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
Posterior hip precautions
- Adduction past neutral
- Hip flexion greater than 90 degrees
- Internal rotation
Anterior hip precautions
- Extension
- External rotation
- Abduction
Hip Arthroplasty Dislocation Risk Factors (8)
- Neuromuscular impairment
- Fracature
- Cognitive dysfunction
- Posterior approach
- History of surgery
- Small femoral head size
- Prosthetic alignment
- Surgeon’s experience
Interventions to prevent recurrent hip dislocations
- Hip braces
- WBing restrictions
- Communication with patient, family and caregivers
High Tibial Osteotomy
- Wedge is created on one side of the tibia to correct joint alignment
- Used to correct unicompartmental disease or angular deformities
Unicompartmental Arthroplasty
Small implants placed on one side of the tibial plateau and one femoral condyle to make joint smoother/more congruent on involved side of the knee joint.
Unicompartmental Arthroplasty Advantages (3)
- Bone conserving
- Rehab is shorter than TKA
- Hardware can last up to 8-10 years on average
Unicompartmental Arthroplasty Disadvantages
- Obesity increases rate of failure
Total Knee Arthroplasty (TKA)
Complete replacement of tibial plateau and femoral condyles.
What patients are the best candidates for TKA?
- Patients <180 lbs
- Patients >60 yrs old
TKA Complications (2)
- Infection
- DVT/PE
What is the best way to determine if one of your patients has a DVT or PE? (3)
- Wells Score for DVT/PE
- DVT score >3 patient at high risk
- PE score >6 patient at high risk
What should knee ROM be after TKA before patient is discharged from the hospital? (2)
- 90 degrees knee flexion
- 0 degrees knee extension
What are the 2 types of shoulder replacement? (2)
- Convention
- Reverse
T/F - In a reverse shoulder arthroplasty the humerus is convex and the glenoid fossa if concave.
False - in a reverse shoulder arthroplasty the glenoid fossa becomes convex and the humeral head becomes concave.
What are the areas of fast track recovery for joint replacements? (4)
- Pre-op patient education
- Nutritional supplementation
- Pain management
- Early Mobilization
T/F: Posterior hip precautions are ER, abduction and flexion greater than 90.
False - IR, flexion greater than 90, adduction past neutral
What are some of the most common joint replacement complications? A. Infection B. High Blood Pressure C. Acute Compartment Syndrome D. DVT/PE E. Fracture
A. Infection
D. DVT/PE
T/F: Obesity, diabetes, and age of 90 or higher are absolute contraindications for joint replacement surgery.
False - these are RELATIVE contraindications. These patients may still be candidates for the surgery.
T/F: THR conserves bone mass but has a higher failure rate than THA.
True
What are the absolute contraindications for joint replacement?
A. Renal/respiratory insufficiency
B. Cognitive impairment
C. Infection
D. Coronary Artery Disease
E. Uncontrolled hypertension
A. Renal/respiratory insufficiency
C. Infection
E. Uncontrolled hypertension
Mini-incision arthroplasty has been found to reduce ________ _____ and length of stay but does not increase ability to regain __________.
blood, loss, function
What does early (acute/subacute) post-op rehab focus on after hip replacement? (7)
- Ice and positioning
- Education on precautions
- Strengthening
- Mobility (bed, transfers, gait, stairs, car transfer)
- Edema management
- Equipment recommendations
- Discharge planning/recommendations
What are the late stage rehab goals? (5)
- Emphasize functional activities
- Strengthen hip flexors, extensors and abductors
- Use resistance training if possible
- Wean patient off assistive device
- Limit high impact/rotational activities
Name the factors that may confirm the diagnosis of a PE according to the Wells PE prediction rule. (7)
- Signs/symptoms of DVT
- PE is the MOST likely diagnosis
- Pt has has surgery or bedridden for at least 3 days in last 4 wks
- Previous history of DVT/PE
- HR >100 bpm
- Hemoptysis (coughing up blood)
- Active cancer
List the factors associated w/ DVT diagnosis according to Wells DVT prediction rule. (10)
- Active cancer
- Paralysis, peresis or plaster immobilization of LE
- Bedridden for at least 3 days or surgery within last 12 weeks
- Localized tenderness around the deep venous system tracks
- Entire leg is swollen
- Calf swelling > 3cm compared to unsymptomatic side
- Pitting edema confined to symptomatic side
- Non-varicose collateral superficial veins
- Previous history of DVT
- Other possible diagnoses are at least as likely as a DVT
When do the majority of THA dislocations occurs?
1-6 weeks after surgery
T/F: Dislocation of THA are more common after revisions than when they are implemented the first time.
True, primary (first time) THA dislocation rate is 0-10%, revision dislocation rate increases to 26%.
