Total Knee Replacement

After sustaining a knee injury that required for surgical intervention while in high school, I struggled with recurring ailments throughout my intercollegiate career. It was not until my father, who is an Osteopathic physician, was performing manipulation on me did we begin to diagnose the potential causes. The issue was muscle imbalance and limited flexibility in certain areas of my body that was shifting majority of my weight onto my knees while performing certain movements. This went unnoticed by physicians because while performing examinations the scope was concentrated on the immediate areas around my knee. With the knowledge I obtained through manipulation I have been able to treat my knee ailments by strengthening and lengthening muscles throughout my body. Having this experience helped solidify that if I am to be the physician I aspire to be, it is imperative to be trained in this form of medicine.

OrthoOklahoma is an orthopedic medical clinic with a physical therapy branch that provides outpatient physical therapy care. The facility has a staff of three licensed physical therapists and a physical therapy assistant along with four physical therapy techs. I was able to observe all three physical therapists, Megan Ripley, Joe Ogle and Ken Roberts. At OrthoOklahoma, the most common patients are post-surgery from repairs of muscles, bones or joints. While shadowing these therapists, I observed cases of total knee replacement, total hip replacement, ACL/meniscus repair, rotator cuff repair, frozen shoulder, labrum repair, and other ailments from wear-and-tear and aging. This experience allowed me to talk to physical therapists about the ins and outs of their job, learn about different exercises and routines for treatment of injuries, and really get an idea of the work it takes to become a well-respected physical therapist.

A total knee replacement (TKA) is the most common joint surgery performed in the United States (Turner, 2011, pp. 27-32). Each year, over 650,000 Americans undergo this surgery (Wittig-Wells, 2015, pp. 45-49). It is an invasive surgery that involves an incision on top of the knee and replacing damaged parts of the knee with artificial parts that are either metal, ceramic or plastic. Someone would get a total knee replacement for damage of the joint, osteoarthritic, posttraumatic, or inflammatory arthritis. The cartilage is damaged, wears away and then you develop bony deformity and contracture of ligaments but it starts out with specific defects or wear of cartilage. The top nursing priorities for a total knee arthroplasty is to “prevent complications, promote optimal mobility, alleviate pain, and provide information about diagnosis, prognosis, and treatment needs” (Doenges, 2014, pg. 627). A possible nursing diagnosis from the patient who is undergoing a TKA might be ‘impaired physical mobility related to pain and discomfort as evidenced by reluctance to attempt movement.’ Another one could be ‘acute pain related to chronic joint disease as evidenced by reports of pain’ (Vera, 2014).

I will be taking sick leave tomorrow, Monday, January 9, 2017, so I can pick-up my mother from the hospital in Winchester, VA. She had knee replacement surgery this past Thursday and she is scheduled to be released around noon tomorrow. I also need to get her prescriptions filled, so it will be a full day.

Orthopedic & Spine Institute (OSI) would like to provide residents with a new and convenient option for receiving urgent orthopedic care services. Staffed by a board certified physician and a fellowship trained physician assistant (PA) as well as technicians to handle imaging, casts, and splints. The average wait for a sports medicine orthopedic surgeon is three to four weeks. When possible the patients will be placed on the schedule of an orthopedic surgeon that is available the day of their injury. However, if the schedule is full the patient receives care from the PA or board certified Family Medicine physician with a subspecialty in sports medicine. This will give the newer orthopedic surgeons an opportunity to see new patients, when this is not possible the patients will be still be able to receive the care they need by the PA without having to wait for an appointment. With a new orthopedic group from a town sixty miles away opens an office across the street, the clinic must make the time to see the patients of our community.

If you're going to have knee replacement surgery, you should expect to have trouble getting around well enough to take care of yourself for several days after the procedure. While you'll be in the hospital a few days, once you've recovered from the actual surgery, you will be discharged to recover in a nursing facility or at home. If you don't have family to help you, hiring home health care will allow you to return home to your familiar surroundings to recuperate. Here why a home health care service is beneficial.

