit bone healing; nsaids increase bleeding/inhibit clotting.

JaredCNA, CNA · Nov 20, 2007

So they may inhibit bone healing; nsaids increase bleeding/inhibit clotting.

Good info. I'm just full of questions right now because I've been flipping through my Pharmacology book for next semester.

Now I'm wondering why our lumbar lams and ACDs get Toradol. And the doc who does the ACDs will schedule the Toradol q4h for his pts...not prn.