Best Practice Guideline Total Knee Arthroplasty Editor Rebekah Filson, MS, RN, ANP-BC, ACNS-BC Authors Candy Mori, MSN, RN, ACNS-BC, ONC Victoria Ribsam, MSN, RN, ONC Reviewer Lisa Mauser, MSN, RN, ONC Additional Contributors Janine Bodden, MSN, NP-C, RN, ONP-C, RNFA Carrie Coppola, MSN, RN-BC, ONC Kari Erickson, RN, BAN, ONC
31
Embed
Best Practice Guideline Total Knee Arthroplasty. NAON - Best...A total knee arthroplasty, also known as knee replacement, is a modern surgical procedure that can be described as knee
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Best Practice Guideline Total Knee Arthroplasty
Editor
Rebekah Filson, MS, RN, ANP-BC, ACNS-BC
Authors
Candy Mori, MSN, RN, ACNS-BC, ONC
Victoria Ribsam, MSN, RN, ONC
Reviewer
Lisa Mauser, MSN, RN, ONC
Additional Contributors
Janine Bodden, MSN, NP-C, RN, ONP-C, RNFA
Carrie Coppola, MSN, RN-BC, ONC
Kari Erickson, RN, BAN, ONC
NAON Best Practice Guideline: Total Knee Arthroplasty Page 2 of 31
Copyright 2017
National Association of Orthopaedic Nurses
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording, or any information storage and retrieval system
without the written permission of the National Association of Orthopaedic Nurses.
Rationale for Guideline ................................................................................................................................ 4
Goal of Best Practice Guideline .................................................................................................................... 4
Definition of the Problem ............................................................................................................................. 4
Continuum of Care ....................................................................................................................................... 5
Preoperative Care .................................................................................................................................... 5
Intraoperative Care ................................................................................................................................ 13
Postoperative Care ................................................................................................................................. 17
Utilization of Clinical Quality Indicators ..................................................................................................... 20
Future of Total Joint Arthroplasty .............................................................................................................. 21
What Does the Future Hold for Total Hip/Knee Replacements? .................................................................. 21
Becoming Joint Commission Disease Specific Certified ................................................................................ 21
Web Sites .................................................................................................................................................. 22
Patient and Family: ................................................................................................................................ 22
Appendix: System for Rating the Strength of Evidence ......................................................................... 31
System for Rating the Strength of Evidence ............................................................................................ 31
Level I .............................................................................................................................................................................................. 31
Level II ............................................................................................................................................................................................. 31
Level III ............................................................................................................................................................................................ 31
Level IV ............................................................................................................................................................................................ 31
Level V ............................................................................................................................................................................................. 31
Level VI ............................................................................................................................................................................................ 31
NAON Best Practice Guideline: Total Knee Arthroplasty Page 4 of 31
Introduction In 2010, the prevalence of total knee arthroplasties in the U.S. was 1.52%, corresponding to 4.7 million
individuals (Kremers et al., 2015). By 2030, total knee arthroplasties are projected to grow by 673% compared
with 2005 (Kurtz, Ong, Lau, Mowat, Halpern, 2007). These increasing demands for total knee arthroplasties are
fueled by aging “baby boomers,” joint injuries, and physically active life styles (Wilson, Schneller,
Montgomery, & Bozic, 2008).
Purpose The purpose of the Best Practice Guideline for Total Knee Arthroplasty is to collate the current available
literature to provide best practice information aimed at the continuum of nursing care for the patient
undergoing a total knee arthroplasty. This guideline will focus on standardizing and improving patient care
pathways for total knee arthroplasty.
Rationale for Guideline The rationale for the guideline is to emphasize the importance of identifying standardized practice guidelines
for the total knee arthroplasty patient. Standardized guidelines help to decrease variations that may lead the
potential for unfavorable outcomes for this population.
Goal of Best Practice Guideline Goals of the guideline offers an assessment of the benefits and harms of various care and practice options for
the total knee arthroplasty patient. This will empower nurses to effectively manage the acute care
requirments of the total knee arthroplasty patient.
Description A total knee arthroplasty, also known as knee replacement, is a modern surgical procedure that can be
described as knee resurfacing (AAOS, 2015). This surgery involves removing the diseased or damaged knee
joint and repairing the weight bearing joint with a metal or plastic prosthetic.
Definition of the Problem Due to the aging population and longer life expectancies the total joint replacement has become as prevalent
as several chronic diseases; stroke (6.8 million), myocardial infarction (7.6 million) and heart failure (5.1
million) (Go et al., 2013). With the growing number of total knee arthroplasties being performed, the health
care community recognizes the need for standardization of evidence based guidelines on acute and chronic
care of individuals with knee replacements. There has been an incrasing awarenees of the need to develop
effective models of care that facilitate acute care management and patient self-management. Research in this
area continues to increase and expand for the care of the total knee arthroplaty patient.
NAON Best Practice Guideline: Total Knee Arthroplasty Page 5 of 31
Pathophysiology The most common cause for the need of a knee replacement is arthritis; osteoarthritis, rheumatoid arthritis,
or post traumatic arthritis (AAOS, 2015):
Osteoarthritis is the most common form of arthritis (CDC, 2015). The pathology of osteoarthritis
includes radiographic changes such as joint space narrowing, osteophytes and bony sclerosis.
Osteoarthritis can be described as progressive loss of hyaline cartilage.
Rheumatoid arthritis is the most common autoimmune inflammatory arthritis (Singh et al., 2015).
Rheumatoid arthritis is a systemic inflammatory disease that can affect multiple joints (Aggarwal et al.,
2015). The pathogenesis of rheumatoid arthritis includes fibrosis, synovial cell proliferation, pannus
formation and erosion of bone and cartilage. The inflammatory response manifests in the synovial
membrane of joints causing hypertrophy and chronic joint inflammation. The overgrowth of the
synovial cells and activation of endothelial cells then leads to erosions of the cartilage and bones.
