Hip and Knee Replacements

Question 1

joint arthroplasty

Answer 1

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

Question 2

Who gets hip replacements?

Answer 2

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

Question 3

What are the steps of a hip replacement?

Answer 3

femoral head removed

acetabulum reamed

shell inserted

femur reamed

femoral component inserted

ball inserted

Question 4

Who gets knee replacements?

Answer 4

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

Question 5

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

Answer 5

weight of the patient

the amount of use the prosthetic gets

Question 6

What is the process of knee replacement?

Answer 6

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

Question 7

What are the pre-surgical rehab processes?

Answer 7

biomechanics

medications

injections

Question 8

What are the acute post-operative rehab processes?

Answer 8

pain management

ROM

joint protection

restoration of function for home

Question 9

What are the subacute post-operative rehab processes?

Answer 9

6-8 weeks post

weaning from assistive device

community access, managing uneven surfaces

increase endurance, aerobic capacity

Question 10

What are the maintenance/enhancement rehab processes?

Answer 10

return to recreational activity

continued joint protection

Question 11

What are the important areas of restoration of function?

Answer 11

manage pain

reduce swelling

restore strength

enhance range of motion (ROM)

establish joint protection strategies

assess for assistive devices/orthoses

Question 12

What are treatments for pain management in PMNR?

Answer 12

anti-inflammatories

opioid analgesics

nerve agents

therapeutic (heat) an cold

Question 13

What helps with swelling reduction?

Answer 13

compression

taping

manual lymphatic drainage

Question 14

How are bio-mechanical abnormalities corrected?

Answer 14

correct leg length discrepancy

proximal and distal joint pathology

proximal weakness

Question 15

Why are bio-mechanical assessments so important?

Answer 15

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

Question 16

What are the changes of the joint motion?

Answer 16

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

Question 17

What are some biomechanical impariments of having a prosthetic knee?

Answer 17

weakness in the quadriceps, hamstrings, and abnormal quadriceps

decreased propioception

decreased ROM

Question 18

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

Answer 18

progressive course targeting functional activity

isometric exercise

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

Question 19

isometric contraction

Answer 19

same length

muscles strengthened at angle trained

strength is not transferred to full range

least amount of joint stress

Question 20

isotonic contraction

Answer 20

same tension

muscle strengthened throughout range

high isotonic loads stress joints

concentric vs. eccentric

Question 21

What is the importance of ROM?

Answer 21

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

Question 22

What are the common gait aids?

Answer 22

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

Question 23

What are some ways to protect the joints?

Answer 23

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)

Question 24

How does an assistive device relieve pain?

Answer 24

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

Question 25

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

Answer 25

prolong life

prevent injury

low impact

low torque

Question 26

What are some possible post-op complications?

Answer 26

DVT

infection

nerve injury

failure of components

heterotopic ossifcation

leg length discrepancy

exacerbation of co-morbidities

Question 27

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

Answer 27

about 110 degrees ideally