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PTRS 746 - Musculoskeletal > Joint Arthroplasty > Flashcards

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
Q

Anterior-lateral approach PRECAUTIONS (3)

A
  • Avoid abduction
  • Avoid hip extension
  • Avoid hip external rotation
26
Q

Early Post-op Intervention (Acute and Sub-acute) - THA

A
  • Ice and Positioning
  • Education - precautions
  • Strengthening - AAROM, AROM, strengthening
  • Mobility - bed, transfers, gait, stair, car transfer
27
Q

Late Intervention (Chronic) - THA

A
  • 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
Q

High Tibial Osteotomy - knee

A
  • Surgical realignment of joint
  • Delays TKA
  • Indicated for unicompartmental disease or angular deformity
  • Allows reasonable joint stability and an active lifestyle
29
Q

TKA Ideal patient

A
  • > 60 y/o

- <180 lbs.

30
Q

Risk Factors - TKA

A
  • Obesity
  • Anemia
  • Malnutrition
  • Diabetes
31
Q

TKA Rehab (Acute and Sub-acute)

A
  • Ice and Positioning
  • ROM: 0 of ext. to 90 of flex
  • Strengthening: Isometrics, ankle pumps, heel slides, SAQ, LAQ
  • Mobility training - gait
32
Q

TKA Late Intervention (Chronic)

A
  • 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
Q

Bilateral TKA

A
  • More common than bilateral THA/THR
  • Can be concurrent or staged
  • Should be bilaterally WBAT
  • Longer recovery, may require inpatient rehab
34
Q

Bilateral THA

A
  • 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
Q

Conventional Shoulder Arthroplasty

A
  • 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
Q

Reverse Shoulder Arthroplasty

A
  • 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
Q

TSA Rehab - Phase 1

A
  • PROM/AAROM
  • Immobilization
  • No AROM or flexion >120, ER >30, Abd >45
38
Q

TSA Rehab - Phase 2

A
  • AAROM/AROM
  • PROM into full ER, flexion <140
  • Initiate AROM
39
Q

TSA Rehab - Phase 3

A
  • AROM/Strength
  • AROM into flexion and ER
  • Strengthen shoulder girdle
  • Avoid overhead activity and forceful stretching
40
Q

Pain Management Types (4)

A
  • PCA - Patient controlled analgesia
  • Epidural - Indwelling
  • Femoral nerve block - Can be indwelling or single injection
  • Oral pain meds - post-op nausea, dizziness, constipation, etc.

PTRS 746 - Musculoskeletal (9 decks)

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