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Preoperative
education of patients
Each patient receives an 18 page document that
outlines what they can expect when they have
their knee replaced. The document goes over
all the complications that can happen ranging
in severity from constipation to death. For the
more common complications we give the
frequency of each in our last 1000 cases.
From my perspective the key thing is to ensure
that the patient’s expectations are reasonable.
The important message that we give out is that
one year from surgery one in every 20 patients
will say that their knee is perfect, one will say
that their knee pain is as bad or worse than
before surgery and the other 18 have some
degree of pain but less than before surgery.
DVT prophylaxis
Each patient is individually risk assessed for
VTE and a typed record of this assessment is
made in the notes. Patients with a personal
history of DVT or PE or any patient receiving
active treatment for cancer receives Exoxaparin
(low molecular weight Heparin daily for
28 days commencing 6 hours or more after
surgery. The normal dose is 40mg daily except
in patients who weigh 100Kgs or more in which
case the daily dose is 60mg. Normally this is
self-administered by the patient following
discharge from hospital. Patients on Warfarin
pre-operatively receive bridging Exoxaparin at
the time of surgery.
All other patients, who make up the significant
majority, receive Aspirin 150mg daily for
6 weeks [1]. This commences again 6 hours
following surgery. Patients who are taking
Aspirin pre-operatively stop taking it a week
before the operation unless they have a history of
TIA or CVA in which case they keep taking it.
Tourniquet
I routinely use a tourniquet. This is inflated
after 5 seconds of elevation and immediately
before the skin incision. I close the wound with
the knee flexed to 90 degrees and the tourniquet
isdeflatedassoonaswoundclosurecommences.
In a routine case tourniquet time is about
30 minutes.
If there are concerns about peripheral vascular
disease or if there is calcification visible in the
arterial tree of the lower limb then I do not use
a tourniquet.
What I do in my Clinical
practice
D. Beverland