The deformity of genu valgus is often caused by dysplasia of femoral lateral condyle, rheumatoid arthritis, and osteoarthritis. It is often associated with bone defects of lateral condyle of the femur and lateral plateau of the tibia, dislocation of the patella, stabilization of the external rotation of the tibia, and the contracture of a posterolateral complex of the knee joint and other diseases.1 Valgus deformity of the knee joint is one of the serious complications in the late stage of knee joint disease. They are mainly seen in patients with rheumatoid arthritis, osteoarthritis, traumatic arthritis, metabolic osteopathy, congenital dysplasia of the lateral femoral condyle, and patients with a history of surgery that has altered the line of force of the lower extremity.2 The common clinical types of valgus deformity of knee joint are SOO classification, Ranawat classification, and Krackow classification. Although the incidence of valgus deformity is less than the varus deformity, the operation is more difficult and the technical requirements are higher.3 The techniques of the osteotomy and soft-tissue balance are most difficult to hold, and there is no unified technical specification at home and abroad. TKA is an effective method to treat the end-stage disease of the knee joint. It can effectively relieve knee joint pain, recover knee joint function, and improve the patients’ quality of life.4,5,6 Due to the increasing population of elderly, the patients suffer from knee joint diseases increased and the application of TKA has also become mature than before.7,8,9 The curative effect of TKA is related not only to the type of prosthesis, the amount of annual operation, appropriate osteotomy, and proper soft tissue balance but also to perioperative nursing care.10 This research aims to compare the differences between the effect of routine care and individualized care after artificial knee replacement for valgus knee joint deformity to provide a basis for better clinical decision-making.
This study used a quasi-randomized controlled trial design. The Ethical Review Board of The Second Affiliated Hospital of the Nanjing University of Chinese Medicine approved the study (2014-441). Written informed consent was obtained from the participant before inclusion.
Based on the calculation results of sample size described in previous studies,10 the sample size required for this test was estimated. From March 2014 to March 2018, 76 patients (39 males and 37 females) with an average age of 67.8 years (53–82 years) were treated in our hospital; In 35 cases left knee and in 41 cases right knee was operated on. The body mass index was 22.5–27.9 kg/m2 (mean 25.9 kg/m2). Etiology: in 46 cases of osteoarthritis, in 10 cases of rheumatoid arthritis, and in 20 cases of traumatic arthritis. The main clinical symptoms were severe knee joint pain and severe pain during weight-bearing. Seventy-six patients were divided into a treatment group (
All the operations were performed by the same group of surgeions. The anterior median incision was made to remove the internal and external meniscus and anterior cruciate ligament, the knee flexion was 90, and the location, reaming and osteotomy was performed. After an osteotomy, the residual osteophyte around the joint was removed and the lateral soft tissue of the contracture was released step by step, and the rectangular space was obtained by extending the joint at the narrow part of the osteotomy space. The tibia and femur pros-thesis were fixed with bone cement, and polyethylene liner was installed after ensuring the balance of flexion and extension space and soft tissue. After prosthesis replacement and fixation, the joint capsule and soft tissue around the knee joint were injected with “cocktail” analgesics.”11 The patellar was checked, a drainage tube was placed in the incision, then the incision was sutured layer by layer, and then bandage it was applied under pressure.
The average tourniquet time was 85 min (75–110 min) and the mean hospitalization days were 5–7 days. All the incisions healed in the first stage without infection and skin necrosis, and complications occurred in 13 cases after the operation, and the operation was successful in all the patients, with an average tourniquet time of 85 min and an average hospitalization of 5–7 days. Among them, six cases developed symptomatic deep venous thrombosis of the lower extremity, four cases showed swelling of the lower extremity after the operation, and mild deep venous thrombosis of the lower extremity was diagnosed by ultrasound Doppler examination. After thrombolytic therapy, one case developed quadriceps extensor knee weakness 3 months after the operation. The patient had a history of 15 years before operation, poor strength of quadriceps femoris, and poor execution of exercise after the operation. All of them were given intensive functional exercises. The symptoms were improved during the recent follow-up. The patients were followed up for 3–48 months (mean 30 months), and the results of the final follow up showed that the knee joint had normal force line, good joint prosthesis position, no loosening and osteolysis, and normal patellar trajectory. The results of the final follow-up showed that the knee joint was in a normal position, and the patella trajectory was normal in the last follow-up.
The control group received routine care as follows: pre-operative preparation and guidance, keeping the ward quiet and tidy, and give current medical treatment after the operation; when the patient complained of pain, the nurse reported the syndrome to the doctor and gave an analgesic treatment according to the condition. After the implementation, the nurse observed and recorded the pain relief. The nurse carried out the doctor's orders and observed the effect of pain relief. Individualized care included:
The pain degree, the range of motion of joint, muscle strength, and stability of the two groups of patients were evaluated by the knee joint function score of American Special Surgical Hospital [Hospital for special surgery (HSS)]. The recovery of the two groups of patients was compared. Pittsburgh sleep quality index (PSQI) was used to assess the postoperative sleep status. The table is composed of 19 topics and can be divided into 7 parts: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disorders, hypnotic drug use, and effects on daytime function. Each part was evaluated by 0, 1, 2, and 3 grades. The cumulative score of each part was the total score of PSQI. The higher the score, the worse the quality of sleep. According to PSQI score ≤3 points, 4–7 points, and >8 points, the sleep quality was divided into three groups: good, medium, and poor.
