Nursing Care in Hip and Knee Arthroplasty in Day Surgery

1,2Mladen Jurišković

3 Ivica Matić

2 Martina Smrekar

2 Sanja Ledinski Fičko

2 Irena Kovačević

1 Division of Trauma and Orthopaedic Surgery, Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia

2 University of Applied Health Sciences, Zagreb, Croatia

3 Chatolic University of Croatia, Zagreb, Croatia

Article received: 22.11.2022.

Article accepted: 22.02.2023.

Author for correspondence:

Mladen Jurišković Department of Surgery

University Hospital Centre Zagreb, Zagreb, Croatia E-mail: mladen.juriskovic@kbc-zagreb.hr

https://doi.org/10.24141/2/7/1/5

Keywords: hip, knee, arthroplasty, day surgery, nurse, complications

Abstract

Background. Arthroplasty is a surgical procedure that has been shown extremely effective in reducing pain, improving joint function and overall quality of life. As a result, arthroplasty is steadily increasing as a procedure, especially in the hip and knee, thereby placing a financial burden on the healthcare system. It is believed that performing hip and knee replace- ments in day surgery should decrease public health costs.

Aim. The aim of the research is to determine the cur- rent knowledge and doubts arising from the litera- ture published so far regarding the performance of hip and knee arthroplasty in day surgery, periopera- tive nursing care, as well as detecting possible po- tential perioperative complications.

Methods. The research of literature was conducted through the electronic databases, Medline via Pub Med (PMC), from March 3, 1992, till December 30, 2021. Key words used in the literature search are arthroplasty, replacement, hip, knee, adverse effects, ambulatory surgical procedures, nursing. Total of 22 papers was analyzed.

Results. A clinical algorithm is suggested to acceler- ate recovery as a possible solution to complications of arthroplasty in outpatient procedures. These al- gorithms reduce the cost of treatment and the risk of complications. In addition to the aforementioned benefits, perioperative outcomes and patient satis- faction are also improved, enabling recovery in the comfort of one's own home, which is especially im- portant for the successful rehabilitation of elderly pa- tients. Nurses should develop empathy for patients,

respecting their individuality and right to participate in treatment. Patients expect professionalism and trust from nurses and have specific expectations of nursing care.

Conclusion. Minimally invasive arthroplasty results in less trauma, less blood loss, less postoperative pain, painful surgical reactions, and improved hip mo- bility. The development of surgery and anesthesia in ambulatory surgery requires nurses to play a particu- larly important role in postoperative recovery.

Introduction

The number of patients undergoing total hip/knee replacement is increasing due to medicine develop- ment and increasing life expectancy. The rapid in- crease in patient numbers and the development of new surgical techniques, precision tools, and meth- ods has put some pressure on surgeons and medi- cal professionals with the goal of expediting early patient recovery and reducing operating time in the hospital (1).

Hip replacement is a surgical procedure in which the hip joint is replaced with an artificial prosthesis. It is an orthopedic surgical procedure in which the head and neck of the femur are surgically removed, and the acetabular cartilage and subchondral bone are removed. After resection, the hip prosthesis is im- planted in an artificial canal located in the medullary region of the proximal femur. In 70% of cases, the primary reason for arthroplasty is osteoarthritis, as it causes severe pain and prevents daily activities. In addition to osteoarthritis, conditions leading to arthroplasty include hip dysplasia, Paget’s disease, trauma, and osteonecrosis of the femoral head (2). Minimally invasive hip arthroplasty is defined as a procedure for installing a total or partial hip endo- prosthesis, through a significantly smaller skin inci- sion than the classic method and with minimal soft tissue trauma. Minimally invasive techniques require great skill and experience of the surgeon and com- plex, sophisticated instruments. Smaller instruments and prostheses allow a smaller surgical incision. Mini- mally invasive arthroplasty is responsible for reduced traumatization of tissues, reduced blood loss, less

postoperative pain, reduced surgical stress response, and is responsible for increased mobility of the hip joint (3,4).

