Routine pre-op screening for septic focus is carried out during the Pre-surgical counseling visit. Prophylactic antibiotics administered as per the guidelines of the American Academy of Orthopedic Surgeons. Urinary catheter is placed for patients who choose to undergo both knee surgeries simultaneously. Centrally air-conditioned Operation Theatres with Positive Pressure ventilation and surgical hoods are used
All patients are put on Triflometer chest physiotherapy and Kendall SCD devices/Stocking for 1 week. Chemical prophylaxis is administered as per the guidelines of the American Academy of Orthopedic Surgeons. Early mobilisation and intensive physiotherapy is given to all patients.
Start walking with a walker 1 day after surgery. Can use a portable commode or walk to the toilet with assistance
A scar about 6 inches long. Occasional clunking noise on certain movements
Pre Anesthetic evaluation is typically done 1 week prior to admission for surgery. Kindly arrive at 8 AM preferably on empty stomach and be prepared to spend 3 hrs in the hospital.
HOW TO IMPROVE TKR IN OBESE PATIENTS
Obesity affects 35% of the adult population in the U.S. A new literature review published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) identifies strategies to improve total knee replacement (TKR) outcomes in patients with obesity. The work, entitled, “Morbid Obesity and Total Knee Arthroplasty: A Growing Problem,” appears in the March 2017 edition.
Researchers found that excess soft tissue in patients with obesity can obstruct visibility in the treatment site during surgery. This lack of visibility can result in difficulty achieving proper alignment and implant fixation as well as longer surgical time. Compared to patients that were obese that did not undergo bariatric surgery prior to TKA, the bariatric patients did worse even with a lower body mass index. This project demonstrated that obesity is a complex issue and further research is necessary to improve outcomes in this patient population undergoing primary TKA.
Preoperatively, nutritional optimization appears to be a limitation of many of the current studies available. This may improve patient outcomes but further investigation is necessary before recommendations can be made. Intraoperatively, utilizing exposure techniques that improve visualization may decrease intraoperative complications. Additionally, the use of a stemmed tibial component may decrease the risk of aseptic tibial loosening in this patient population. Postoperatively, obese patients may have multiple medical comorbidities including diabetes, coronary artery disease, etc. These comorbidities should be closely monitored as they may impact patient outcomes.
Performing a TKA in an obese patient is not a routine TKA. Careful perioperative planning can lead to significantly improved results in this patient population. Nutritional and medical optimization appear to be two key factors in improving outcomes.