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More than 500,000 total knee arthroplasty (TKA) surgeries were performed in 2006 and the number is expected to continue to increase (S. Kim, 2008). A background in evidence-based nursing care will assist any nurse assigned in caring for a postoperative TKA patient. Strong pain assessment and reassessment skills with an understanding of multimodal pain management benefits pain control and patient recovery from TKA surgery. Safe mobilization and therapy techniques that reflect evidence-based practice will keep patients safe. Providing nursing interventions that prevent complications from infections or thromboembolism will reduce never events from occurring. This article will present evidence for the care of a postoperative TKA patient.
Total knee arthroplasty (TKA) is a successful, cost-effective, low-risk therapy that offers pain relief and improves function for patients who do not respond to nonsurgical treatment (Zhang et al, 2008). DeFrances, Lucas, Buie, and Golosinski (2008) report that 542,000 TKA surgeries were performed in 2006, almost double the number from 2000. Kim (2008) estimates that 1.5 million primary TKA surgeries will be performed in 2015. Total knee arthroplasty is performed for patients who suffer joint failure from osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, or osteonecrosis. Because of the expanding number of people undergoing TKA surgery, the chances that a nurse will provide postoperative care for a TKA patient is highly likely. This article will examine evidence-based practices of postoperative nursing care for TKA patients.
Pain Management
Aggressive postoperative pain management is required for TKA patients (National Institute of Health, 2003). Strong assessment of the patient's pain is the first step toward intervening to manage pain. Pain management interventions are both pharmacologic and nonpharmacologic. Table 1 includes a synthesis of evidence related to pain management. Pain management requires a skilled assessment, involvement of patient, and the use of a multimodal approach (Institute for Clinical Systems Improvement [ICSI], 2008; Registered Nurses' Association of Ontario [RNOA], 2002).
PAIN ASSESSMENT
The most reliable indicator of pain is through self-report (ICSI, 2008). The nurse should educate the patient to report the amount of pain that is being experienced. The amount and type of pain should be assessed using a valid and reliable pain scale such as the Numeric Rating Scale or the Wong/Baker Facial Pain Scale (ICSI, 2008; RNOA, 2002). Guidelines from the...