Knee arthroplasty is a surgical procedure in which the knee joint is replaced with a prosthesis. The function of a healthy knee joint is to connect the lower leg bones with the upper leg bones. The surface where these bones meet becomes worn over time. Arthritis is often the cause of detrition, but there can be other reasons that cause joint pain and swelling. The most common reason for arthroplasty is the inability of other methods to eliminate permanent pain and oth- er accompanying symptoms associated with arthritis. Arthroplasty aims to reduce the pain, increase the quality of life, and maintain or improve knee function. The procedure is performed in different age groups (5). Knee arthroplasty can be performed using partial and total endoprosthesis. Changes in the knee are the result of mechanical and biological factors. The knee joint consists of 3 parts that can be replaced by an endoprosthesis. These are medial, lateral, and patellofemoral.

The majority of patients that undergo an implanta- tion of a knee endoprosthesis is indicated to have degenerative changes in two or more compartments, so for them the best choice is a total endoprosthesis. Only a small number has only one section affected, and it is more often the medial part of the knee that is damaged, therefore a partial endoprosthesis can be used. Total knee arthroplasty replaces all three sections of the knee joint, medial, lateral, and patel- lofemoral (5). Minimally invasive knee arthroplasty is a surgical method that is quite similar to the tradi- tional method. The difference is that with minimally invasive surgery, there is significantly less destruc- tion of the tissue surrounding the knee. The artificial implants used in the minimally invasive method are the same as those used in the traditional method. However, the instruments used in the minimally in- vasive method are specially designed and, therefore enable the preparation of the femur and tibia for the acceptance of implants with sparing traumatization of the bones and tissues (6).

Thanks to the accelerated recovery algorithm, post- operative recovery is accelerated, and morbidity, treatment and hospital days are reduced. The devel- opment of the algorithm is based on the analysis of the various components responsible for the acceler- ated recovery. These components include optimizing comorbidities and educating the patient and every-

one involved in the course of treatment and care, anesthesia and analgesia techniques, surgical tech- niques, postoperative pain management, and imme- diate and post-rehabilitation techniques during the recovery phase (7). Premedication was administered following a preoperative patient interview, document review, and physical examination. Premedication in- cludes medications given before anesthesia, most commonly sedatives for sedation, pain relievers, an- tibiotics for prophylactic purposes, antiemetics, some medications that the patient takes on a regular basis, and others necessary to safely administer the anes- thesia.

With the development of medicine, society has be- come more and more aware of the status of nurses and their role in the surgical care of patients. After being discharged the same day (in Europe) or 24 hours later (in the US), patients continued treatment in their own home. The treatment performed is under the supervision and responsibility of a nurse (8). The job of a nurse requires an increased level of skill and knowledge due to possible complications associated with total joint replacement surgery and anesthe- sia. The most common postoperative complications of total joint arthroplasty are deep vein thrombosis, pulmonary embolism, postoperative wound infection, bleeding, pain, endoprosthesis dislocation, and res- piratory complications. During the home visit, the car- egiver must identify all possible complications and make the right decision about continuing treatment.

The aim of this study was to determine the current state of knowledge and concerns emerging from the literature published to date on the perioperative care of patients undergoing total and partial hip and knee replacements in day surgery, and to show nurse’s role in patient care during and after knee arthroplasty.

Methods

Reviews and clinical studies, i.e., complete articles, were used to prepare this article. Inclusion crite- ria were papers enrolling patients with hip trauma or chronic degenerative disease of the hip or knee, or patients with indications for hip or knee replace- ment. Exclusive criteria were work performed on the

pediatric population. Selected articles are written in English. The literature search covers the period from March 3, 1992, to December 30, 2021. The Medline database was searched through the PubMed inter- face. The following was used for the search: “Arthro- plasty, Replacement, Hip/adverse effects”[Mesh] OR “Arthroplasty, Replacement, Hip/nursing”[Mesh])) OR ((“Arthroplasty, Replacement, Knee/adverse effects”[Mesh)] OR “Arthroplasty, Replacement, Knee/nursing”[Mesh]))) AND (“Ambulatory Surgical Procedures”[Mesh]). A total of 51 items were found. After reading the abstracts of the selected papers in detail, 22 papers were selected for further analysis.