Data were analyzed using IBM SPSS 19.0. Independent-Samples
Comparison of the knee joint function score of American Special Surgical Hospital (HSS) between the two groups is given in Table 1.
Comparison of HSS scores between the two groups.
Control group | Experimental group | |||
---|---|---|---|---|
Preoperative | 36.5 ± 6.2 | 38.2 ± 5.4 | 1.27 | |
Postoperative | 89.4 ± 3.4 | 91.2 ± 2.2 | −2.72 | |
−46.73 | −55.28 | |||
0.000 | 0.000 |
Comparison of preoperative PSQI scores between the two groups is given in Table 2.
Comparison of preoperative PSQI scores between the two groups.
Group | Number of examples | Subjective sleep quality | Sleep latency | Sleep persistence | Habitual sleep efficiency | Sleep disorder | Use of sleeping drugs | Daytime dysfunction |
---|---|---|---|---|---|---|---|---|
Control group | 39 | 1.56 ± 0.42 | 1.68 ± 0.50 | 1.46 ± 0.32 | 1.43 ± 0.34 | 1.42 ± 0.29 | 0.85 ± 0.35 | 1.96 ± 0.77 |
Experimental group | 37 | 1.72 ± 0.50 | 1.74 ± 0.48 | 1.56 ± 0.46 | 1.46 ± 0.43 | 1.47 ± 0.22 | 0.83 ± 0.25 | 1.93 ± 0.53 |
1.514 | 0.533 | 1.105 | 0.338 | 0.843 | 0.646 | 0.259 | ||
0.134 | 0.595 | 0.273 | 0.736 | 0.402 | 0.521 | 0.796 |
Comparison of PSQI scores between the two groups after the intervention is given in Table 3.
Comparison of PSQI scores between the two groups after intervention.
Group | Number of examples | Subjective sleep quality | Sleep latency | Sleep persistence | Habitual sleep efficiency | Sleep disorder | Use of sleeping drugs | Daytime dysfunction |
---|---|---|---|---|---|---|---|---|
Control group | 39 | 1.40 ± 0.48 | 1.65 ± 0.38 | 1.61 ± 0.38 | 1.56 ± 0.32 | 1.52 ± 0.36 | 0.79 ± 0.23 | 1.88 ± 0.36 |
Experimental group | 37 | 1.76 ± 0.45 | 1.45 ± 0.25 | 1.12 ± 0.28 | 1.24 ± 0.23 | 1.13 ± 0.24 | 0.26 ± 0.12 | 1.48 ± 0.46 |
−3.369 | 2.695 | 6.372 | 4.983 | 5.526 | 12.493 | 4.234 | ||
0.001 | 0.008 | 0.0001 | 0.0001 | 0.0001 | 0.0001 | 0.0001 |
TKA is the first choice for the treatment of osteoarthritis, joint pain, flexion contracture, valgus deformity, and so on.12,13 It can relieve pain and reconstruct the function of the knee joint. Pain is considered to be the most common complication after TKA, and local tissue trauma is the main cause of pain after TKA.14,15 In the past, the nerve blocking method was used to control pain, and because of incomplete obturator nerve block, the clinical effect was not obvious. Recently, some researchers have adopted the technique of total joint analgesia, which has also achieved good results. In this group, intraoperative “cocktail” analgesia, combined with intra-articular indwelling catheter analgesia, was used to control pain 24 h after the operation. Kerr found that this analgesic method was simple, effective, and without side effects.16 Fischer confirmed that high-dose intra-articular “cocktail” can significantly alleviate pain after TKA, improve patient satisfaction, and have no side effects such as muscle weakness.17 In recent years, due to the change of medical model, inpatients pay more attention to perioperative care and hope to achieve a good perioperative process through individualized nursing.18 However, most of the patients undergoing TKA surgery are elderly patients so they have a slow sensory response, large surgical stimulation, and poor psychological endurance. At the same time, some patients do not have a high educational level and poor compliance with TKA, and some of them have a low educational level and poor compliance with TKA.19,20 The purpose of the operation and the implementation of postoperative rehabilitation exercises could not be understood. Table 1 shows that although HSS scores improved in both groups after knee arthroplasty, individualized care was more effective in promoting patient recovery. Table 2 shows that there was no significant difference in sleep quality between the two groups before operation (
To sum up, effective control of pain after total knee arthroplasty, nurses master all aspects of joint replacement of scientific nursing and rehabilitation guidance. At the same time, postoperative rehabilitation exercise is also the key to the success of the operation. It can make a reasonable rehabilitation exercise plan for patients to restore the function of the affected limb and improve the quality of life of patients. To some extent, individualized nursing can promote the recovery of patients. Therefore, clinical nurses can design a nursing plan according to the individual nursing methods mentioned in this article, which is suitable for local patients with valgus deformity of the knee. In addition, we suggest that hospital decision-making departments should take more account of the manpower and costs of individualized care.
Our research has two limitations. First, the study design of this article is a quasi-randomized controlled. The researchers did not randomize the included patients, which may increase the risk of bias. Second, individualized care requires more manpower and costs. In this study, human factors are less considered in the research process, which may lead to a decline in the quality of individualized care.