Table 2.
Day-to-day management goals for a patient undergoing total hip or knee arthroplasty
| Patient management goals | |
| Preadmission clinic | Preoperative bloods (FBC, U & E, clotting screen, G & S) |
| Preoperative radiograph | |
| Physiotherapy assessment | |
| Occupational therapy (OT) assessment | |
| Day of surgery (preoperative) | Consent form signed |
| Anaesthetic assessment | |
| Commence fluid chart, assess need for catheter | |
| Observations 4 hourly | |
| Nil by mouth 6 h for food, 3 h for clear fluids | |
| Nutrition risk assessment | |
| Pain score assessment explained | |
| Moving and handling risk assessment | |
| Falls risk assessment | |
| Waterlow pressure sore risk assessment | |
| Thromboprophylaxis: TED stockings + LMWH prescribed | |
| Discharge planning discussed with patient and relatives | |
| Return of home situation questionnaire | |
| IV antibiotics at induction (flucloxacillin unless penicillin allergic) | |
| Day of surgery (postoperative) | PCA |
| Autologous blood reinfusion | |
| 3x IV antibiotics | |
| IV fluid | |
| 30-min observations, including limb | |
| Check patient-passed urine (assess need for catheter) | |
| POD-1 | Discontinue PCA and prescribe step-down analgesia (regular oral paracetamol + regular weak opioid + oramorph as required for breakthrough pain) |
| Remove drain and dress site | |
| Wound-site dressing checked | |
| Postoperative blood tests: FBC, U & E, others as required | |
| Postoperative radiograph | |
| Oralisation of fluid intake | |
| Check pressure areas | |
| Deep breathing exercises | |
| Bed physiotherapy exercises | |
| Mobilise out of bed and transfer bed to chair with assistance | |
| POD-2 | Wound-site dressing change if heavily soiled |
| Drain-site dressing checked | |
| Dressed in own clothes to discourage sick role | |
| Expected discharge date finalised with MDT | |
| Sitting/standing exercises | |
| Sit to stand from chair | |
| Mobilise 10 m/to toilet with aids | |
| POD-3 | Review analgesia |
| Teach self-administration of LMWH | |
| Check OT equipment in place at home | |
| Independent standing balance without aids | |
| Independent with transfers | |
| Negotiate one step with aids | |
| POD-4 | Discharge documentation ready, including community referrals if indicated |
| Independent mobilisation (including sideways, backwards) with aids | |
| Negotiate stairs with aids | |
| Knee flexion to 90° while sitting (TKA only) | |
| POD-5 | Discharge home |
POD postoperative day, FBC full blood count, U & E urea and electrolytes, G & S group and screen, PCA patient-controlled analgesia, IV intravenous, MDT multidisciplinary team, LMWH low molecular weight heparin, OT occupational therapy, TKA total knee arthroplasty