Results

Selection of patients eligible for one-day partial or total knee and hip arthroplasty is the most important factor with a critical impact on potential periopera- tive complications (9). Serious complications often occur within 24 hours of surgery, so identifying high- risk candidates is especially important to maintain patient safety and reduce the likelihood of readmis- sion to a medical facility (10). In day surgery, it is extremely important to consider the complex inter- dependence of certain factors influencing patient se- lection for hip and knee arthroplasty. There are many factors to consider that are critical to the success of the surgical procedure. These factors are related to anesthesia technique, patient characteristics, and various social factors. The presence of concomitant diseases is also extremely important in selecting suitable candidates. Comorbidity has a major impact on perioperative complications, which translates into longer hospital stays and more frequent readmis- sions. Concomitant diseases that increase the risk of rehospitalization are mainly cardiovascular disease, especially heart valve stenosis and heart failure. In addition to cardiovascular disease, respiratory dis- ease and cirrhosis are also important. One criterion that is certainly crucial in-patient selection is ASA physical status (ASA, English American Society of Anaesthesiologists) (table 1).

ASA Physical Status is used to classify the severity of concomitant diseases, i.e., to assess the patient’s

health status. The CCI (Charlson Comorbidity Index) was also used, which is a valid method for assessing general health status and assessing possible read- mission. The most common reason for rehospitaliza- tion is infection, although new studies have shown that this type of DM has limited impact on postop-

erative morbidity and mortality (11). Studies aimed at determining the effect of age on the success of accelerated recovery algorithms have shown mixed results. Results of a study in Denmark on accelerated recovery algorithms and age showed that age 80 and above limits the success of accelerated recovery al- gorithms. The length of hospital stay increases due to older age, as does the number of readmissions due to perioperative complications (12). However, a re- cent study in the United Kingdom showed that peo- ple over the age of 85 benefited the most from an accelerated recovery algorithm. Hospitals using the accelerated recovery algorithm significantly reduced the number of readmissions compared to the aver- age number of readmissions without the accelerated recovery algorithm, and the length of stay was re- duced from 5 days to 4 days, with the greatest ben- efit observed in people over the age of 85 (13). It is because of these results that further research on the age of the patients and total joint arthroplasty is warranted.

Table 2. Paper results used in analysis

Discussion

The most important factor that affects the outcome of the operation is the evaluation and optimization of accompanying diseases before the hip or knee joint replacement procedure. Smoking, low, or high body mass index (BMI, Body mass index), malnutri- tion are among the significant risk factors associated with possible complications. In the US, more than 8% of patients preparing for knee and hip arthroplasty have diabetes. Complications caused by diabetes are a tendency to infections and a prolonged stay in the hospital. To avoid possible complications, it is impor- tant that patients regularly control their blood sugar levels (15). A factor that can be influenced before performing arthroplasty to reduce the possibility of infection and improve the outcome of treatment is smoking.

The importance of the nurse’s role starts from the beginning of the patient’s reception, where patient’s education is one of the most important ways through which the course of treatment and improvement of patient’s recovery and the outcome of the operation can be influenced. Research has shown that preoper- ative education greatly affects the reduction of anxi- ety before the procedure and postoperative complica- tions. The introduction of education programs, which usually start 3 weeks before surgery, has reduced hospital stay for 24 hours (16). During the education, it is crucial not only to inform the patient, but also their family. By educating family and friends, we en- sure optimal care after leaving the hospital. The most important goal of education is to make the patient an active participant in the entire treatment process, and in this task the role and responsibility of the nurse is very significant (11).

