Joint Arthroplasty Flashcards
Joint Replacement Rehab Goals (4)
- Restore joint function
- Increase strength/muscle control
- Decrease pain
- Return patient to previous level of function!!!!
Primary Indications for Joint Replacement (6)
- Disabling pain
- Decreased function
- Marked impairment in ROM
- Instability/deformity
- Recurrent dislocations
- Failure of previous interventions
Absolute Contraindications of Joint Arthroplasty (5)
- Infection
- Severe/uncontrolled hypertension
- Progressive neurological disease
- Dementia (not always a contraindication)
- Renal or respiratory insufficiency
Relative Contraindications of Joint Arthroplasty (3)
- Obesity
- Diabetes
- Age 90
Complications of Joint Replacement (12)
- DVT/PE
- Infection
- Arthrofibrosis
- Complex regional pain syndrome
- Arthroplasty loosening/failure
- Allergic reaction
- Pneumonia
- Hematoma
- Surgical fracture
- Prosthesis ma-lalignment
- Heterotropic Ossification (HA)
- Dislocation
Bearing Surface Types (3)
- Metal on polyethylene (most common)
- Metal on metal
- Ceramic on ceramic
Fixation Types (2)
- Cemented
- Uncemented
Cemented Advantages (3)
- More stable
- Better short/mid term outcomes
- Less residual pain
Cemented Disadvantages (3)
- Longer operation time
- Difficult to revise later
- Allergic reaction/infection
Uncemented Advantages (3)
- Lower risk of stroke, DVT and PE
- Conserves bone mass
- Better long-term outcomes
Uncemented Disadvantages (3)
- Expensive
- Increased risk of peri-prosthetic fracture
- Lack of outcome data
Mini-Incision Arthroplasty
- Uses smaller incision (1-2in)
- Possibly reduces pain, bleeding and time to discharge
- Technically demanding
Metal on polyethylene Advantages (3)
- Less expensive
- Most supported by evidence
- Predictable survivability
Metal on polyethylene Disadvantages
- Polyethylene debris may cause sepsis and loosening
Metal on metal Advantages (2)
- Low friction and wear
- Lower risk of dislocation
Metal on metal Disadvantages (2)
- Metal poisoning
- Metal ions may have carcinogenic effects
Ceramic on ceramic Advantages (2)
- Low friction and wear
- Non-toxic material
Ceramic on ceramic Disadvantages (3)
- Most expensive
- High amount of surgical expertise required
- Joint may make noise
Total Hip Resurfacing (THR)
- Metal implants just cover the surface of the acetabulum and femoral head to make the joint smoother.
- Good treatment for younger/active adults
THR Advantages (4)
- Bone conserving
- Lower friction/wear
- Lower risk of dislocation
- Quicker recovery/return to high level activities
THR Disadvantages (4)
- Higher failure rate
- Metal on metal implant may cause metal poisoning
- Not supported by much data
- Surgery is harder to perform
Total Hip Arthroplasty (THA)
Surgical metal implants completely replace femoral head and neck and articulate with a new metal acetabulum.
THA Advantages (4)
- Highly supported by evidence
- Easier to perform than THR
- Used on variety of patient/age groups
- Better long-term outcomes
THA Disadvantages (2)
- Higher risk of dislocation
- Harder to revise due to lack of bone conservation