Arthroplasty Flashcards
What are the goals of a hip arthroplasty?
- Pain relief
- Restoration of structure within joint
- Mobility
- QOL
What are the different types of hip arthroplasty?
- Hybrid cemented THA
- Resurfacing arthroplasty for avascular necrosis (head of femur)
- Noncemented modular THA
What are the indications for hip arthroplasty?
- OA
- Avascular necrosis
- Inflammatory arthritis (RA, AS, JCA)
- Non union of neck of femur #
- TB
- Tumour
What does a physio need to be concerned with following arthroplasty?
- Weight bearing status
- What structures were cut during the surgery (i.e. need rehab)
What structures are cut during a hip arthroplasty?
- Skin
- Fascia
- Glutes split
- Sciatic nerve retracted
- Short external rotators divided
- Capsule exposed & opened
What are the complications of hip arthroplasty?
- Blood loos & shock, anaemia, confusion
- Thromboembolism
- Dislocation
- Femur/acetabular #
- Infection
- Loosening
- Wear
What does appropriate rehabilitation need to recognise and address?
- Patient’s home & environment
- Pre op history & impairments
- Surgical history & technique
- Surgeon’s assessment of the tissue status upon finalisation of the surgery
What are the common restrictions following hip arthroplasty?
- Active/passive ROM
- ROM limits
- Weight bearing status
What are some of the common issue around the hip when people have chronic dysfunction?
- OA
- Tendinopathy
- Bursitis
- Core strength
What are some of the things that should be taught to the patient before a THR (phase 1)?
- Ankle pumps
- Quadriceps sets
- Gluteal sets
- Active hip & knee flexion (heel slides)
- Isometric hip abduction
- Active hip abduction
What are the typical THR goals for the first 5 days post op?
Day 1:
- Sit out of bed
- Knee & hip exercises
- Chest physio
- Abduction pillow
Day 2:
- Assisted walking
- Lots of exercises
Day 5:
- Home
- PT at home (stairs, step)
What movements typically should be avoided post THR?
- Internal rotation
- Adduction
- Hip flexion past 90 deg
What are the precautions post hip arthroplasty?
- Prevent DVT
- Prevent dislocation (avoid FADIR - low chairs, roll in bed)
- Prevent infection
What are the general principles for post op stage 1 for arthroplasty?
- Treatment & exercise
- Mobility
- Comfort
- Hygiene
- Clothing/dressing
- Safety education
- Other joints health
- Education re future progression
- Discharge planning
What are the typical goals for phase 2a of a THR (1-2 days post op)?
- Prevent complications
- Increase muscle contraction
- Improve control of affected leg
- Help patient sit up for 30 mins
- Reinforce THR precautions
What are the typical goals for phase 2b of a THR (3-7 days post op)?
- Promote transfer & gait independence
- Reinforce THR precautions
- Discharge
What are the typical goals for phase 3 of a THR (1-6 weeks post op)?
- Evaluate safety of the home
- Assure patient independence
- Plant patient’s return to work
What are the essential components of discharge?
- Home exercises
- Understanding of progressions & restrictions
- Team (OT, nurse, GP)
- Appointment for follow-up with physio
What are the indications for knee arthroplasty?
- OA
- RA
- Post-traumatic arthritis
- When joint dysfunction is causing a loss in QOL
What are the surgery goals for knee arthroplasty?
- Restore QOL
- Relieve pain
- Provide motion with stability
- Correct deformity (e.g. valgus/varus)
What are the different designs of knee arthroplasty?
- Unicompartmental (medial/lateral)
- Unconstrained (dep on ligament integrity)
- Semi constrained (most common)
- Fully constrained (rotating hinges)
What are the complications of knee arthroplasty?
- Thromboembolism
- Poor wound healing
- Infection
- Joint instability
- Fractures
- Patella tendon rupture
- Peroneal nerve injuries
- Component loosening
- Wear
What are the typical knee arthroplasty goals for the first 5 days post op?
Day 1:
- Sit out of bed
- Continuous passive motion
- Knee exercises
- Chest physio
Day 2:
- Assisted walking
- CPM, exercises
Day 5
- Home, PT at home
What are the precautions for knee arthroplasty?
- Wound care
- Prevention of DVTs
- Early motion is essential
What are the indications for shoulder arthroplasty?
- OA
- Rotator cuff arthropathy
- Fracture/disclocation
- RA
- Avascular necrosis
- Other inflammatory arthritis
- Instability
- Tumour
What are the complications of shoulder arthroplasty?
- Infection
- Dislocation
- Loosening of a component
- Periprosthetic humeral & glenoid fractures
- Nerve injuries
- Fractures of prosthetic component
- Heterotrophic ossification
What are the typical rehab protocols for shoulder arthroplasty?
- Abduction pillow 1-6 weeks
- Or sling & swathe bandage
Neer program
- Day 5: assisted ROM
- Day 7: active assisted
- Day 14: active assisted exercises sitting & standing
- Day 21: isometric & active progression of exercises
What are the precautions for shoulder arthroplasty?
- Prevent tear of rotator cuff suturing
- Prevent dislocation (horizontal abduction not permitted until flexion at 140 deg)