Post-traumatic arthritis is caused by a physical injury such as vehicle accident, fall, dislocation, or any
source of blunt trauma (Lotz, 2010). These injuries damage the articular cartilage and the bone,
changing the mechanics of the joint and accelerating the progression towards osteoarthritis. The
pathogenesis of posttraumatic arthritis occurs with the injury and progresses over time. Initially there
is cell necrosis, collagen rupture and hemarthrosis. Months later there is apoptosis, leukocyte
infiltration, and extracellular matrix degradation. Over the years the joint tissue will remodel and
chronic inflammation will be present.
Continuum of Care
Preoperative Care
Nutrition Screening
Nutrition screening prior to surgery is simply assessing the patient for nutrition deficiencies. Clinical
malnutrition is associated with increased surgical complications, morbidity and mortality, prolongs
Trust, 2013) (Level IV), and overall enhance clinical and functional outcomes.
The implementation of these programs begins preoperatively; however, they should continue throughout
operative experience. There are many key interventions that comprise the enhancement recovery program
for total hip and total knee arthroplasties (Ibrahim, Alazzawi, Bizam, & Haddad 2013; Machin, Phillips, Parker,
Carrannante & Trust, 2013; NHS, 2008; Stowers, Lemanu, Coleman, Hill, & Munro, 2014). One of these
interventions includes a thorough nursing assessment including measures such as weight, height and BMI,
hemoglobin A1C, renal function, activity level and management of co-morbidities. The American Academy of
Surgeons (AAOS), Surgical Management of Osteoarthritis of the Knee Practice Guideline (2015), states there is
strong evidence to support obese TKA patients have less improvement in outcomes and moderate evidence to
support that patients with diabetes are at a higher risk for complications after a TKA. The documentation of a
complete and thorough nursing assessment can facilitate the healthcare team in effectively caring for and
educating the patient throughout the perioperative stay. The table below was constructed based on the
literature for Enhanced Recovery After Surgery (ERAS) for total hip and total knee arthroplasties and
comprises of the optimal times, interventions, and outcomes of an enhanced recovery program. This is a
reference only of options that were utilized successfully for improved outcomes.
NAON Best Practice Guideline: Total Knee Arthroplasty Page 9 of 31
Table 1-1: Enhanced Recovery After Surgery Implementation Table
Optimal Timing Intervention Outcome
Preoperative Care -Thorough assessment -VTE prophylaxis risk assessment and planning -Education -Anesthesia consultation -Case management consultation -Nutrition assessment -Minimal fasting time -Neuromuscular electrical stimulation -PreHab -HgbA1C -Multimodal analgesia pre and post
op
Staph prophylaxis, nares
-Optimize general health and co-morbidities -Manage expectations and decrease anxieties about stay -Meet discharge requirements -Optimized preoperative care -Improved wound healing -Improved glycemic control
Intraoperative Care -Warming systems -Tranexamic acid -Avoid drains -Minimally invasive surgery techniques -Optimized anesthetic techniques
-Reduced length of stay -Reduce blood loss and subsequent transfusions -Reduced surgery times -Maintenance of normovolemia and normothermia -Reduced physical stress of surgery
Postoperative Comfort Needs -Pulsed electromagnetic fields -Local anesthetic around joints -Regular and effective analgesia -Prophylaxis for nausea
-Reduced pain and allow for earlier mobilization -Enhanced comfort
Postoperative Care -Wound dressings -Early ambulation -Pharmacological and mechanical prophylaxis -Emphasis on normal eating patterns and hydration -Promotion of ‘wellness’ – remove catheter, drips and drains -Clear discharge arrangements
-Reduce VTE -Speed recovery -Optimize Independence -Optimized postoperative care
Many of the interventions, such as nutrition assessment, fasting times, tranexamic acid and avoiding drains, has
extensive literature and practice guidelines to support implementation. It is highly recommended that these
interventions be researched and specific guidelines followed when implementing .Unfortunately, many of these
interventions defy our traditional practices, therefore, implementation can be challenging; however, nursing has an
integral role in patient care and can have a direct influence on optimization of care for total knee and total hip
arthroplasty patient. Some programs have found success in the following risk stratification tools: (1) Risk Assessment
NAON Best Practice Guideline: Total Knee Arthroplasty Page 10 of 31
and Prediction Tool (RAPT), (2) Predicting Location after Arthroplasty Nomogram (PLAN), (3) Morbidity and Mortality
Acute Predictor (arthro-MAP), (4) Penn Arthroplasty Risk Score.
Blood Transfusions Prevention
Historically, joint arthroplasties required extensive soft tissue release and bone incisions, which often resulted
in significant blood loss. Reducing blood loss has a positive clinical impact on the patient’s recovery, including
the need for blood transfusions and minimizing the additional risks associated with blood transfusions
(Bierbaum, et al., 1999). Many procedures have been tested and associated with reduced blood loss in total
joint arthroplasties: (1) tourniquet use during surgery (Yi, Tan, Chen, Chen, & Huang, 2014; Li et al., 2014)
(Level II), (2) drain placement protocols (Stucinskas, et al., 2009), (3) fibrin sealants (Li, et al., 2015) (Level II),
Standardized protocols, discharge coordinators, and home care programs have proven effective in
decreasing 30 day readmissions (Kheir et al., 2015) (Level IV).
Ensuring that care transitions smoothly to each new phase of care, with the patient as a contributing
partner, has the potential to improve pain management and functional outcomes (Samuels, J.
&Woodward, R., 2015) (Level V).
Utilization of Clinical Quality Indicators The Institute of Medicine has created a framework for healthcare quality that includes six aims for
improvement (Institute of Medicine [IOM], 2001).
1. Patient safety protects patients from intended or unintended harm as a result of care.
2. Effective care is based in scientific knowledge and provided to only those in need of care.
3. Patient-centered care is respectful of individual patient needs, values, and choices.
4. Patients should be included in all clinical decisions.
5. Care must be delivered in a timely and efficient manner.
NAON Best Practice Guideline: Total Knee Arthroplasty Page 21 of 31
6. Equitable care provides for all patients despite gender, ethnicity, geographic location, and
socioeconomic status (IOM, 2001).
