Phase I Admission to the day before surgery
1. Upon admission, the patient completes history taking, physical examination, preoperative functional assessment (filling out the HSS score sheet for the knee), stops taking aspirin and blood-activating drugs, etc., and records them in the medical history.
2. Twelve preoperative routine tests for joint surgery patients [three routine tests, coagulogram, biochemistry, hematocrit, C-reactive protein, complete set before transfusion, D-dimer, PCT, chest X-ray (frontal and lateral films), electrocardiogram, abdominal ultrasound (liver, gallbladder, pancreas, spleen, both kidneys, etc.), vascular ultrasound of the heart and affected limbs, etc., and record them in the course of the disease, and promptly review and propose treatment if there are abnormal results].
3. Knee lesions: frontal and lateral radiographs of both knees and axial patellar radiographs; the photos should be enlarged at 1:1, with the words “Please take CR films and print them according to the size of the original film box for measurement”.
4. Pre-operative CT and MRI examinations for patients with bone tumors.
5, preoperative CT examination for patients with joint revision.
6.All kinds of laboratory test sheets and other examination reports should be arranged neatly in chronological order. Positive indicators and important negative indicators should be recorded in the course record.
7. Pre-operative medical disease control: the medical course record should record the medical medication and effect, and the reason for longer treatment of medical disease should be recorded
Phase II Day before surgery
1.Pre-operative evaluation: diagnosis, indications, contraindications, surgical plan development
2.Surgical team members arrangement, preoperative health education: turning, getting out of bed, toileting, sitting and standing posture, instructing patients on limb muscle training (flexion and extension of the knee joint, dorsiflexion and plantarflexion of the ankle joint)
3.Pre-operative preparation
3.1. Discuss and draw up the treatment plan within the group, and fill in the Preoperative Summary and Pre-surgical Checklist carefully
3.2. Pre-operative discussion records within the department.
3.3. Pre-operative summary and family conversation records; sign the surgical consent form, informed consent form and blood transfusion consent form
3.4, measurement of X-ray film and selection of prosthesis
3.5. routine preparation of 400 ml of blood
3.6, preoperative skin preparation (sterile gauze wrapped with iodine fluoride to sterilize the affected knee, female knee washed twice with soap and water)
3.7. morning infusion of fluids (about 1500 ml of Ringer’s solution or sugar saline)
3.8. instructing the patient to practice coughing up sputum
3.9. Bringing knee extension brace when the patient enters the operating room.
3.10. starting oral non-steroidal anti-inflammatory analgesic (Celecoxib 200mg Bid) one day before surgery.
Phase III Intraoperative quality control
1. Catheterization after anesthesia.
2. Antibiotic transfusion half an hour before surgery; one additional dose of antimicrobial for surgery time more than 3 hours.
3. intraoperative blood transfusion exceeding 400 ml should be explained in the course record and the amount of blood transfused should be recorded.
4. Femoral nerve block after anesthesia
Phase IV Postoperative management
1. Postoperative preventive treatment of medical diseases, management of complications, analgesic treatment (recorded in the medical record)
2. Postoperative rehabilitation treatment: the following must be recorded in detail in the medical record
2.1 On the day of surgery, observe and record body temperature, blood pressure, heart rate, drainage, motor-sensory circulation of the affected limb, wound dressing, instruct the patient to sit and stand early, cough up sputum, prevent pulmonary infection, instruct the patient on proper postoperative rehabilitation: ankle dorsiflexion and plantarflexion exercises within 6 hours after surgery, ankle dorsiflexion, plantarflexion and flexion/extension knee functional exercises within 6 to 24 hours; the use of analgesic pump and effect.
2.2 On the first day after surgery, observe and record the body temperature, blood pressure, heart rate, drainage, motor-sensory circulation of the affected limb and wound dressing, remove the drainage tube and urinary catheter, review the postoperative film, blood routine and biochemistry, and correct the disturbance of the internal environment in a timely manner; perform functional exercises of ankle dorsiflexion, plantarflexion and flexion-extension knee joint, and prevent thrombosis with low-molecular heparin calcium (until discharge, the reason must be indicated in the case if anti-thrombotic treatment was not performed), and The use and effect of analgesic pump.
2.3 On the second postoperative day, observe and record the body temperature, blood pressure, heart rate, motor-sensory circulation of the affected limb, wound dressing, mobility with the aid of a walker, functional exercise of the joint, and partial weight-bearing of the affected limb.
2.4 On the third day after surgery, body temperature and wound dressing were observed and recorded, and the patient walked with partial weight-bearing with the aid of a walker.
2.5 On the fourth postoperative day, stop the intravenous use of antimicrobial agents (the reason must be stated in the medical record if the use of antimicrobial agents needs to be prolonged), walker-assisted down-to-earth activities, partial weight-bearing walking.
2.6 On the fifth postoperative day, walker-assisted partial weight-bearing walking.
2.7 On the sixth postoperative day, the skin suture is removed and the patient is discharged from the hospital. The discharge certificate should record the following: diagnosis, surgical procedure, prosthesis manufacturer and type, post-discharge precautions [rest for three months, knee flexion and extension exercises, partial weight-bearing walking with the aid of a walker, oral antimicrobial and antithrombotic medication as appropriate (use antithrombotic medication until January after discharge), if there is a decrease in resistance such as a cold or If there is any systemic active infection such as dental infection or invasive operation, oral antimicrobial agent should be taken in time, and outpatient follow-up should be conducted in 1, 2, 3, 6 and 12 months after discharge, and then once a year thereafter].
2.8 After discharge until three months after surgery, walker-assisted ambulation, and after three months, walking under the protection of a cane was started.