In order for patients to undergo surgery as soon as possible, they need to be consulted with specialists, in which case nurses and surgeons propose indica- tions for surgical treatment, allowing patients to find the greatest comfort in them. This alone can reduce fear and anxiety, build trust, and improve communi- cation and outcomes. The patient is told about their current condition, treatment, upcoming surgery, what will happen before and after surgery, when they will be able to walk independently again, what surgery will be used, and what posture they will assume. The more knowledge that is passed on to the patient, the

more relaxed and cooperative they will be. Informa- tion must be clear, detailed, useful and simple (12).

In the last few years in developed healthcare sys- tems, surgical techniques have been improved. From standard arthroplasty techniques, new approaches have been developed. Nowadays, what defines mini- mally invasive arthroplasty is the shorter length of the surgical incision and less surgical trauma. How- ever, although the aesthetic aspect is very important to patients, as a rule it should not be of great im- portance. Minimally invasive surgery is certainly not performed only for the aesthetics, but also for other factors that affect the perioperative course and the course of rehabilitation itself. Minimally invasive surgical techniques allow minor dissection of soft tissue, including muscles, ligaments and joint cap- sule. Thanks to minimally invasive techniques, tis- sue trauma and pain are reduced, blood loss as well as the need for drainage are less, and the patient’s mobility is increased. The minimally invasive tech- nique requires an extremely skilled and experienced orthopaedic surgeon and corresponding increasingly sophisticated instruments and prostheses. Modern approaches to knee arthroplasty involve an incision smaller than 14 cm, avoiding quadriceps disruption, subluxation rather than twisting and dislocation of the knee. In total hip arthroplasty, the use of mini- mally invasive techniques results in greater mobility, reduced blood loss, and shorter hospital stays (6).

The results of the research showed that mortal- ity in people who were under regional anaesthesia was reduced by 1/3 in contrast to people who were under general anaesthesia. Furthermore, the use of regional anaesthesia reduced the incidence of deep vein thrombosis by 44%, pulmonary embolism by 55%, the need for transfusion was reduced by 50%, and the incidence of pneumonia was reduced by 39% (21). As far as infections are concerned, research shows that the probability of infection is twice as high in patients who were under general anesthesia than in patients who were under regional anesthe- sia (22). Although it has been proven that regional anaesthesia has several advantages compared to general anaesthesia, there are also several disadvan- tages. Spinal anaesthesia in outpatients should be avoided. The reason is that spinal anaesthesia has many undesirable effects such as urinary retention, respiratory depression, itching (22).

The nurse’s role in the postoperative period is pri- marily to help patient recover from anesthesia. Af-

ter recovering from anesthesia, the patient requires intensive care. In order to receive full and complete care, the patient is transferred to the recovery room after anesthesia. Today, these wards are equipped with high-tech equipment to monitor the patient’s vital signs and provide comprehensive care and con- trol of the patient’s condition. This room contains all instruments and equipment needed for emergency operations. These include ventilators, intubation and resuscitation equipment, defibrillators, as well as various infusions and necessary medicines. To en- sure the best possible care, the patient’s bed must be accessed from at least 3 sides. It is important to monitor vital signs and check dressings and drains. Pay special attention to the patient’s breathing to avoid hypoxemia.

If the patient met the necessary criteria for dis- charge from the recovery room, the decision was made whether the patient remained in the recovery room or was transferred to postoperative anesthesia based on the assessment of clinical status by expe- rienced staff using a specific point scale. Criteria for transferring patients from the post-anesthesia moni- toring room to the surgical department (8):

1. good respiratory function

2. stable vital signs including blood pressure and pulse

3. suitable orientation in time and space, answers coherently to simple questions, without signs of delirium

4. satisfactory hourly diuresis

5. without nausea and vomiting

6. good control of postoperative pain

7. without major losses on surgical drains that re- quire quick surgical intervention