Quality improvement is a cycle that starts with the definition of a goal or problem and then a change to
practice with an evaluation of the outcome. There are many systematic process improvement methods
available. Despite the method employed, structure must be applied to any changes made to achieve the aims
of healthcare quality (Wyszewianski, 2014). Quality indicators to improve the care of the total knee
replacement patient may be aligned with the organization’s goals and the overarching goals of the Institute of
Medicine.
Future of Total Joint Arthroplasty
LOS or same day discharge
preoperative optimization
group therapy
discharge class
preoperative home site visit or home care phone call
What Does the Future Hold for Total Hip/Knee Replacements? Telerehabilitiation may be a promising alternative to traditional face-to-face conventional rehabilitation.
Many programs are going to same day discharge.
Becoming Joint Commission Disease Specific Certified Joint Arthroplasty programs can benefit from becoming certified by The Joint Commission under their Disease-
Specific Care Certification. Advanced certification is offered for total hip and knee replacement. Advanced
certification looks at the broader continuum of care and involves a much more rigorous on-site review (The
Joint Commission, 2016). Certification by a national body validates a program of excellence by its use of
evidenced based guidelines and adhering to and utilizing clinical practice standards (Mori, 2012). Applying for
and maintaining certification holds a program accountable for commitment to quality care that ultimately
benefits the patient and the facility. With certification, a facility becomes known to patients and competing
health care facilities as a center of excellence. These facilities demonstrate use of advanced technologies,
efficiency in patient care, and have impetus and direction for a successful program. An increase presurgical
class attendance, an increase in patient satisfaction, improvement on postoperative documentation, and an
increase of orthopaedic certified nurses were all process improvements one facility noted from seeking
certification (Mori, 2012). McWilliam-Ross (2011) state the certification process is a demonstration of the
program’s commitment to unceasingly pursuing the best possible patient care.
NAON Best Practice Guideline: Total Knee Arthroplasty Page 22 of 31
Web Sites
Professionals:
American Academy of Orthopaedic Surgeons: www.aaos.org
National Association of Orthopaedic Nurses: www.orthonurse.org
The Joint Commission: www.jointcommission.org
The National Guidelines Clearinghouse: www.guideline.gov
Healthline Total Knee Replacement Surgery: http://www.healthline.com/health/total-knee-
replacement-surgery
NAON Best Practice Guideline: Total Knee Arthroplasty Page 23 of 31
References
AAOS OrthoInfo Total Hip Replacement. http://orthoinfo.aaos.org/topic.cfm?topic=a00377 Adam, S. S., McDuffie, J. R., Lahiewicz, P. F., Ortel, T. L., & Williams Jr., J. W. (2013). Comparative effectiveness
of new oral anticoagulants and standard thromboprophylaxis in patients having total hip or knee replacement: A systematic review. Annals of Internal Medicine, 159, 275-284. Retrieved from www.annals.org
Aggarwal, R., Ringold, S., Khanna, D., Neogi, T., Johnson, S. R., Miller, A., …Feldman, B.M. (2015). Distinctions between diagnostic and classification criteria. Arthritis Care and Research, Doi: 10.1002/acr.22583 American Academy of Orthopaedic Surgeons (AAOS). (2015). Total Knee Replacement. OrthoInfo. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00389. American Academy of Orthopaedic Surgeons. (2011). Managing pain with medications after orthopaedic surgery. Retrieved from http://www.Orthoinfo.aaos.org/topic.cfm?topic=A00650. American Academy of Orthopaedic Surgeons. (2011). American Academy of Orthopaedic Surgeons clinical
practice guidelines on preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. Retrieved from http://www.aaos.org/research/guidelines/ VTE/VTE_full_guideline.pdf
American Society of Anesthesiologisis (ASA). (2015). Standards for basic anesthetic monitoring. Retrieved from http://www.asahq.org/.../standards-for-basic-anesthetic-monitoring/en/1 Ayers, D., Franklin, P., Ploutz-Snyer, R., & Boisver, C. (2005). Total knee replacement outcome and coexisting physical and emotional illness. Clincial Orthopaedics and Related Research, 440, 157- 161. Bauer, M.C., Pogatzki-Zahn, E.M., & Zahn, P.K. (2014). Regional analgesia techniques for total knee replacement. Current Opinion in Anaesthesiology, 5, 501-506. Benzon, H. T., Avram, M. J., Green, D., & Bonow, R. O. (2013). New oral anticoagulants and regional
anaesthesia. British Journal of Anaesthesia, 111, i96-i113. http://dx.doi.org/10.1093/bja/aet401 Bergin, C., Speroni, K., Travis, T., Bergin, J., Sheridan, M., Kelly, K., Danile, M.G. (2014). Effect of preoperative incentive spirometry patietn education on patietn outcomes in the knee and hip joint replacement population. Jouranl o f Perianesthesia Nursing, 29,1, 20-27. Berend, K.R., Lombardi, A.V., & Mallory, T.H. (2004). Rapid recovery protocol for per-operative care of total hip and total knee replacement patients. Surgical technology International, 13, 239-247. Bierbaum, B.E., Callaghan, J.J., Galante, J.O., Rubash, H.E., Tooms, R.E., & Welch, R.B. (1999). An analysis of blood management in patietns having a total hip or knee arthroplasty. American Journal of Bone and Joint Surgery, 81, 2-10. Bjerke-Kroll, B. T., Sculco, P. K., McLawhorn, A. S., Christ, A. B., Gladnick, B. P., & Mayman, D. J. (2014). The
increased total cost associated with post-operative drains in total hip and knee arthroplasty. The Journal of Arthroplasty, 895-899. http://dx.doi.org/10.1016/j.arth.2013.10.027
Bjerregaard, L. S., Hornum, U., Troldborg, C., Bogoe, S., Bagi, P., & Kehlet, H. (2016). Postoperative urinary catheterization thresholds of 500 versus 800 ml after fast-track total hip and knee arthroplasty: A randomized, open-label, controlled trial. Anesthesiology, 124, 1256-1264. http://dx.doi.org/10.1097/ALN.00000000000001112
Bratzler, D. and Houck, P. (2004). Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project. Clinical Infectious Diseases, 38:1706-1715. Bratzler, D. and Houck, P. (2005). Antimicrobial Prophylaxis for Surgery: an advisory statement from the National Surgical Infection Prevention Project. The American Journal of Surgery, 189:395-404.
