Difference between revisions of "Knee arthroplasty"

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{{Infobox surgical procedure
| anesthesia_type = General or spinal
Regional
| airway = ETT/LMA if general
| lines_access = PIV
| monitors = Standard
5-lead ECG
| considerations_preoperative =
| considerations_intraoperative =
| considerations_postoperative =
}}
 
'''Knee arthroplasty''' is a surgical procedure to resurface a knee damaged by arthritis.
 
== Overview ==
 
=== Indications ===
 
* Knee arthritis (inflammatory) or arthrosis (non-inflammatory degeneration)
* Infected knee
* Loose or malpositioned knee prothesis
 
=== Surgical procedure ===
 
*
 
== Preoperative management ==
 
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|Arthritis may impair neck ROM or cause cervical nerve root compression. 
|-
|Cardiovascular
|Patients with arthritis may have limited exercise tolerance due to knee pain, thus impairing assessment of cardiovascular function. Stress echo may be needed for cardiac evaluation.
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|Patients may have rheumatoid arthritis
|}
 
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
 
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
 
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
 
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
 
* Adductor canal block
* Femoral nerve block +/- lateral femoral cutaneous
* Sciatic nerve block
 
 
Note: Some surgeons will perform a periarticular injection with a long-lasting local anesthetic (i.e. liposomal bupivicaine) prior to emergence. 
 
== Intraoperative management ==
 
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
 
* Standard ASA monitors
* PIV
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
 
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
 
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
 
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
 
== Postoperative management ==
 
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
 
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
 
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
 
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
 
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}
 
== References ==
 
[[Category:Surgical procedures]]

Latest revision as of 23:45, 4 April 2022

Knee arthroplasty
Anesthesia type

General or spinal Regional

Airway

ETT/LMA if general

Lines and access

PIV

Monitors

Standard 5-lead ECG

Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating
In development
User likes
0

Knee arthroplasty is a surgical procedure to resurface a knee damaged by arthritis.

Overview

Indications

  • Knee arthritis (inflammatory) or arthrosis (non-inflammatory degeneration)
  • Infected knee
  • Loose or malpositioned knee prothesis

Surgical procedure

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic Arthritis may impair neck ROM or cause cervical nerve root compression.
Cardiovascular Patients with arthritis may have limited exercise tolerance due to knee pain, thus impairing assessment of cardiovascular function. Stress echo may be needed for cardiac evaluation.
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other Patients may have rheumatoid arthritis

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

  • Adductor canal block
  • Femoral nerve block +/- lateral femoral cutaneous
  • Sciatic nerve block


Note: Some surgeons will perform a periarticular injection with a long-lasting local anesthetic (i.e. liposomal bupivicaine) prior to emergence.

Intraoperative management

Monitoring and access

  • Standard ASA monitors
  • PIV

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Barrett Larson, Chris Rishel and Tony Wang

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