8. patient in normothermia

   After the surgery is complete and the patient is transferred from the recovery room, follow-up care continues on the ward. With the transfer to the ward, patient care is entirely up to the nursing staff. Dur- ing the postoperative period, nurses must check vital signs, including temperature, and assess level of consciousness at least every two hours. Monitor- ing of vital functions provides information about the

   patient’s cardiorespiratory system and indicates pos- sible complications. In addition, it is extremely im- portant to monitor possible neurovascular changes in the operated limb. This includes skin tone, tem- perature, pulse, and capillary refill at least hourly. A nurse must monitor bleeding and control the amount of blood passing through the drain. Nurses’ interven- tions are aimed at maintaining IV fluids and closely monitoring fluid balance during the postoperative period. Nurses frequently assess patient comfort and monitor and participate in the continuation of pain medication. Pain after surgery is the number one worry for patients, therefore it is important to con- sider pain control measures and explain how to man- age pain before surgery. It is important for patients to understand the impact of pain on early mobility and recovery. To prevent thromboembolism and mus- cle wasting, the nurse encourag patients to move and exercise as soon as possible and provid enough training for them to continue exercising at home (8).

   Optimizing the factors that cause pain, nausea and vomiting, orthostatic intolerance, will result in earlier discharge, rare unplanned admissions and greater pa- tient satisfaction (11). It is necessary to educate the patient on the importance of personal hygiene, in or- der to prevent possible infections and complications around the surgical site (8).

   With the surgery completed, the primary goals of the entire surgical team and the patient are early mobi- lization and expedited physical therapy. Although deceptively simple, this goal is often undermined by factors that need to be optimized before a patient is discharged from the hospital and begins home physical therapy (11). The caregiver should explain how to improve joint mobility and how to use assis- tive devices when changing positions and walking. This is important because after surgery, the patient is already familiar with the postural changes and has no doubts about how to perform specific movements (8).

   In order for a patient to be discharged, they must meet several conditions. The patient should be able to stand unaided from a supine position. In addition, they should be able to stand up from a chair and walk 30 m unaided, and they should be able to ascend and descend stairs (11).

   
   

   
   

   

   Conclusion

   
   

   

   
   

   Hip and knee arthroplasty in day surgery is gaining in importance as a safe and cost-effective procedure. Recent literature confirms the importance of devel- oping multidisciplinary clinical algorithms to accel- erate recovery and improve perioperative safety. As the creation of clinical algorithms involves the entire perioperative team, nurses play an important role in creating processes related to postoperative care. During this time, the primary role of the nursing staff is to educate the patient on how to live with the im- plant while minimizing potential complications and adverse events.

   
   

   
   

   

   References

   
   

   

   
   

   1. Berger RA, Kusuma SK, Sanders SA, Thill ES, Sporer SM. The feasibility and perioperative complications of outpatient knee arthroplasty. Clin Orthop Relat Res. 2009;467(6):1443-9.

   2. Siopack JS, Jergesen HE. Total hip arthroplasty. West J Med. 1995;162(3):243-9.

   3. Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Ver- heyen CC. Minimally invasive versus classic pro- cedures in total hip arthroplasty: a double-blind randomized controlled trial. Clin Orthop Relat Res. 2011;469(1):200-8.

   4. Siddiqui NA, Mohandas P, Muirhead-Allwood S, Nuthall

      T. (I) a review of minimally invasive hip replacement surgery—current practice and the way forward. Curr Orthop. 2005;19(4):247–54.

   5. Special Hospital for Orthopedics and Traumatol- ogy Akromiom. Prostheses of the knee joint 2016. Available from: http://www.akromion.hr/ortopedija/ koljeno/proteze-koljenskog-zgloba/119. Accessed: 20.09.2022. Croatian.

   6. Bonutti PM, Mont MA, McMahon M, Ragland PS, Kester

      M. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am. 2004;86-A Suppl 2:26-32.