Buehlmann, M., Frei, R., Fenner, L., Dangel, M., Fluckiger, U. & Widmer, A.F. (2008). Highly effective regimen for decolonization of methicillin resistand Staphylococcus aureus carriers. Infection Control and
NAON Best Practice Guideline: Total Knee Arthroplasty Page 24 of 31
Hospital Epidemiology, 29(6), 510-516. Callaghan, J. J., Pugely, A., Liu, S., Noiseux, N., Willenborg, M., & Peck, D. (2015). Measuring rapid recovery program outcomes: Are all patients candidates fro rapid recovery. The Journal of Arthroplasty, 30, 531- 532. http://dx.doi.org/10.1016/j.arth.2015.01.024 Capdevila, X., Macair, P., Dadure, C., Choquet, O., Biboulet, P., Ryckwaert, Y. and d’Athis, F. (2002). Continuous Psoas Compartment Block for Postoperative Analgesia After Total Hip Arthroplasty: New Landmarks, Technical Guidelines, and Clinical Evaluation. Anesthesia Analog, 94:1606-1613. Capdevila, X., Bringuier, S., & Borgeat, A. (2009). Infectious risk of continuous peripheral nerve blocks. Anesthesiology, 110: 182 Carli,F., & Zavorsky, G.S. (2005). Optimizing functional exercise capacity in the elderly surgical population. Current Opinion in Clinical Nutrition and Metabolic Care, 8(1), 23-32. Centers for Disease Control and Prevention (CDC). (2015). Osteoarthritis. Retrieved from http://www.cdc.gov/arthritis/basics/osteoarthritis.htm Chou, R., Gordon, D., De-Leon, O., Rosenberg, J., Bickler, S., Brennan, T., Carter, …& Wu, C. Guidelines on the management of postoperative pain. The Journal of Pain, 17(2), 131-157. Clarke, H.D., Timm, V.L., Goldberg, B.R., & Hattrup, S. J. (2012). Preoperative patient education reduces in hospital falls after total knee arthroplasty. Clincal Orthopaedics and Related Research, 470,244-249. Cohen, A., Drost, P., Merchant, N., Mitchell, S., Orme, M., Rublee, D., ... Sutton, A. (2012). The efficacy and safety of pharmacological prophylaxis of venous thromboembolism following elective knee or hip replacement: systematic review and network meta-analysis. Clinical and Applied Thrombosis/Hemostasis, 18, 611-627. http://dx.doi.org/10.1177/1076029612437579 Courville, X., Tomek, I., Kirkland, K., Birhle, M., Kanton, S., & Finlayson, S. (2012). Cost effectiveness of preoperative nasal mupirocin treatment in preventing surgical site infection in patients undergoing total hip and knee arthroplasty: A cost effectiveness analysis. Infection control and hospital epidemiology, 33(2), 152-159. Doi: 10.1086/663704 Daines, B., Dennis, D., and Amann, S. (2015). Infection Prevention in Total Knee Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons, 23: 356-364. de Lissovoy, G., Fraeman, K., Hutchins, V., Murphy, D., Song, D., Vaughn, B. (2009). Surgical site infection: Incidence and impact on hospital utilization and treatment costs. American Journal of Infection Control, 37, 387-397. Doi: 10.1016/j.ajic.2008.12.010. Ditmyer, M.M., Topp, R., & Pifer, M. (2002). Prehabilitation in preparation for orhtopaedic surery. Orthopaedic Nursing, 21(5), 43-54. Dobbelaere, A., Schuermans, N., Smet, S., Van Der Straeten, C., & Victor, J. (2015). Comparative study of innovative postoperative wound dressings after total knee replacement. Acta Orthopaedica Belgica, 81, 454-461. Edwards, P. K., Levine, M., Cullinan, K., Newbern, G., & Barnes, C. L. (2015). Avoiding readmissions - Support systems required after discharge to continued rapid recovery? The Journal of Arthroplasty, 30, 527- 530. http://dx.doi.org/10.1016/j.arth.2014.12.029
Elia, M., (2003). Nutritional screening of adults: a multidisciplinary approach. BAPEN (ed.) Ferguson, M., Capra, S., Bauer, J., & banks, M. (1999). Development of a valid and reliable malnutrition screeing tool for adult acute hospital patients. Nutrition, 15, 458-464. Flores-Garcia, M., Garcia-Perez, F., Curbelo, R., Perez-Porta, I., Nishishinya, B., Piedad Rosario Lozano, M., &
Carmona, L. (2016). Efficacy and safety of home-based exercises versus individualized supervised outpatient physical therapy programs after total knee arthroplasty: A systematic review and meta-analysis. European Society of Sports Traumatology, Knee Surgery, Arthroscopy. http://dx.doi.org/10.1007/s00167-016-4231-x
NAON Best Practice Guideline: Total Knee Arthroplasty Page 25 of 31
Forster, R., & Stewart, M. (2015, May). Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database of Systematic Reviews, 3. http://dx.doi.org/10.1002/14651858.CD004179.pub2.
Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Borden, W.B., …Ameriacn Heart Association Statistics Committee and Stroke Statistics Subcommittee. (2013). Heart disease and stroke statitiscs-2013 update: A report from the American Heart Association. Circulation, 127(1), e6-245. Doi: http://dx.doi.org/10.1161/CIR.0b013e31828124ad Goodin, B. McGuire, L., Allshouse, M., Stapleton,L., Haythornthwaite, J., … Edwards, R. (2009). Associations between catastrophizing and endogenours pain inhibitory processes: sex differences. Journal of Pain, 10(2), 180-190. Gottschalk, M.B., Johnson, J.P., Sadlack C.K., & Mitchell, P.M. (2014). Decreased infection rates following total joint arthroplasty in a large county run teaching hospital: A single surgeon's experience and possible solution. Journal of Arthroplasty, 29, 1610–1616. Hass, S., Jaekel, C., & Nesbitt, B. (2015). Nursing strategies to reduce length of stay for persons undergoing total knee replacement: Integrateive review of key variables. Journal of Nursing Care Quality, 30(3), 283-288. Huang, R., Greenky, M., Kerr, G.J., Austin, M.S., & Parvizi, J. (2013). The effect of malnutrition on patients undergoing elective joint arthroplasty. Journal of Arthroplasty, 28,21–24. Huang, S.W., Chen, P.H., & Chou, Y.H. (2012). Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patietns. Orthopaedic Traumatology:Surgery & Research, 98: 259-264. Huang, Z., Ma, J., Shen, B., & Pei, F. (2015). General anesthesia: To catheterize or not? A prospective
randomized controlled study of patients undergoing total knee arthroplasty. The Journal of Arthroplasty, 30, 502-506. http://dx.doi.org/10.1016/j.arth.2014.09.028
Hunter, R. (2014) Nursing management of constipation in the medical-surgical setting. Med-Surg Matters, 23(2): 4-9. Hurdle, D.E. (2001). Social support: A critical factor in women’s health and health promotion. Health Social Work, 26(2), 72-79. Husted, H., Holm, G., & Jacobsen, S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthopaedica,79, 168–173. Ibrahim,M.S., Alazzawi, S., Nizam, I., & Haddad, F.S. (2013). An evidence based review of enhanced recovery interventions in knee replacement surgery. Annals of The Roal College of Surgeons Of England, 95, 386- 389. Illingworth, K.D., Mihalko, W., Parvizi, J., Sculco, T., McArthur, B., el Bitar, Y., & Saleh, K. J. (2013). How to minimize infection and thereby maximize patient outcomes in total joint arthroplasty: A multicenter approach. The Journal of Bone and Joint Surgery, 95(e50), 1-13. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century.
Washington, DC: National Academies Press. Isaac, D., Faode, T., Liu, P., I’Anson, H., Dillow, K., & Gill, P. (2005). Accelerated rehabilitiation after total knee replacement. Knee, 12(5), 346-50. Jacobsen, P.B., & Butler, R.W. (1996). Relation of cognitive coping and catastrophizing to acute pain and analgesic use following breast cancer surgery. Journal of Behavioral Medicine, 19,17-29. Jaffe, R.R., Samuels, S.I., Schmiesing, C.A., Golianu, B. (2004). Hip, pelvis, upper leg surgery. In Huddleston, J.I., Bellino, M.J., Goodman, S.B., Mihm, F.G., Eggerhalbeis, C. (Ed.), Anesthesiologists Manual of Surgical Procedures. (4th ed.), (pp.991-1000). Philadelphia, PA: Walters Kluwer, Lippincott Williams & Wilkins.
NAON Best Practice Guideline: Total Knee Arthroplasty Page 26 of 31
Jakobsen, T., Kehlet, H., Husted, H., Petersen, J. & Bandholm, T. (2014). Early progressive strength training to enhance recovery after fast track total knee arthroplasty: A randomized controlled trial. Arthritis Care and Research, 66(12): 1856-1866. Johnson, A., Daley, J., Zywiel, M., Delanois, R. and Mont, M. (2010). Preoperative Chlorhexidine Preparation and the Incidence of Surgical Site Infections After Hip Arthroplasy. The Journal of Arthroplasty, 25(6). Johnson, E., Horwood, J., & Gooberman-Hill, R. Trajectories of need: understanding patients’ use of support during the journey through knee replacement. Disability and Rehabilitation, 38(26), 2550-2563. Jones, S., Alnaib, M., Kokkinakis, M., Wilkinson, M., St Clair Gisbon, A., & Kader, D. (2011). Pre-operative patient education reduces length of stay after knee joint arthroplasty. Orthopaedic Surgery, 93: 71-75. Kedi, W., Xingen, Z., Qing, B., Chen, Z., Weng, K., Zhang, X., & ... Zhao, C. (2016). The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty: A meta-analysis. Medicine, 95(39), 1-9. doi:10.1097/MD.0000000000004960 Keefe, F., Lefebvre, J., Egert, J., Affleck, G., Sullivan, M., & Caldwell, D. (2000). The relationship of gender to pain, pain behavior, and disability in osteoparthritis patietns: the role of catastrophizing. Pain, 87, 325- 334. Kehlet, H. and Wilmore, D. (2002). Multimodal strategies to improve surgical outcome. The American Journal of Surgery, 183, 630-641. Khatod, M., Inacio, M. C., Bini, S. A., & Paxton, E. W. (2012). Pulmonary embolism prophylaxis in more than 30,000 total knee arthroplasty patients: Is there a best choice? The Journal of Arthroplasty, 27, 167- 172. http://dx.doi.org/10.1016/j.arth.2011.04.006 Kim, D., Spencer, M., Davidson, S., Li, L., Shaw, J., Gulczynski,D., Hunter, D., Martha, J., Miley, G., Parazin, S., Djoie, P., & Richmond, J. (2010). Institutional prescreening for detection and eradication of methicillin resistant staphylococcus aureus in patients undergoing elective orthopaedic surgery. The Journal of Bone and Joint Surgery, 92-A(9), 1820-1826. Kremers, H.M., Larson, D.R., Crowson, C.S., Kremers, W.K., Washington, R.E., Steiner, C.A., …Berry, D.J. (2015). Prevalence of total hip and knee replacement in the United States. The Jouranl of Bone and Joint Surgery, 97,1386-1397. Kruizenga, H.M., Seidell, J.C., de Vet, H.W., Wierdsma, N.J., & Van Bokhorst-de Van der Schueren. (2005). Developemtn and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clinical Nutrition, 24, 75-82. Kulshrestha, V., & Kumar, S. (2013). DVT prophylaxis after TKA: Routine anticoagulation vs risk screening approach - A randomized study. The Journal of Arthroplasty, 28, 1868-1873. http://dx.doi.org/10.1016/j.arth.2013.05.025
