Joint Arthroplasty Flashcards

1
Q

Joint Replacement Rehab Goals (4)

A
  • Restore joint function
  • Increase strength/muscle control
  • Decrease pain
  • Return patient to previous level of function!!!!
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2
Q

Primary Indications for Joint Replacement (6)

A

- Disabling pain

- Decreased function

  • Marked impairment in ROM
  • Instability/deformity
  • Recurrent dislocations
  • Failure of previous interventions
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3
Q

Absolute Contraindications of Joint Arthroplasty (5)

A
  • Infection
  • Severe/uncontrolled hypertension
  • Progressive neurological disease
  • Dementia (not always a contraindication)
  • Renal or respiratory insufficiency
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4
Q

Relative Contraindications of Joint Arthroplasty (3)

A
  • Obesity
  • Diabetes
  • Age 90
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5
Q

Complications of Joint Replacement (12)

A
  • DVT/PE
  • Infection
  • Arthrofibrosis
  • Complex regional pain syndrome
  • Arthroplasty loosening/failure
  • Allergic reaction
  • Pneumonia
  • Hematoma
  • Surgical fracture
  • Prosthesis ma-lalignment
  • Heterotropic Ossification (HA)
  • Dislocation
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6
Q

Bearing Surface Types (3)

A
  • Metal on polyethylene (most common)
  • Metal on metal
  • Ceramic on ceramic
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7
Q

Fixation Types (2)

A
  • Cemented
  • Uncemented
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8
Q

Cemented Advantages (3)

A
  • More stable
  • Better short/mid term outcomes
  • Less residual pain
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9
Q

Cemented Disadvantages (3)

A
  • Longer operation time
  • Difficult to revise later
  • Allergic reaction/infection
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10
Q

Uncemented Advantages (3)

A
  • Lower risk of stroke, DVT and PE
  • Conserves bone mass
  • Better long-term outcomes
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11
Q

Uncemented Disadvantages (3)

A
  • Expensive
  • Increased risk of peri-prosthetic fracture
  • Lack of outcome data
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12
Q

Mini-Incision Arthroplasty

A
  • Uses smaller incision (1-2in)
  • Possibly reduces pain, bleeding and time to discharge
  • Technically demanding
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13
Q

Metal on polyethylene Advantages (3)

A
  • Less expensive
  • Most supported by evidence
  • Predictable survivability
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14
Q

Metal on polyethylene Disadvantages

A
  • Polyethylene debris may cause sepsis and loosening
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15
Q

Metal on metal Advantages (2)

A
  • Low friction and wear
  • Lower risk of dislocation
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16
Q

Metal on metal Disadvantages (2)

A
  • Metal poisoning
  • Metal ions may have carcinogenic effects
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17
Q

Ceramic on ceramic Advantages (2)

A
  • Low friction and wear
  • Non-toxic material
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18
Q

Ceramic on ceramic Disadvantages (3)

A
  • Most expensive
  • High amount of surgical expertise required
  • Joint may make noise
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19
Q

Total Hip Resurfacing (THR)

A
  • Metal implants just cover the surface of the acetabulum and femoral head to make the joint smoother.
  • Good treatment for younger/active adults
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20
Q

THR Advantages (4)

A
  • Bone conserving
  • Lower friction/wear
  • Lower risk of dislocation
  • Quicker recovery/return to high level activities
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21
Q

THR Disadvantages (4)

A
  • Higher failure rate
  • Metal on metal implant may cause metal poisoning
  • Not supported by much data
  • Surgery is harder to perform
22
Q

Total Hip Arthroplasty (THA)

A

Surgical metal implants completely replace femoral head and neck and articulate with a new metal acetabulum.

23
Q

THA Advantages (4)

A
  • Highly supported by evidence
  • Easier to perform than THR
  • Used on variety of patient/age groups
  • Better long-term outcomes
24
Q

THA Disadvantages (2)

A
  • Higher risk of dislocation
  • Harder to revise due to lack of bone conservation
25
Posterior hip precautions
- Adduction past neutral - Hip flexion greater than 90 degrees - Internal rotation
26
Anterior hip precautions
- Extension - External rotation - Abduction
27
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
28
Interventions to prevent recurrent hip dislocations
- Hip braces - WBing restrictions - Communication with patient, family and caregivers
29
High Tibial Osteotomy
- Wedge is created on one side of the tibia to correct joint alignment - Used to correct unicompartmental disease or angular deformities
30
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.
31
Unicompartmental Arthroplasty Advantages (3)
- Bone conserving - Rehab is shorter than TKA - Hardware can last up to 8-10 years on average
32
Unicompartmental Arthroplasty Disadvantages
- Obesity increases rate of failure
33
Total Knee Arthroplasty (TKA)
Complete replacement of tibial plateau and femoral condyles.
34
What patients are the best candidates for TKA?
- Patients \<180 lbs - Patients \>60 yrs old
35
TKA Complications (2)
- Infection - DVT/PE
36
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
37
What should knee ROM be after TKA before patient is discharged from the hospital? (2)
- 90 degrees knee flexion - 0 degrees knee extension
38
What are the 2 types of shoulder replacement? (2)
- Convention - Reverse
39
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.
40
What are the areas of fast track recovery for joint replacements? (4)
- Pre-op patient education - Nutritional supplementation - Pain management - Early Mobilization
41
T/F: Posterior hip precautions are ER, abduction and flexion greater than 90.
False - IR, flexion greater than 90, adduction past neutral
42
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
43
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.
44
T/F: THR conserves bone mass but has a higher failure rate than THA.
True
45
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
46
Mini-incision arthroplasty has been found to reduce ________ \_\_\_\_\_ and length of stay but does not increase ability to regain \_\_\_\_\_\_\_\_\_\_.
blood, loss, function
47
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
48
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
49
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
50
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
51
When do the majority of THA dislocations occurs?
1-6 weeks after surgery
52
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%.