Informatics In Improving the Outcome of Joint Replacement Surgery

Osteoarthritis, or degenerative joint disease, effects many people worldwide. It is characterized by degeneration of the articular cartilage, which no longer functions as a shock absorber in the joint. Generally, obesity, aging and wear and tear on the joint are the chief factors in developing this potentially crippling disease, which usually involves weight-bearing joints first. Arthroscopy and MRI are diagnostic, highly technological procedures often used for diagnosis of joint deterioration. What used to be classified as a crippling joint disease, osteoarthritis of a joint can often be relieved by joint replacement surgery, the hip and knee being the most frequently replaced. Prior to surgery, the nurse has the responsibility of educating the patient on both the procedure and recovery, including maintenance of the prosthetic joint. A vast array of information is available through in-hospital computer based programs and websites. Some hospitals have joint replacement “schools,” which provide up-to-date information to perspective patients. Labs will be drawn prior to surgery and nurses may have computerized access to them before the surgeon; the nurse must alert the physician to concerning values such as decreased hgb/hct or increased bleeding times. After surgery, the nurse is again concerned with the informatics available in the immediate post-op period and during the entire recovery process; which would again involve timely reporting to the physician abnormal lab values in CBC, CMP and bleeding times. Because information is readily available through computer access following most lab draws, the physician is able to act rapidly to correct potential or actual problems (i.e. blood transfusion, antibiotics, hold or increase anticoagulants, etc), therefore, improving patient outcome. As technology develops, surgical techniques improve in that many joint replacements are able to be performed with much smaller incisions than in the past. The desired patient outcome in joint replacement surgery is restoration of function without surgical complication. Through the use of technology in the pre-op, intra-op and post-op periods, including the many patient education materials available, nurses most definitely play a critical role in this process.

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