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I'm a med-surg nurse with 10 years of experience, but I've been at home raising kids the last five years. Next week I start a new job in a specialty clinic for joint replacements. My first "training" week will be in the total knee section of the center. Can you tell me what kind of changes have taken place since I've been out?

The number of surgeries to replace part or all of the knee joint has tripled in the last 10 years. Along with that increase has come many changes in the way reconstructive knee surgeries are done. Just as you have discovered with your new employment, there's been a trend away from hospital-based surgeries. More surgeons are specializing in a particular procedure such as reconstructive knee surgery. That has led to high-volume specialty centers where surgeons perform many knee joint replacements each week. The result has been improved outcomes, fewer complications, and lower costs. With improved technology, surgeons have been able to offer patients improved standard of care. For example, computer navigation and tools to make more specific cuts have reduced differences that occur from surgeon to surgeon. More careful attention to the mechanical axis of the implant has also improved how long the implants last. A natural outcome of that focus has been improved function for patients. Another change in how surgeries are done has been the move from open incision to minimally invasive surgery. Along with smaller incisions that preserve the soft tissues has come a concept called rapid recovery rehab. Patients are up and walking and putting weight on the knee right away. Everything in the rehab protocol is speeded up. But even as some things have changed, many other things have stayed the same. Your basic nursing skills and experience dealing with anxious or post-operative patients will serve you well as you head back into active nursing practice. Good luck!

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