Kurtz, S., Ong, K., Lau, E., Mowa, F., Halpern, M. (2007). Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. The Jouranl of Bone and Joint Surgery, 89(4), 780- 785. Kurtz, S. Lau, E., Schmier, J., Ong, K., Zhao, K., Pavizi, J. (2008). Infection burden for hip and knee arthroplasty in the United States. The Journal of Arthroplasty, 23(7), 984-991. Lange-Collette,J. (2002). Promoting health among perimenopausal women through diet and exercise. Journal of American Acadamey of Nurse Practioners, 14(4), 172-177. Lavand’homme, P., & Thienpont,E. (2015). Pain after total knee arthroplasty: a narrative review focusing on the stratification of patients at risk for persistent pain. The Bone and Joint Journal, 97-B(10 Suppl A), 45-48. Lewis, G.N., Rice, D.A., McNair, P.J., & Kluger, M. (2014). Predictors of persisitent pain after total knee arthroplasty: a systematic review and meta analysis. British Jouranl of Anaesthesia. Retrieved from: http://bja.oxfordjournals.org. doi:10.1093/bja/aeu441
NAON Best Practice Guideline: Total Knee Arthroplasty Page 27 of 31
Li, X., Yin, L., Chen, ZY., Zhu, L., Wang, H.,…, Zhang, Y. (2014). The effect of tourniquet use in total knee arthrplasty: grading theevidence through an updated meta-analysis of randomized, controlled trials. European Journal of Orthopaedic Surgery and Traumatology, 24: 973. doi:10.1007/s00590-013-1278-y. Li, Z., Fu, X., Tian, P., Liu, W., Li, Y., Zheng, Y., & ... Deng, W. (2015). Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 23(7), 2019-2025. doi:10.1007/s00167-014-2898-4. Lim, C.S., & Davies, A.H. (2014). Graduated compression stockings. Canadian Medical Association Journal, 186, E391-E98. Doi:10.1503/cmaj.131281 Lin, P.C., Hung, S.H., Wu, H.F., Hsu, H.C., Chu, C.Y. & Su, S.J. (2011). The effects of a care map for total knee replacement patietns. Journal of Clinical Nursing, 20,21-22, 3119-3127. Liu, J., Yao-min, L., Juian-gang, C., & Wang, L. (2015). Effects of knee position on blood loss following total knee arthroplasty: a randomized, controlled study. Jouranl of Orthopaedic Surgery and Research, 10:69. Doi10.1186/s13018-015-0213-9 Liu, S.S., Zayas, V.M., Gordon, M.A., Beathe, J.C., Maalouf, …Ya Deau, J.T. (2009). A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesthesia & Analgesia. 2009, 109(1), 265-71. Lotz, M.K. (2010). New developments in osteoparthritis: Posttraumatic osteoarthritis: pathogenesis and pharmacological treatment options. Arthritis Research and Therapy, 12(211). Open Access https://arthritis-research.biomedcentral.com/articles/10.1186/ar3046 Doi: 10.1186/ar3046. Manoharan, V., Grant, A. L., Harris, A. C., Hazratwala, K., Wilkinson, M. P., & McEwen, P. J. (2016). Closed incision negative pressure wound therapy vs conventional dry dressings after knee arthroplasty: A randomized controlled study. The Journal of Arthroplasty, 31, 2487-2494. http://dx.doi.org/10.1016/j.arth.2016.04.016 Maradit Kremers, H., Larson, D., Crowson, C., Kremers, W., Washington, R., Steiner, C., Jiranek, W., Berry, D. (2015). Prevalence of Total Hip and Knee Replacement in the United States. The Journal of Bone and Joint Surgery-American Volume, 97(17), 1386-1397.
Mazaleski, A. (2011). Postoperative total joint replacement class for support persons: Enhancing patient and family centered care using a quality improvement model. Orthopaedic Nursing, 30, 361-364. http://dx.doi.org/10.1097/NOR.0b013e31823710b5
McGuiness, W., Vella, E., & Harrison, D. (2004). Influence of dressing changes on wound temperature. Journal of Wound Care, 13, 383-385. http://dx.doi.org/10.12968/jowc.2004.13.9.26702
McWilliam-Ross, K. (2011). A clinical nurse specialist led journey to The Joint Commission disease-specific certification in hip fractuers. Orhopaedic Nursing, 30(2), 89-95. Mitchell, K. (2015). 4 ways to improve joint replacement hospital discharge . Retrieved from
Montero-Marin, J., Prado-Abril, J., Demaizo, P., Gascon, S., & Garcia-Campayo, J. (2014). Coping with stress a nd types of burnout: explanatory power of different coping strategies. PLoS One, 9, e89090. Mori, C. (2015). Implementing evidence based practice to reduce infections following arthroplasty. Orthopaedic Nursing, 34(4), 188-194. Mori, C. (2014). A-voiding catastrophe: implementing a nurse driven protocol. MedSurg Nursing, 23(1), 15-21. Mori, C. (2012). Bone up your program, certification process for the total knee replacement and total hip replacement center. Orthopaedic Nursing, 31(5), 287-293. National Guideline Clearinghouse (NGC). Guideline summary: American Academy of Orthopaedic Surgeons clinical practice guideline on surgical management of osteoarthritis of the knee. In: National Guideline
NAON Best Practice Guideline: Total Knee Arthroplasty Page 28 of 31
Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2015 Dec 04. [cited 2016 Nov 29]. Available: https://www.guideline.gov National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Constipation. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/constipation National Institute for Health and Care Excellence. (2010). https://pathways.nice.org.uk/pathways/venous-
Newman, J. T., Morgan, S. J., Resende, G. V., Williams, A. E., Hammerberg, E. M., & Dayton, M. R. (2011). Modality of wounds closure after total knee replacement: Are staples as safe as sutures? A retrospective study of 181 patients. Patient Safety in Surgery, 5(26). Retrieved from http://www.pssjournal.com/content/5/1/26
NHS Institute for Innovation and Improvement. (2008). Enhanced recovery programme. Retrieved from: www.institute.nhs.uk/quality_and_service_improvment-tools/quality_and_service_improvement _tools/enhanced_recovery_programme.html. Nicholson, J.A., Dowrick, A.S., & Liew, S.M. (2012). Nutritional status and short-term outcome of hip arthroplasty. Journal of Orthopaedic Surgery,20,331–335. Oden, K., Doran, J., Yu, S., Bolz, N., Bosco, J. & Iorio, R. (2016). Risk-Stratified Venous Thromboembolism Prophylaxis After Total Joint Arthroplasty: Aspirin and Sequential Pneumatic Compression Devices vs Aggressive Chemoprophylaxis. The Journal of Arthroplasty, 31(9), 78-82. Ousey, K., Gillibrand, W., & Stephenson, J. (2013). Achieving international consensus for the prevention of orthopaedic wound blistering. Results of a Delphi survey. International Wound Journal, 10, 177-184. http://dx.doi.org/10.1111/j.1742-481x.2012.00965.x.Epub2012Mar8 Panahi, P., Stroh, M., Casper D., Parvizi, J., and Austin, M. (2012). Operating Room Traffic is a Major Concern During Total Joint Arthroplasy. Clinical Orthopeadics and Related Research, 470: 2690-2694. Pearson, J. S. (2001). Extending a rehabilitation pathway to include multiple providers: Outcomes and pitfalls. Rehabilitation Nursing, 26, 54-65. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12035700
Pedersen, N.W, & Pedersen, D. (1992). Nutrition as a prognostic indicator in amputations. A prospective study of 47 cases. Acta Orthopaedica Scandinavica Journal, 63,675–678. Perlas, A., Kirkham, K. R., Billing, R., Tse, C., Brull, R., Gandhi, R., & Chan, V. W. (2013). The impact of analgesic
modality on early ambulation following total knee arthroplasty. Regional Anesthesia and Pain Medicine, 38, 334-339. http://dx.doi.org/10.1097/AAP.0b013e318296b6a0
Pierce, T., Cherian, J., Jauregui, J., Elmallah, R., Lieberman, J., and Mont, M. (2015). A Current Review of Mechanical Compression and Its Role in Venous Thromboembolic Prophylaxis in Total Knee and Total Hip Arthroplasty. The Journal of Arthroplasty, 30 (12), 2279-2284. Pryor, F. and Messmer, P. (1998). The Effect of Traffic Patterns in the OR on Surgical Site Infections. AORN, 68(4), 649-660. Pratt, W.B., Veitch, J.M., & McRoberts, R.L. (1981). Nutritional status of orthopedic patients with surgical complications. Clinical Orthopaedics and Related Research, 155, 81–84. Pua, Y., & Ong, P. (2014). Association of early ambulation with legth of stay and costs in total knee arthroplasty. American Joournal of Physical Medicine and Rehabilitation, 93, 962-970. http://dx.doi.org/10.1097/PHM.0000000000000116 Quinn, M., Bowe, A., Galvin, R., Dawson, P., & O’Byrne, J. (2014). The use of postoperative suction drainage in total knee arthroplasty: A systematic review. International Orthopaedics, 39, 653-658. http://dx.doi.org/10.1007/s00264-014-2455-2 Radcliff, T. A., Cote, M. J., Olson, D. L., & Liebrecht, D. (2012). Rehabiliatation settings after joint replacement: An application of multiattrubute preference elicitation. Evaluation & the Health Professions, 35, 182-
NAON Best Practice Guideline: Total Knee Arthroplasty Page 29 of 31
198. http://dx.doi.org/10.1177/0163278711427558 Rao, N., Cannella, B., Crosset, L., Yates, A., McGough, R., Hamilton, C. (2011). Preoperative screening/decolonization for staphylococcus aureus to prevent orthopedic surgical site infection. The journal of Arthroplasty (26)8, 1501-1507. Singh, J.A., Saag, K.G., Bridges JR, S.L., Akl, E.A., Bannuru, R.R., Sullivan, M.C., …Mcalindon, T. (2015). 2015 American college of rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care and Research, 1-25. Doi: 10.1002/acr.22783. Stowers, M. Lemanu, D., Colemna, B., Hill, A., Munro, J. (2014). Review article: Periopeartive care in enhanced recovery for total hip and kene arthroplasty. Jouranl of Orthopaedic Surgery, 22(3), 383-392. Stucinskas, J., Tarasevicius, S., Cebatorius, A., Robertsson, O., Smailys, A., Wingstrand, H. (2009). Conventional drainage versus four hour clamping drainage after total knee arthroplasty in severe osteoarthritis: aprospecitve, randomized trial. International Orthopaedics, 33, 1275-1278. doi:10.1007/s00264-008- 0662-4. Su, E. P., Perna, M., Boettner, F., Mayman, D. J., Gerlinger, T., Barsoum, W., ... Lee, G. (2012). A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. The Journal of Bone & Joint Surgery, 94, 153-156. http://dx.doi.org/10.1302/0301-620X.94B11.30832 Tai, T., Chang, C., Lai, K., Lin, C., Yang, C., Tai, T., & ... Yang, C. (2012). Effects of tourniquet use on blood loss and soft-tissue damage in total knee arthroplasty: a randomized controlled trial. Journal Of Bone & Joint Surgery, American Volume, 94-A(24), 2209-2215. doi:10.2106/JBJS.K.00813
