Hip and Knee Replacements Flashcards

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1
Q

joint arthroplasty

A

total hip and knee replacements

primaries and revisions expected to rise

>50% will be done on patients less than 65 years-old by 2030

most replacements will likely wear out if the patient is young

try to put off as long as possible and lose weight

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2
Q

Who gets hip replacements?

A

patients with severe hip pain from end stage radiographic osteoarthritis

they have failed non-operative treatment with:

  • physical therapy/weight losss
  • NSAIDs
  • cone/crutches
  • cortisone injections
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3
Q

What are the steps of a hip replacement?

A

femoral head removed

acetabulum reamed

shell inserted

femur reamed

femoral component inserted

ball inserted

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4
Q

Who gets knee replacements?

A

patients with severe pain from end-stage radiographic osteoarthritis

they have failed non-operative treatment with:

  • physical therapy/weight loss
  • NSAIDs
  • cane/crutches
  • injections
  • braces
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5
Q

What factors determine the period of time a prosthetic joint will last?

A

weight of the patient

the amount of use the prosthetic gets

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6
Q

What is the process of knee replacement?

A

remove the end of the femur

remove the top of the tibia

remove the back of the patella

pop in the femur component

pop in the tibia components

pop on the patella

grout the new joint on

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7
Q

What are the pre-surgical rehab processes?

A

biomechanics

medications

injections

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8
Q

What are the acute post-operative rehab processes?

A

pain management

ROM

joint protection

restoration of function for home

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9
Q

What are the subacute post-operative rehab processes?

A

6-8 weeks post

weaning from assistive device

community access, managing uneven surfaces

increase endurance, aerobic capacity

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10
Q

What are the maintenance/enhancement rehab processes?

A

return to recreational activity

continued joint protection

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11
Q

What are the important areas of restoration of function?

A

manage pain

reduce swelling

restore strength

enhance range of motion (ROM)

establish joint protection strategies

assess for assistive devices/orthoses

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12
Q

What are treatments for pain management in PMNR?

A

anti-inflammatories

opioid analgesics

nerve agents

therapeutic (heat) an cold

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13
Q

What helps with swelling reduction?

A

compression

taping

manual lymphatic drainage

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14
Q

How are bio-mechanical abnormalities corrected?

A

correct leg length discrepancy

proximal and distal joint pathology

proximal weakness

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15
Q

Why are bio-mechanical assessments so important?

A

arthritis decreases bio-mechanical integrity of joints and surrounding structures

the driving force of the pathologic changes is removed by surgery

rehabilitation addresses altered joint and gait mechanics to resume normal pain free motion

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16
Q

What are the changes of the joint motion?

A

decreased joint motion

muscle atrophy, weakness, diminished endurance

joint effusion

arthrogenic inhibition of muscle function

poor coordination of normal synchronous activity

lose postural stability and distribution of forces

energy- inefficient gait patterns, and altered joint-loading responses

increases spasm, contractures

17
Q

What are some biomechanical impariments of having a prosthetic knee?

A

weakness in the quadriceps, hamstrings, and abnormal quadriceps

decreased propioception

decreased ROM

18
Q

What are the important factors to restoring strength post-op?

A

progressive course targeting functional activity

isometric exercise

isotonic (low resistance) to improve strength and endurace over full range

19
Q

isometric contraction

A

same length

muscles strengthened at angle trained

strength is not transferred to full range

least amount of joint stress

20
Q

isotonic contraction

A

same tension

muscle strengthened throughout range

high isotonic loads stress joints

concentric vs. eccentric

21
Q

What is the importance of ROM?

A

strength gets all the attention

ROM is also critical for function

power is useless without functional range

stretching to prevent capsular adhesions, contracture, and ROM

passive or active

22
Q

What are the common gait aids?

A

a strait cane - unloads the limb by 25%

custom handgrip pieces

platform attachments distribute weight on the forearm

* also adaptive advices for transfer of ADLs

23
Q

What are some ways to protect the joints?

A

use the largest possible joints for activity

avoid overuse with rest periods

unload painful joints - adaptive equipment

employ efficient strategies for activity

stabilize/splint joint for support in functional positions (Orthoses)

24
Q

How does an assistive device relieve pain?

A

decrease need for muscles (hip abductors) on affected side to contract

may relieve up to 60% of the load on the hip in stance phase

supported gait with a walker 2-3 times body weight

compared to 4-7 times without

25
Q

What are the goals for return in activity after a joint replacement?

A

prolong life

prevent injury

low impact

low torque

26
Q

What are some possible post-op complications?

A

DVT

infection

nerve injury

failure of components

heterotopic ossifcation

leg length discrepancy

exacerbation of co-morbidities

27
Q

How much ROM of the hip is needed for normal day-to-day function?

A

about 110 degrees ideally