Bilateral Knee Osteoarthritis: Pathophysiology, Treatment, and Nursing Interventions

Running head: KNEE OSTEOARTHRITIS 1
Bilateral Knee Osteoarthritis
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Bilateral Knee Osteoarthritis
Knees are the largest and the most used joints in the human body. As such, the knees are
subjected to tear and wear with time. Knee joints consist of three bones, the kneecap (patella),
shinbone (tibia), and thighbone (femur). At the intersection, is a slippery cartilage that provides a
smooth surface to facilitate motion and a cushion between the three bones. Due to the numerous
functions of the knee joints, they are susceptible to various conditions. Key among these
conditions is the knee osteoarthritis. This paper highlights the condition knee osteoarthritis (OA),
focusing on the pathophysiology and treatment. Besides, the article focuses on total knee
replacement as the treatment for the condition, highlights the complications of the surgery, and
the necessary nursing interventions.
Bilateral knee OA develops with time as the cartilage wears and tears down. As the
deterioration of the cartilage persists, performing daily activities becomes difficult. The
symptoms may include: a flare-up of knee pain, swelling in the surrounding area, persistent pain
on the knee joint, achy pain after activity, inability of the knee to straighten, and a glaring
weakness in the knee (Medina, 2016). According to the American Academy of Orthopaedic
Surgeons, wear and tear of the cartilage can be caused by increasing age, overweight, genetic
factors, previous foot injury. These risk factors wear down the protective cartilage; consequently,
the three bones rub together causing pain and inflammation. Diabetes also increases the risk of
cartilage wearing and tearing down (Medina, 2016).
One the treatment of the bilateral knee OA is the total knee replacement. This treatment
requires surgery; some parts of the bones and the cartilage are removed and replaced by metal
and plastic implants (McGrory et al., 2016). This operation helps relieve pain and restores a
smooth surface for the bones to flex and move freely. However, like all the surgeries several

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risks and complications can occur. These risks and complications may include wound infections,
deep vein thrombosis, heart attack, nerve damage, and stroke (Medina, 2016). Therefore, it is
vital that the nurse receiving the patient at the Post Anaesthetic Care Unit carries out initial
assessments. For our case scenario, the appropriate evaluations include positive patient
identification and physical assessments.
For registered nurses receiving a patient in the PANU, it is appropriate that they have the
correct patient identity. In this case, failure to have the right information may result in
medication errors, wrong surgical interventions, and transfusion errors. In various studies on the
safety of the patients, patient misidentification has been identified as the root cause of majority
errors in the healthcare industry (Callum et al., 2019). Positive patient identification is so crucial
that the United States listed it as the leading goal in the National Patient Safety Goals of 2003.
Identification ensures proper medical intervention and safer care that ultimately results in quality
care (T. et al., 2010).
Most literature has pointed to cardiovascular and respiratory complications as the most
common and significant. These complications if not recognized and treated early can be fatal,
hence need for a quick postoperative physical examination (Neyret & Demey, 2014). To observe
the cardiac and respiratory systems the nurse assesses a patient’s: pulse, systolic blood pressure,
respiratory rate, and oxygen saturation. An abrupt change in these parameters may be indicative
that the patient is suffering from myocardial infarction, heart failure, acute respiratory distress
syndrome, or a pulmonary embolism. Also, through physical examination, the nurse should be
vigilant in assessing the renal system for any kidney complication (Dushan & Atiknson, 2017).
One of the complications of undergoing total knee replacement is the development of
deep vein thrombosis (DVT). DVT is the formation of blood clots in the veins surrounding the

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incision area. If not recognized and intervened these blood clots could march to the lungs causing
a pulmonary embolism (Neyret & Demey, 2014). The clots strain the flow of blood and could
result in severe damage to the lungs and low oxygen levels in the blood. In some instances,
pulmonary embolism can be fatal if the clot is allowed to grow big and block the total flow of
blood to and from the lungs. Additionally, given the fact that the patient has a prior history of
angina, it takes priority to check for blood clots during the patient’s initial physical examination
(Essien et al., 2019).
Another complication to highlight is the surgical wound dehiscence (SWD). After
surgery, incision sites are sutured by a margin approximation dressing. A postoperative wound
occurs when these margins are pulled apart before complete healing of the wound. In Australia,
the reported figure of SWD occurrence has been reported as 3% of all the patients undergoing
total knee replacement. SWD impairs wound healing, lengthens the hospital stay, increases the
healthcare costs, and has negative psychological wellbeing of the patient (Sandy-Hodgetts et al.,
2016). Therefore, identification and early intervention of this condition should be a priority.
During the physical examination, the nurse should pay close attention to the presence of bleeding
and drainage from the incision as it could be indicative of SWD (Jonsson et al., 2014).
The most significant cause of wound dehiscence is an infection. Therefore, it is crucial
that early signs of surgical site infection should be examined and treated (Hall et al., 2014). An
abrupt wound discharge should be considered as a sign of infection unless proven otherwise.
Other risk factors of wound dehiscence include obesity or malnutrition. Malnutrition can slow
healing due to insufficient vitamins and proteins necessary for recovery. Moreover, the presence
of some disorders such as anaemia, diabetes, and hypertension have been proved to accelerate