(7 & 8) Lower Limb Arthroplasties Flashcards
What is a joint replacement?
the replacement of a joint that has been damaged, usually by OA
What is a primary joint replacement?
damaged joint removed and replaced by an artificial implant
What is a revision joint replacement?
repair or replacement of an artificial implant
What is the Irish National Orthopaedic Register (INOR)?
Care and outcomes of patients who have had hip and knee surgery
What are some commonly used patient reported outcome measures for THR &TKR?
- EQ-5D-3L
- Oxford hip score
- Oxford knee score
What is the most common age range for a THR & TKR?
60-69 years
What is a THR?
excision of damaged bone and insertion of implants to both acetabular and femoral components of the hip joint
What is the aim of a THR?
- relieve pain and stiffness
- improve QOL & function
What are THR indications (5)?
- OA
- Developmental dysplasia
- Avascular necrosis
- Post trauma
- FAI
What type of anaesthetic is commonly used for THR?
Spinal anaesthetic
What is the most common surgical approach during a THR?
posterior/posterolateral
What are the steps in a THR operation?
- incision made, tissues divided to expose joint
- joint capsule opened
- hip dislocated & head femur removed
- bone surfaces prepared
- implants inserted with/without cement
- movement checked & tissues reattached
What are the THR prosthesis’?
- Acetabular component (metal alloy outer shell or plastic)
- Femoral component (metal or ceramic head on stem)
What are some THR complications (7)?
- blood clots
- altered leg length
- prosthesis wear/loosening
- dislocation
- infection
- CRPS
- nerve damage
What is involved in a THR pre assessment?
- advice & education
- ROM & strength
- mobility function
- expectations
What is a general guide for physio post THR?
- Day 0/1 Mob
- Ax & mgmt resp status if necessary
- mobility & gait education
- exercise therapy
- advice and education
What are some hip precautions post THR?
- Do not cross legs
- Do not sleep on op side
- avoid adduction past midline
- avoid flexion past 90
- avoid hip rotation/twisting
What is some general discharge criteria for a THR?
- independent with walking aid
- independent transfers
- independent on stairs
- independently able to perform exercises at home
What is expected from week 6 onwards following THR?
- wean off walking aids as able
- gradual return normal activities
- walking & pool walking highly recommended
- RTP if applicable
How long roughly does a THR last?
15-25 years
What are indications for a revision THR (5)?
- Aseptic loosening
- Component failure
- Infection
- Instability
- Pain of unknown origin
What is a TKR?
resurfacing of ends of femur and tibia, sometimes underside of the patella
What is a partial knee replacement?
affected part of the knee replaced, quicker recovery
What is the aim of a TKR?
- reduce pain & stiffness
- Improve QOL and function
What are the outcomes like for PKR & TKR?
- some patient reported outcomes measures higher PKR
- PKR more cost effective at 5 years
What are indications for TKR?
- OA
- Post Trauma
- RA
What type of anaesthetic is used for TKR?
spinal anaesthetic
What are the steps in the operation for a TKR?
- ends of tibia & femur are removed
- implants fixed with cement
- metal component @ end femur & metal stem inserted into tibia, covered plastic
What are some complications TKR?
- blood clots
- knee stiffness
- prosthesis wear & loosening
- infection
- CRPS
- nerve damage
What is involved in the pre Ax for a TKR?
- advice & education
- ROM & strengthening
- mobility function
- expectations
What is a general rehab guide following TKR?
- Day 0/1 Mob
- Ax & mgmt resp status if necessary
- mobility & gait education
- exercise therapy
What are the aims of physio post TKR?
- aim for AROM 90 degrees with good quad function
- 80-90 for stairs
- 125 degrees squatting
What is arthrofibrosis?
- complication of injury or trauma
- production excess scar tissue
- loss ROM
- tissue swelling & pain
What are risk factor for arthrofibrosis?
- Pre-op ROM
- Complexity surgery
- Post-op rehab
- Genetic disposition
- Hx previous surgeries
What is some discharge criteria following a TKR?
- independent with walking aid
- independent transfers
- independent stairs
- independently complete home exercises
- aim 90 knee flex
How long on average to TKR & UKR usually last?
~25 years
What leads to a revision TKR?
- instability
- unknown pain
- infection
- aseptic loosening
- malalignment