   7. Kehlet H, Thienpont E. Fast-track knee arthroplasty

      -- status and future challenges. Knee. 2013;20 Suppl 1:S29-33.

   8. Nursing care of client having total joint arthroplasty 2016. Available from: https://wps.prenhall.com/wps/ media/objects/737/755395/joint_replacement.pdf Accessed: 10.10.2022.

   9. Ghomrawi HM, Franco Ferrando N, Mandl LA, Do H, Noor N, Gonzalez Della Valle A. How often are pati- ent and surgeon recovery expectations for total joint arthroplasty aligned? Results of a pilot study. HSS J. 2011;7(3):229-34.

   10. Courtney PM, Rozell JC, Melnic CM, Lee GC. Who should not undergo short stay hip and knee arthroplasty? Risk factors associated with major medical complica- tions following primary total joint arthroplasty. J Ar- throplasty. 2015;30(9 Suppl):1-4.

   11. Khan A, Joshi GP. Anesthesia for ambulatory major to- tal joint arthroplasty: the future is now! Current Ane- sthesiology Reports. 2016;6(4):362-69.

   12. Jørgensen CC, Kehlet H; Lundbeck Foundation Cen- tre for Fast-track Hip and Knee Replacement Colla- borative Group. Role of patient characteristics for fast-track hip and knee arthroplasty. Br J Anaesth. 2013;110(6):972-80.

   13. Starks I, Wainwright TW, Lewis J, Lloyd J, Middleton RG. Older patients have the most to gain from ortho- paedic enhanced recovery programmes. Age Ageing. 2014;43(5):642-8.

   14. Clement RC, Derman PB, Graham DS, Speck RM, Flynn DN, Levin LS, Fleisher LA. Risk factors, causes, and the economic implications of unplanned readmissi- ons following total hip arthroplasty. J Arthroplasty. 2013;28(8 Suppl):7-10.

   15. Bolognesi MP, Marchant MH Jr, Viens NA, Cook C, Pi- etrobon R, Vail TP. The impact of diabetes on peri- operative patient outcomes after total hip and total knee arthroplasty in the United States. J Arthroplasty. 2008;23(6 Suppl 1):92-8.

   16. Yoon RS, Nellans KW, Geller JA, Kim AD, Jacobs MR, Macaulay W. Patient education before hip or knee arthroplasty lowers length of stay. J Arthroplasty. 2010;25(4):547-51.

   17. Ibrahim MS, Khan MA, Nizam I, Haddad FS. Peri-opera- tive interventions producing better functional outco- mes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review. BMC Med. 2013;11:37.

   18. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res. 2009;467(6):1577-81.

   19. Jibodh SR, Gurkan I, Wenz JF. In-hospital outcome and resource use in hip arthroplasty: influence of body mass. Orthopedics. 2004;27(6):594-601.

   20. Maurice-Szamburski A, Auquier P, Viarre-Oreal V, Cuvillon P, Carles M, Ripart J, et al; PremedX Study In- vestigators. Effect of sedative premedication on pati- ent experience after general anesthesia: a randomi- zed clinical trial. JAMA. 2015;313(9):916-25.

       
       

   21. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, et al. Reduction of postoperative mortality and morbidity with epidural or spinal ana- esthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.

   22. Chang CC, Lin HC, Lin HW, Lin HC. Anesthetic manage- ment and surgical site infections in total hip or knee replacement: a population-based study. Anesthesio- logy. 2010;113(2):279-84.

   23. Maurer SG, Chen AL, Hiebert R, Pereira GC, Di Cesare PE. Comparison of outcomes of using spinal versus general anesthesia in total hip arthroplasty. Am J Ort- hop (Belle Mead NJ). 2007;36(7):E101-6.

   24. Harsten A, Kehlet H, Toksvig-Larsen S. Recovery after total intravenous general anaesthesia or spinal anae- sthesia for total knee arthroplasty: a randomized trial. Br J Anaesth. 2013;111(3):391-9.

