Part 1 The Calos-Clark Family
1.2 Calos-Clark family case study 1: Total knee replacement
Jennene Greenhill and Anna Foster
Introduction to case study
Learning Objectives
By the end of this case study, you should be able to:
- Describe the anatomy and physiology of the knee and conditions associated with the need for a total knee replacement (TKR).
- Explain appropriate nursing care for patients who undergo total knee replacement surgery.
- Identify strategies to prevent complications and preoperative and postoperative care.
- Describe the importance of pain relief in the rehabilitation of the patient undergoing a total knee replacement.
Scenario
Giani is now 68 years old and has been a dancer and professional performer for 25 years. Over the last 10 years, he has had several injuries and has been experiencing increasing arthritic pain in his left knee. After multiple visits to his GP for ongoing treatment and monitoring, as well as regular acupuncture and massage, the pain has become unbearable. As a result, 2 years ago he was referred to an orthopaedic surgeon, Dr Kim, who placed him on a waiting list for knee surgery. The pain was beginning to affect his fitness and activity levels as well as his mental health. The doctor said that if knee pain is preventing him from undertaking adequate regular exercise, then the benefit of total knee replacement (TKR) is substantially increased. Furthermore, the procedure would prevent him from being in a high-risk group. Giani and Jay both know how dangerous it is to be immobile and neither wants a sedentary lifestyle.
Prior to admission, Dr Kim took a medical history and blood tests to gather information about Giani’s general health and the extent of his knee pain and ability to function. He undertook a physical examination to assess the range of motion in Giani’s knee, as well as stability, strength, and overall leg alignment. Giani also had x-rays and a magnetic resonance imaging (MRI) scan to determine the extent of damage and deformity in his knee. Jay and Giani had to drive one hour to Lismore or Tweed Heads for most of these appointments.
Giani and Jay talked to some of their friends who had had this operation. They wanted to learn about what was involved the procedure, the pros and cons and risks. Their friend Murphy told them how he had a rapid reduction in swelling in the knee about 6-8 weeks post-op but needed to have quite a lot of rehab to work on his strength and bending. Their friend Carla had swelling in her knee for nearly 6 months, which improved with ice and elevation at the end of the day, and was able to get back into swimming 6 weeks post-op. At 12 weeks Carla added in bicycle riding around town and found that was an excellent way for her to build mobility and range of movement in her knee. Ted, Jay’s brother-in-law, said it was the best thing he had ever done, after his knee was hurt during a motorcycle accident; now he is driving, walking, swimming, and playing golf again, all within