tkr rehabilitation

8/11/2019 Tkr Rehabilitation

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Anatomy of the Knee

Made up of

three bones:

Femur (thighbone)

Tibia (lower leg

bone)

Patella (knee

cap)


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KNEE RANGE OF MOVEMENTS

ROM :

0 to 140 degrees of

flexion.

In osteoarthritis ROM

decreases.

By TKR we need to

increase the ROM.


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OSTEOARTHRITIS


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Knee Joint

Healthy knee joint Arthritic knee joint


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Clinical examination

Swelling

Joint line tenderness

Crepitus on ROM.

Decreased ROM Deformity of knee

Skin condition & legvascularity.


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PRE OPERATIVE EVALUATION

Previous medication:

Stop blood thinners

Surgical profile:

CBP

Hb%-- TWBC

-- Platelet count

Blood urea & serumcreatinine.

PT & INR

Serum electrolytes


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Pre operative care

Look for any infection in

body.

IV access.

Blood reserve.

Pre operative

medication. Blood sugar levels.

Foleys catheterisation


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Pre operative preparation

Shaving of leg from mid thigh to mid leg.

Betadine scrubbing 2 times at 10 pm and 6 amunder aseptic conditions.


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TKR


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In recovery room

Vitals

IV fluids

Elevation of limb

Suction drain


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Post op pain management

IV/IM/Oral analgesics.

Epidural anesthesia.

Local anesthesia

Nerve blocks.

Transdermal patches


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Post operative antibiotics

IV CEPHALOSPORINS

FOR 2 DAYS.

THEN CONTINUE ORALCEPHALOSPORINS FOR

10 MORE DAYS.


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DVT PROPHYLAXIS

S/C LOW MOLECULAR

WEIGHT HEPARINS (EX:

CLEXANE) FOR 5 DAYS.

THEN ORAL

ANTICOAGULANTS.


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1STPOST OPERATIVE DAY

Pain management

Repeat Hb%.

Urine out put

Fever

Drain collection

Wound soakage


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POST OPERATIVE PROTOCOL

The patients knee was immobilized in a Jones compressive

bandage and a knee immobilizer immediately post operatively.The patients were started on IV antibiotics and DVT prophylaxis

in the form of subcutaneous low molecular weight heparin.

1st post op day, patient was taught static quadriceps exercises.

2nd post op day, the dressingwas debulked and wound

inspected. Patient was made to walk full weight bearing within

the limits of pain with the knee immobilizer and advised tocontinue static quadriceps exercises.


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POST OP PROTOCOL

4 th post op day, knee flexion was started and patient wastaught dynamic quadriceps exercises.

IV antibiotics were given for the first 48 hours post op andthe switched over to oral antibiotics for the next five days.

DVT prophylaxis was given for the first five days postoperatively.

12th post op day, sutures were removed and patient wasadvised to continue regular physiotherapy.


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ICE PACK APPLICATION


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Physiotherapy

Static quadrices

exercises Ankle pumps

Static knee

extension

Knee bending


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THANK U

tkr rehabilitation

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