   25. Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persi- stent pain after joint replacement: prevalence, sen- sory qualities, and postoperative determinants. Pain. 2011;152(3):566-72.

   26. Kerr DR, Kohan L. Local infiltration analgesia: a tech- nique for the control of acute postoperative pain following knee and hip surgery: a case study of 325 patients. Acta Orthop. 2008;79(2):174-83.

   27. Perlas A, Kirkham KR, Billing R, Tse C, Brull R, Gandhi R,et al. The impact of analgesic modality on early am- bulation following total knee arthroplasty. Reg Ane- sth Pain Med. 2013;38(4):334-9.

   28. Montazeri K, Kashefi P, Honarmand A. Pre-emptive ga- bapentin significantly reduces postoperative pain and morphine demand following lower extremity orthopa- edic surgery. Singapore Med J. 2007;48(8):748-51.

   29. Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87(5):1047-53.

   30. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projecti- ons of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-5.

ULOGA MEDICINSKE SESTRE U ARTROPLASTICI KUKA I KOLJENA U JEDNODNEVNOJ KIRURGIJI

Sažetak

Uvod. Artroplastika je kirurški zahvat zgloba s izraz- itim učinkom na poboljšanje njegove funkcije, sman- jenje bolova te poboljšanje kvalitete života bolesni- ka. Stoga je izvođenje artroplastike, posebice kuka i koljena, u stalnom porastu, što za posljedicu ima do- datno financijsko opterećenje zdravstvenog sustava. Smatra se da bi financijskom rasterećenju moglo do- prinijeti izvođenje zahvata u jednodnevnoj kirurgiji.

Cilj. Cilj je istraživanja pregledom literature utvrditi recentne spoznaje o izvođenju zahvata artroplastike kuka i koljena u jednodnevnoj kirurgiji te perioper- acijskoj sestrinskoj skrbi, s posebnim osvrtom na prepoznavanje potencijalnih perioperacijskih kom- plikacija.

Metode. Pregled literature učinjen je pretraživanjem bibliografske baze podataka Medline preko sučelja PubMed (PMC) te selekcijom članaka objavljenih na engleskom jeziku u razdoblju od 3. ožujka 1992. do

30. prosinca 2021. Strategija pretraživanja kom- binirala je ključne riječi: artroplastika, kuk, koljeno, komplikacije, jednodnevna kirurgija, zdravstvena nje- ga. Ukupno je analizirano 22 rada.

Rezultati. Kao moguće rješenje problema komplikaci- ja operacijskih zahvata artroplastike u jednodnevnoj kirurgiji literatura navodi upotrebu kliničkih algorita- ma ubrzanog oporavka. Algoritmi smanjuju troškove liječenja i smanjuju rizik komplikacija. Uz navedene prednosti, dolazi i do poboljšanja perioperacijskih ishoda te zadovoljstva bolesnika, kojima je omogućen

oporavak u ugodnoj okolini vlastitog doma, što ima posebnu važnost za uspješnost oporavka starijih bolesnika. Medicinska sestra mora uspostaviti em- patijski odnos, poštivati pacijentovu jedinstvenost i individualnost te njegova prava da sudjeluje u svo- jem liječenju. Pacijent od medicinske sestre očekuje povjerenje, podršku te najbolju sestrinsku skrb.

Zaključak. Minimalno invazivna artroplastika zaslužna je za smanjeno traumatiziranje tkiva, smanjen gubitak krvi, manju poslijeoperacijsku bol i ublažen kirurški stresni odgovor te je zaslužna za povećanu pokretljivost zgloba kuka. Razvoj kirurgije i anestezije u jednodnevnoj kirurgiji sve više zahtijeva znatan doprinos medicinske sestre u poslijeoperaci- jskom oporavku.

Ključne riječi: kuk, koljeno, artroplastika, jednodnevna ki- rurgija, medicinska sestra, komplikacije