The American Academy of Orthopaedic Surgeons. (2014). Activities after knee replacement. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=a00357
The Joint Commission. (2016). Disease Specific Certification Orthopedic. Retrieved from https://www.jointcommission.org/certification/dsc_orthopedic.aspx Tischler, E. H., Restrepo, C., Oh, J., Matthews, C. N., Chen, A. F., & Parvizi, J. (2015). Urinary retentionis rare
after total joint arthroplasty when using opioid-free regional anesthesia. The Journal of Arthroplasty. http://dx.doi.org/10.1016/j.arth.2015.09.007
Top, R., Ditmyer, M., King, K., Doherty, K., & Hornyak, J. III. (2002). The effect of bed rest and potential of prehabilitation on patients in the intensive care unity. AACN Advanced Critical Care, 13(2), 263-276. Tsang, L. F. (2015). Developing an evidence-based nursing protocol on wound drain management for total
joint arthroplasty. International Journal of Orthopaedic and Trauma Nursing, 19, 61-73. http://dx.doi.org/10.1016/j.ijotn.2014.02.008
Tsang, L. F., Cheng, H. C., Ho, H. S., Hsu, Y. C., Chow, C. M., Law, H. W., ... Yuen Sham, A. S. (2016). TRanslating evidence-based protocol of wound drain management for total joint arthroplasty into practice: A quasi-experimental study. International Journal of Orthopaedic and Trauma Nursing, 21, 49-61. http://dx.doi.org/10.1016/j.ijotn.2015.07.002
van Bokhorst-de van der Schueren, M. A., Guaitoli, P. R., Jansma, E. P., & de Vet, H. C. (2014). Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clinical Nutrition, 33(1), 39-58. doi:10.1016/j.clnu.2013.04.008 Walters, M., Sayeed, Z., El-Othmani, M. M., & Saleh, K. J. (2016). Reducing length of stay in total joint
arthroplasty care. Orthopedic Clinics of North America, 47, 653-660. http://dx.doi.org/10.1016/j.ocl.2016.05.006
Weiser, M.C., Eng, M., & Moucha, C. S. (2015) The current state of screening and decolonization for the prevention of staphylococcus aureus surgical site infection after total hip and knee arthroplasty. The Journal of Bone and Joint Surgery, 97, 1449-14458. doi:10.2106/JBJS.N.01114 White, J.J., Houghton-Clemmey, R., & Marval, P. (2013). Enhanced recovery after surgery (ERAS): orthopaedic
NAON Best Practice Guideline: Total Knee Arthroplasty Page 30 of 31
perspective. Clinical Feature, 23(10), 228-232. Whitehouse, J., Friedman, D., Kirkland, K., Richardson, W., & Sexton, D. (2002). The impact of surgical site infections following orthopedic surgery at a community hospital and a university hospital: Adverse quality of life, excess length of stay and extra cost. Infection Control and Hospital Epidemiology, 23(4), 183-189. Wilson, N.A., Schneller, E.S., Montgomery, K., & Bozic, K. (2008). Hip and knee implants: current trends and policy considerations. Health Affairs, 27, 1587-1598. Wolinsky, R.D., Coe, R.M., McIntosh, W.A., Kubena, K.S., Prendergast, J.M., … Landmann, W.A. (1990). Progress int eh development of a nutritional risk index. Journal of Nutrition, 120(11), 1549-1553. Wyszewianski, L. (2014). Basic concepts of healthcare quality. In M. S. Joshi, E. R. Ransom, D. B. Nash, & S. B. Ransom (Eds.), The healthcare quality book: Vision, strategy, and tools (3rd ed., pp. 31-53). Chicago, IL: Health Administration Press. Yamada K, Imaizumi T, Uemura M, Takada N, Kim Y (2001) Comparison between 1-hour and 24-hour drain clamping using diluted epinephrine solution after total knee arthroplasty. J Arthroplasty 16:458–462. Yi, J., Hui, D., Jian, L., & Yixin, Z. (2014). Aspirin combined with mechanical measures to prevent venous thromboembolism after total knee arthroplasty: A randomized controlled trial. Chinese Medical Journal, 127, 2201-2205. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.20132175 Yi, S., Tan, J., Chen, C., Chen, H., Huang, W. (2014). The use of pneumatic tourniquet in total knee arthroplasty:
a meta analysis. Archives of Orthopaedic and Trauma surgery, 134, 1469-1476. Yu, A. L., Alfieri, D. C., Bartucci, K. N., Holzmeister, A. M., & Rees, H. W. (2016). Wound hygiene practices after total knee arthroplasty: Does it matter? The Journal of Arthroplasty, 31, 2256-2259. http://dx.doi.org/10.1016/j.arth.2016.03.040
Yoon R.S., Nellans, K.W., Geller, J.A., Kim, A.D., Jacobs, M.R., & Macaulay, W. (2010). Patietn education before hip or knee arthroplasy loweres length of stay. The Jouranl of Arthroplasty, 25,4, 547-551. Zarghooni, K., Bredow, J., Siewe, J., Deutloff, N., Meyer, H. S., & Lohmann, C. (2015). Is the modern versus
conventional wound dressings warranted after primary knee and hip arthroplasty? Results of a prospective comparative study. Acta Orthopaedica Belgica, 81, 768-775. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26790803
Zhang, W., Liu, A., Hu, D., Xue, D., Li, C., Zhang, K., ... Pan, Z. (2015). Indwelling versus intermittent urinary catheterization following total joint arthroplasty: A systematic review and meta-analysis. PLOS One, 10(7), 1-13. http://dx.doi.org/10.1371/journal.pone.0130636
Zhao-Yu, C., Yan, G., Wei, C., Yuejv, L., & Ying-Ze, Z. (2013). Reduced blood loss after intra articular tranexamic acid injection during total knee arthroplasty: a meta analysis of the literature. Knee Surgery Sports Traumatology Arthroscopy, 2013. Zywiel, M. Stroh, D., Lee, S., Bonutti, P., & Mont, M. (2011). Chronic opioid use prior to total knee arthrplasty. American Journal of Bone and Joint Surgery, 93-A, 1988-1993.