Joint Arthroplasty Flashcards
Primary causes for Joint Replacement (5)
- OA
- RA
- Traumatic arthritis
- Avascular necrosis
- Fracture repair
Primary* indications for Joint Replacement (6)
- Marked, disabling pain*
- Decreased function*
- Marked impairment in ROM
- Instability and/or deformity
- Recurrent dislocation
- Failure of prior interventions/surgeries
Contraindications for Joint Replacement (3)
- Infection (biggest concern)
- Severe of uncontrolled HTN
- Progressive neurological disease
Relative Contraindications (3)
- Obesity
- Diabetes
- Age: 90
Main Complications (4)
- Venous Thromboemoblism (DVT or PE)
- Infection (acute and long-term)
- Arthrofibrosis
- Complex Regional Pain Syndrome
Metal-on-polyethylene - advantages
- Cost effective
- Evidence supports use
- Predictable lifespan
Metal-on-polyethylene - disadvantages
-Polyethylene debris may lead to aseptic loosening
Metal-on-metal - advantages
- Low friction/wear
- Lower dislocation risk
Metal-on-metal - disadvantages
- Possible carcinogenic effect of metal ions
- Metallosis
Ceramic-on-ceramic - advantages
- Low friction/wear
- Inert material
Ceramic-on-ceramic - disadvantages
- Expensive
- Requires expert insertion technique
- Possible joint noise
Uncemented Fixation - Advantages
- Lower risk of cardiovascular and VTE events
- Bone conserving
Uncemented Fixation - Disadvantages
- Increased risk of peri-prosthetic fracture
- Lack of good long-term outcome data
Cemented Fixation - Advantages
- More stable initially
- Better short and mid-term outcomes
Cemented Fixation - Disadvantages
- Longer operative time
- More difficult to revise
- Potential for adverse reaction to cement
Approaches for THA (7)
- Direct anterior
- Anterolateral
- Direct lateral
- Lateral Transtrochanteric
- Posterolateral
- Posterior mini
- Anterior mini
What is a Total arthroplasty?
New acetabulum
What is a Hemi arthroplasty?
Person’s original acetabulum
Total Hip Resurfacing (THR) - Advantages
- Moving a lot less bone
- Joint is more stable
Resurfacing - Advantages (4)
- Lower dislocation risk
- Bone conserving
- Low wear/friction
- Quicker recovery and return to high demand activity
Resurfacing - Disadvantages (4)
- Higher early failure rates
- Metallosis
- Technically difficult
- Little long-term data
- **Femoral neck fracture
Arthroplasty - Advantages (4)
- Well-studied
- Easier to perform
- Suitable for wider range of patient populations
- Better long-term outcomes
Arthroplasty - Disadvantages (3)
- Higher dislocation risk
- More difficult to revise
- More functionally limiting
Posterior-lateral approach PRECAUTIONS (3)
- Avoid adduction beyond neutral
- Avoid hip flexion > 90 degrees
- Avoid hip internal rotation
Anterior-lateral approach PRECAUTIONS (3)
- Avoid abduction
- Avoid hip extension
- Avoid hip external rotation
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
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
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
TKA Ideal patient
- > 60 y/o
- <180 lbs.
Risk Factors - TKA
- Obesity
- Anemia
- Malnutrition
- Diabetes
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
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
Bilateral TKA
- More common than bilateral THA/THR
- Can be concurrent or staged
- Should be bilaterally WBAT
- Longer recovery, may require inpatient rehab
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
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
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
TSA Rehab - Phase 1
- PROM/AAROM
- Immobilization
- No AROM or flexion >120, ER >30, Abd >45
TSA Rehab - Phase 2
- AAROM/AROM
- PROM into full ER, flexion <140
- Initiate AROM
TSA Rehab - Phase 3
- AROM/Strength
- AROM into flexion and ER
- Strengthen shoulder girdle
- Avoid overhead activity and forceful stretching
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.
