Hip and Knee Replacements Flashcards
joint arthroplasty
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
Who gets hip replacements?
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
What are the steps of a hip replacement?
femoral head removed
acetabulum reamed
shell inserted
femur reamed
femoral component inserted
ball inserted
Who gets knee replacements?
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
What factors determine the period of time a prosthetic joint will last?
weight of the patient
the amount of use the prosthetic gets
What is the process of knee replacement?
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
What are the pre-surgical rehab processes?
biomechanics
medications
injections
What are the acute post-operative rehab processes?
pain management
ROM
joint protection
restoration of function for home
What are the subacute post-operative rehab processes?
6-8 weeks post
weaning from assistive device
community access, managing uneven surfaces
increase endurance, aerobic capacity
What are the maintenance/enhancement rehab processes?
return to recreational activity
continued joint protection
What are the important areas of restoration of function?
manage pain
reduce swelling
restore strength
enhance range of motion (ROM)
establish joint protection strategies
assess for assistive devices/orthoses
What are treatments for pain management in PMNR?
anti-inflammatories
opioid analgesics
nerve agents
therapeutic (heat) an cold
What helps with swelling reduction?
compression
taping
manual lymphatic drainage
How are bio-mechanical abnormalities corrected?
correct leg length discrepancy
proximal and distal joint pathology
proximal weakness
Why are bio-mechanical assessments so important?
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
What are the changes of the joint motion?
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
What are some biomechanical impariments of having a prosthetic knee?
weakness in the quadriceps, hamstrings, and abnormal quadriceps
decreased propioception
decreased ROM
What are the important factors to restoring strength post-op?
progressive course targeting functional activity
isometric exercise
isotonic (low resistance) to improve strength and endurace over full range
isometric contraction
same length
muscles strengthened at angle trained
strength is not transferred to full range
least amount of joint stress
isotonic contraction
same tension
muscle strengthened throughout range
high isotonic loads stress joints
concentric vs. eccentric
What is the importance of ROM?
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
What are the common gait aids?
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
What are some ways to protect the joints?
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)
How does an assistive device relieve pain?
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
