Joint Arthroplasty Flashcards

1
Q

Primary causes for Joint Replacement (5)

A
  • OA
  • RA
  • Traumatic arthritis
  • Avascular necrosis
  • Fracture repair
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2
Q

Primary* indications for Joint Replacement (6)

A
  • Marked, disabling pain*
  • Decreased function*
  • Marked impairment in ROM
  • Instability and/or deformity
  • Recurrent dislocation
  • Failure of prior interventions/surgeries
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3
Q

Contraindications for Joint Replacement (3)

A
  • Infection (biggest concern)
  • Severe of uncontrolled HTN
  • Progressive neurological disease
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4
Q

Relative Contraindications (3)

A
  • Obesity
  • Diabetes
  • Age: 90
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5
Q

Main Complications (4)

A
  • Venous Thromboemoblism (DVT or PE)
  • Infection (acute and long-term)
  • Arthrofibrosis
  • Complex Regional Pain Syndrome
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6
Q

Metal-on-polyethylene - advantages

A
  • Cost effective
  • Evidence supports use
  • Predictable lifespan
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7
Q

Metal-on-polyethylene - disadvantages

A

-Polyethylene debris may lead to aseptic loosening

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8
Q

Metal-on-metal - advantages

A
  • Low friction/wear

- Lower dislocation risk

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9
Q

Metal-on-metal - disadvantages

A
  • Possible carcinogenic effect of metal ions

- Metallosis

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10
Q

Ceramic-on-ceramic - advantages

A
  • Low friction/wear

- Inert material

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11
Q

Ceramic-on-ceramic - disadvantages

A
  • Expensive
  • Requires expert insertion technique
  • Possible joint noise
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12
Q

Uncemented Fixation - Advantages

A
  • Lower risk of cardiovascular and VTE events

- Bone conserving

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13
Q

Uncemented Fixation - Disadvantages

A
  • Increased risk of peri-prosthetic fracture

- Lack of good long-term outcome data

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14
Q

Cemented Fixation - Advantages

A
  • More stable initially

- Better short and mid-term outcomes

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15
Q

Cemented Fixation - Disadvantages

A
  • Longer operative time
  • More difficult to revise
  • Potential for adverse reaction to cement
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16
Q

Approaches for THA (7)

A
  • Direct anterior
  • Anterolateral
  • Direct lateral
  • Lateral Transtrochanteric
  • Posterolateral
  • Posterior mini
  • Anterior mini
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17
Q

What is a Total arthroplasty?

A

New acetabulum

18
Q

What is a Hemi arthroplasty?

A

Person’s original acetabulum

19
Q

Total Hip Resurfacing (THR) - Advantages

A
  • Moving a lot less bone

- Joint is more stable

20
Q

Resurfacing - Advantages (4)

A
  • Lower dislocation risk
  • Bone conserving
  • Low wear/friction
  • Quicker recovery and return to high demand activity
21
Q

Resurfacing - Disadvantages (4)

A
  • Higher early failure rates
  • Metallosis
  • Technically difficult
  • Little long-term data
  • **Femoral neck fracture
22
Q

Arthroplasty - Advantages (4)

A
  • Well-studied
  • Easier to perform
  • Suitable for wider range of patient populations
  • Better long-term outcomes
23
Q

Arthroplasty - Disadvantages (3)

A
  • Higher dislocation risk
  • More difficult to revise
  • More functionally limiting
24
Q

Posterior-lateral approach PRECAUTIONS (3)

A
  • Avoid adduction beyond neutral
  • Avoid hip flexion > 90 degrees
  • Avoid hip internal rotation
25
Anterior-lateral approach PRECAUTIONS (3)
- Avoid abduction - Avoid hip extension - Avoid hip external rotation
26
Early Post-op Intervention (Acute and Sub-acute) - THA
- Ice and Positioning - Education - precautions - Strengthening - AAROM, AROM, strengthening - Mobility - bed, transfers, gait, stair, car transfer
27
Late Intervention (Chronic) - THA
- Emphasize functional activities - Strengthen hip flexors, extensors, and abductors - Include resistance training, if possible - Wean from assistive device - Limit high impact activity with rotational forces
28
High Tibial Osteotomy - knee
- Surgical realignment of joint - Delays TKA - Indicated for unicompartmental disease or angular deformity - Allows reasonable joint stability and an active lifestyle
29
TKA Ideal patient
- >60 y/o | - <180 lbs.
30
Risk Factors - TKA
- Obesity - Anemia - Malnutrition - Diabetes
31
TKA Rehab (Acute and Sub-acute)
- Ice and Positioning - ROM: 0 of ext. to 90 of flex - Strengthening: Isometrics, ankle pumps, heel slides, SAQ, LAQ - Mobility training - gait
32
TKA Late Intervention (Chronic)
- Emphasize functional activity - Interventions to increase ROM including modalities and soft tissue mobilization - Strengthening, muscle control and balance - Limit high impact activities with heavy rotational forces
33
Bilateral TKA
- More common than bilateral THA/THR - Can be concurrent or staged - Should be bilaterally WBAT - Longer recovery, may require inpatient rehab
34
Bilateral THA
- Usually staged by at least 1 week, but often > 6 weeks b/w surgeries - Increases risk for venous thromboembolism - Adherence to bilateral posterior hip precautions is difficult
35
Conventional Shoulder Arthroplasty
- Cemented or un-cemented - Indicated for OA and intact RTC - Glenoid component omitted if cartilage is intact, bone quality is poor or RTC tendons are irreparably torn
36
Reverse Shoulder Arthroplasty
- Normal ball and socket arrangement is switched - Allows use of deltoid to lift arm (vs. RTC) - Indicated if RTC is fully torn, hx of failed replacement
37
TSA Rehab - Phase 1
- PROM/AAROM - Immobilization - No AROM or flexion >120, ER >30, Abd >45
38
TSA Rehab - Phase 2
- AAROM/AROM - PROM into full ER, flexion <140 - Initiate AROM
39
TSA Rehab - Phase 3
- AROM/Strength - AROM into flexion and ER - Strengthen shoulder girdle - Avoid overhead activity and forceful stretching
40
Pain Management Types (4)
- PCA - Patient controlled analgesia - Epidural - Indwelling - Femoral nerve block - Can be indwelling or single injection - Oral pain meds - post-op nausea, dizziness, constipation, etc.