Useful article on Knee replacement surgery

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Interesting.....though I wouldn't really consider it to be all "current" information because a good number of the sources for the article are 5 years and older.
 
It was a pretty comprehensive article, but I would take issue with the "aggressive" physical therapy called for.
 
I haven't looked at it yet - I will. But maybe we are misinterpreting the use of the word aggressive. Maybe they mean an aggressive schedule, in the sense of keeping it up, rather than the use of force to the point of pain? I wonder if we can interview our rehab sources and find someone that is of our like thinking. Also, Jacky, I'm wondering if we can line up somone with experience and an actual program for Btkr. Wouldn't that be nice?
 
Good point regarding the "aggressive rehab". It isn't completely clear from the article whether they mean doing the exercises aggressively (to the point of pain) or just having an aggressive schedule.

I think we should just use our own interpretation ie do the standard exercises as appropriate (ie regularly but sensibly).
 
Aggressive is defined as tending to attack or be hostile; vigorous. Synonyms are pushing; energetic; combative, offensive, pugnacious, invasive. The word alone puts me off and send me running the opposite direction when used with TKR recovery.

How about regular, moderate, gradually increasing exercises? I find this a lot more appealing. Just my opinion.


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"blood loss of 1500ml to be expected"??? Not in my experience. :skeptical:
"Neither technique appears to be better or worse in terms of preventing cardiovascular complications and reducing mortality. " is also not in keeping with opinion in JBJS
"early mobilization and early aggressive physical therapy (beginning 2 hours after surgery) have been shown to be very important to ensure a quick recovery and improved function. Patient compliance in this difficult period is critical.
Fully complying with this aggressive program of exercise and mobilization is difficult for many patients, but a good long-term outcome depends on conscientious compliance." :DOH: :th_heehee:
"Depending on their occupation, most patients can return to work within 4 to 6 weeks after the surgery." :hate-shocked:

Best bit of all
"Author Information: Dana Bartlett is a poison information specialist at the Philadelphia (Pa.) Poison Control Center."
What in the name of Hades does she know about TKR?

Also note this is an article for OR nurses and therefore not of any real substance.

(sorry Dewy)
 
Jo,

Steady on,

Actually the article says: "Blood loss of up to 1,500 mL during the procedure and a postoperative hemoglobin level decline of up to 3 g/dL should be anticipated, and several units of typed and crossmatched blood should be available." (my italics). I don't think she meant that 1,500 ml was typical or common - she was indicating it was more the upper limit.

She does give a reference to a recent Canadian "systematic review of the contemporary literature" for "Neither technique appears to be better or worse in terms of preventing cardiovascular complications and reducing mortality"

Regarding the "Aggressive rehab" etc. This is an American paper and they often have a different view of rehab over there cf UK. I've already indicated that we shouldn't take that at face value.

I suspect that "Return to work in 4-6 week" also reflects the fact that it is a American paper and they often have much less sick leave over there.

But you are right that it is an article for nurses. It is not intended to introduce anything new, but it seemed to present a good overview of current thinking (albeit with a US bias) in an accessible way. That was my thinking anyway.
 
Are you sure?

48 of the 52 references are from 2008 or later. And the majority of the references are from 2010 or later

Okay.....I didn't count. It just seemed to me that a lot were fairly old. Things change so rapidly, to me studies reported in 2008 or even 2009 are on the "aging" list. That's just my opinion.....
 
Jo, steady on,
Actually the article says: "Blood loss of up to 1,500 mL during the procedure.... should be anticipated" (my italics). I don't think she meant that 1,500 ml was typical or common - she was indicating it was more the upper limit.
She may not have meant it but she did say it - all I was saying was that I've never seen that much blood loss during a TKR. Generally, the swabs are pretty much blood free after the first 10 mins or so and the blood loss so small we wouldn't even bother the weigh them. Unless the case is being done without a tourniquet, of course! But even a litre would be unusual.

Any drops in Hb in the first 24hrs are usually due to drainage.
Regarding the "Aggressive rehab" etc. This is an American paper and they often have a different view of rehab over there cf UK. I've already indicated that we shouldn't take that at face value.
I know and it makes me really despair to see it being reproduced like that, especially someone who is not even a specialist in the field.
I suspect that "Return to work in 4-6 week" also reflects the fact that it is a American paper and they often have much less sick leave over there.
But you are right that it is an article for nurses. It is not intended to introduce anything new, but it seemed to present a good overview of current thinking (albeit with a US bias) in an accessible way. That was my thinking anyway.
Sadly articles by and for nurses are invariably dumbed down - and I speak as one who was been published frequently in all UK nursing journals 1970-1990. They sort of hover midway between a JBJS article and one out of Womans' Own! :snork: And that's despite the "university" based training, nurse consultants and specialists and so on. I've yet to see a nurse produced article that had any real meat to it!
 
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