I worked for a few months in Adult Reconstruction clinic where I learned thatthe focus on alleviating pain and restoring function quickly was precisely the type of care I hope to offer my future patients. I will forever remember a patient who was completely debilitated with severe arthritis in her hips walk pain free at the next clinic visit. The satisfaction that I derive from guiding patients through the process of recovery and improvement will allow me to excel in orthopaedic surgery and provide me with a lifetime of rewarding relationships with my future

ACTIONS AND USESNifedipine is CCB generally prescribed for HTN and variant or vasospastic angina. It is occasionally used to treat Raynaud's phenomenon and hypertrophic cardiomyopathy. Nifedipine acts by selectively bloking calcium channels in myocardial and vascular smooth muscle, including those in the coronary arteries. This results in less oxygen utilization by the heart, an increase in cardiac output, and a fall in blood pressure. It is available as extended-release tablets (XL).

Joint replacements are among the most common and successful orthopedic surgeries, giving more people the opportunity to remain active well into their golden years. (American) The American Academy of Orthopaedic Surgeons estimates there are more than 300,000 total hip replacements (THRs) and 600,000 total knee replacements (TKRs) performed every year—numbers that will only increase in the future. Most patients who undergo total joint replacement, or arthroplasty, experience a dramatic reduction in pain and a significant improvement in their ability to function in daily life. (American Hip)

The doctors and authors had strong evidence that when patients visited the treatment center and when directed to do physical exercise at home by a doctor, all patients whether directed to come into a clinic or do their exercises at home, all patients had shown significant improvements with the recovery of their knees. The study had proven that the patients who were directed to come into a clinic instead of doing physical therapy at home had proven to be a better off then the patients who did their physical therapy in the comfort of their own home. The patients progress was tested by a six minute walk that they completed a couple times during and after physical therapy was finished. “Both groups showed clinically and statistically significant improvements in six minute walk distances and WOMAC scores at 4 weeks; improvements were still evident in both groups at eight

Research Question: Does a Multicomponent Discharge Planning Program improve patient and hospital outcomes in older adults undergoing total knee arthroplasty?

People undergo total knee replacement when arthritis or injury erodes the joint's natural cushioning to the point where it's hard to walk even short distances without severe pain.

Total hip replacement or THR is a clinically effective procedure for the treatment of pain and disability that arises due to the final stage arthritis of the hip. THR is prescribed for the patients who do not respond to the options that are non surgical, self management, education of the patient, physical therapy, acupuncture, and exercise. ( Pivec. et.al,2012). Numerous procedures , a range of implant designs are available and it is the surgeon who has to decide upon as to which type of fixation technique should be used and which bearing couple should be chosen, component fixation method. Both cementless and cemented fixation are used currently for THR surgery. The implants of total hip replacement consists of acetabular component,

Enhanced recover after surgery (ERAS) pathway aims is to improve pre-operative care and fitness for surgery, increased information, encourage early mobility, self care post-operatively. It has been widely introduced nationally across many surgical specialities as evidence has shown it improves patient’s outcomes and reduces complications and length of stay in hospital (Nicholson et al 2014, Massimiliano et al 2014). However the effect of ERAS from the patients’ perspectives has not been widely researched as most studies are quantitative and explore clinical outcomes with no reference to the patient experience during the process. Qualitative research enables the researcher to explore perceptions and experiences rather than quantitative

At Paras Centre for Joint Replacement, we believe that every patient is unique. Therefore, we customize the physiotherapy protocol for the patient during the post-operative recuperating period depending upon the intra-operative observation of patient’s bone & soft tissue quality, soft tissue balancing, deformity and so forth. So our team of expert rehabilitation specialists rigorously trains the patients with the simplified protocols under the personal supervision of surgeons so that what you get is “Just what is precisely tailored for you”. More than 95% patients (except the unreliable ones) do not need supervision of physiotherapist at home as they are able to follow the custom-made exercise regimen taught to them during hospital stay at home very well. Our surgical team vigilantly keeps track of the patient’s performance at home by meticulous follow