(7 & 8) Lower Limb Arthroplasties

Question 1

What is a joint replacement?

Answer 1

the replacement of a joint that has been damaged, usually by OA

Question 2

What is a primary joint replacement?

Answer 2

damaged joint removed and replaced by an artificial implant

Question 3

What is a revision joint replacement?

Answer 3

repair or replacement of an artificial implant

Question 4

What is the Irish National Orthopaedic Register (INOR)?

Answer 4

Care and outcomes of patients who have had hip and knee surgery

Question 5

What are some commonly used patient reported outcome measures for THR &TKR?

Answer 5

• EQ-5D-3L
• Oxford hip score
• Oxford knee score

Question 6

What is the most common age range for a THR & TKR?

Answer 6

60-69 years

Question 7

What is a THR?

Answer 7

excision of damaged bone and insertion of implants to both acetabular and femoral components of the hip joint

Question 8

What is the aim of a THR?

Answer 8

• relieve pain and stiffness
• improve QOL & function

Question 9

What are THR indications (5)?

Answer 9

• OA
• Developmental dysplasia
• Avascular necrosis
• Post trauma
• FAI

Question 10

What type of anaesthetic is commonly used for THR?

Answer 10

Spinal anaesthetic

Question 11

What is the most common surgical approach during a THR?

Answer 11

posterior/posterolateral

Question 12

What are the steps in a THR operation?

Answer 12

• 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

Question 13

What are the THR prosthesis’?

Answer 13

• Acetabular component (metal alloy outer shell or plastic)
• Femoral component (metal or ceramic head on stem)

Question 14

What are some THR complications (7)?

Answer 14

• blood clots
• altered leg length
• prosthesis wear/loosening
• dislocation
• infection
• CRPS
• nerve damage

Question 15

What is involved in a THR pre assessment?

Answer 15

• advice & education
• ROM & strength
• mobility function
• expectations

Question 16

What is a general guide for physio post THR?

Answer 16

• Day 0/1 Mob
• Ax & mgmt resp status if necessary
• mobility & gait education
• exercise therapy
• advice and education

Question 17

What are some hip precautions post THR?

Answer 17

• Do not cross legs
• Do not sleep on op side
• avoid adduction past midline
• avoid flexion past 90
• avoid hip rotation/twisting

Question 18

What is some general discharge criteria for a THR?

Answer 18

• independent with walking aid
• independent transfers
• independent on stairs
• independently able to perform exercises at home

Question 19

What is expected from week 6 onwards following THR?

Answer 19

• wean off walking aids as able
• gradual return normal activities
• walking & pool walking highly recommended
• RTP if applicable

Question 20

How long roughly does a THR last?

Answer 20

15-25 years

Question 21

What are indications for a revision THR (5)?

Answer 21

• Aseptic loosening
• Component failure
• Infection
• Instability
• Pain of unknown origin

Question 22

What is a TKR?

Answer 22

resurfacing of ends of femur and tibia, sometimes underside of the patella

Question 23

What is a partial knee replacement?

Answer 23

affected part of the knee replaced, quicker recovery

Question 24

What is the aim of a TKR?

Answer 24

• reduce pain & stiffness
• Improve QOL and function

Question 25

What are the outcomes like for PKR & TKR?

Answer 25

• some patient reported outcomes measures higher PKR
• PKR more cost effective at 5 years

Question 26

What are indications for TKR?

Answer 26

• OA
• Post Trauma
• RA

Question 27

What type of anaesthetic is used for TKR?

Answer 27

spinal anaesthetic

Question 28

What are the steps in the operation for a TKR?

Answer 28

• ends of tibia & femur are removed
• implants fixed with cement
• metal component @ end femur & metal stem inserted into tibia, covered plastic

Question 29

What are some complications TKR?

Answer 29

• blood clots
• knee stiffness
• prosthesis wear & loosening
• infection
• CRPS
• nerve damage

Question 30

What is involved in the pre Ax for a TKR?

Answer 30

• advice & education
• ROM & strengthening
• mobility function
• expectations

Question 31

What is a general rehab guide following TKR?

Answer 31

• Day 0/1 Mob
• Ax & mgmt resp status if necessary
• mobility & gait education
• exercise therapy

Question 32

What are the aims of physio post TKR?

Answer 32

• aim for AROM 90 degrees with good quad function
• 80-90 for stairs
• 125 degrees squatting

Question 33

What is arthrofibrosis?

Answer 33

• complication of injury or trauma
• production excess scar tissue
• loss ROM
• tissue swelling & pain

Question 34

What are risk factor for arthrofibrosis?

Answer 34

• Pre-op ROM
• Complexity surgery
• Post-op rehab
• Genetic disposition
• Hx previous surgeries

Question 35

What is some discharge criteria following a TKR?

Answer 35

• independent with walking aid
• independent transfers
• independent stairs
• independently complete home exercises
• aim 90 knee flex

Question 36

How long on average to TKR & UKR usually last?

Answer 36

~25 years

Question 37

What leads to a revision TKR?

Answer 37

• instability
• unknown pain
• infection
• aseptic loosening
• malalignment