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Musculoskeletal I > Joint Arthroplasty > Flashcards

Joint Arthroplasty Flashcards

1
Q

Primary Causes of Joint Arthroplasty

A
  1. RA/OA - VERY COMMON
  2. Traumatic arthritis
  3. Avascular necrosis
  4. Fracture repair
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2
Q

Primary Indications for Joint Arthroplasty

A 
#1 = marked, disabling pain
#2 = decreased function

Others - marked impairment in ROM, instability and/or deformity, recurrent dislocations, & failure of prior surgeries/interventions

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3
Q

Contraindications for Joint Arthroplasty

A
  1. Infection - most significant because it very easily travels to prosthetic joint
  2. severe or uncontrolled HTN
  3. Progressive neurological disease (ALS, MS)
  4. Dementia
  5. Latent renal or respiratory insufficiency
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4
Q

Goals of Post-Surgical Rehab Joint Arthroplasty

A
  • Restore function
  • Decrease pain
    (very aggressive pain control)
  • Gain muscle control/strength
  • Return to previous levels of functioning
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5
Q

Bearing Surfaces of Hip Arthroplasty

-adv & disadv

A
  1. Metal-on-polyethylene
    - ADV: cost effective, evidence & predictable lifespan
    - DISADV: debris may lead to aseptic loosening & failure
  2. Metal-on-metal
    - ADV: low friction/wear, lower dislocation
    - DISADV: possible carcinogenic effect of metal ions, metallosis
  3. Ceramic-on-ceramic
    - ADV: low friction/wear, inert material
    - DISADV: expensive, requires expert insertion technique, possible joint noise
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6
Q

Uncemented vs. Cemented Fixation

-adv & disadv

A

Uncemented

  • ADV: lower risk of CV and VTE events, bone conserving, more expensive, better long term outcomes?
  • DISADV: increased risk of peri-prosthetic fracture, lack of good long-term outcome data

Cemented

  • ADV: more stable initially, better short- and mid-term outcomes, less residual pain?
  • DISADV: longer operative time, more difficult to revise, potential for adverse reaction to cement
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7
Q

Mini-Incision Arthroplasty

A

1-2 smaller incisions (2-6inches vs. 8-10inches)

Evidence shows possible short term advantages (less pain and bleeding –> quicker discharge) but no striking evidence that it provides a huge advantage in long term

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8
Q

Hip Resurfacing

A

For younger, more active patients

Reshapes the femoral head & a skinny stem sticks down into the femoral neck (conserves bone) + acetabular component
–>head is larger and more mimics normal joint congruency = better function

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9
Q

Hip Resurfacing vs. Arthroplasty

A

Resurfacing

  • ADV: lower dislocation risk, bone conserving, low wear/friction, quicker recovery & return to high demand activity
  • DISADV: higher early failure rates, metallosis, difficult procedure, little long-term data

Arthroplasty

  • ADV: well studied, easier to perform, suitable for wider range of populations, better long term outcomes
  • DISADV: higher dislocation risk, more difficult to revise, more functionally limiting (removes more bone)
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10
Q

Early Post-Op Rehab for Hip Arthroplasty

A

Acute to subacute

  1. Ice & positioning
  2. Education - movement & WB precautions
  3. Strengthening -
    - AAROM –> AROM –> RAROM
    - isometrics good to wake up muscles but should progress to isotonic ASAP (heel slides, SAQ, LAQ, ankle pumps)
    - closed chain & functional mvmts asap
  4. Mobility (precautions)
  5. Edema management
  6. Equipment recommendations
  7. Discharge planning
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11
Q

Late Post-Op Rehab for Hip Arthroplasty

A

Chronic stage

  1. Emphasize functional activities
  2. Strengthen hip flexors, extensors & abductors & include resistance if possible
  3. Wean away from assistive device
  4. Limit high impact activity or activities w/ rotational forces
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12
Q

Types of Knee Arthroplasty

A
  1. Tibial Osteotomy
  2. Unicompartmental Arthroplasty
  3. Total knee arthroplasty
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13
Q

Tibial Osteotomy

-what is it, indications

A

Surgical realignment of the tibia and the femur
-cut a wedge in the bone at proximal end of tibia & stabilize w/ artificial or graft

WHY?
takes pressure off medial or lateral compartment, delays TKA (est. about 9 years)

Indications - unicompartmental disease, angular deformity, & younger population

Allows for reasonable joint stability & an active lifestyle

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14
Q

Unicompartmental Arthroplasty

-defn, indications

A

Replacement of one compartment

Indications - flexion >90, full extension, < TKA

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15
Q

Total Knee Arthroplasty

-defn & indications

A

Complete replacement of femoral condyles & tibial plateau

Indications - >60 years old, <180lbs w/ severe ROM & functional limitations

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16
Q

Potential Complications of Knee (& hip) Arthroplasty

-risk factors for each

A
  1. Infection –> easily spreads to prosthetic
    - can be at surgical site or deep peri-prosthetic
    - 20% associated w/ MRSA (@ knee)
    - Risk factors: obesity, anemia, malnutrition, & diabetes
  2. Venous thromboembolism (DVT & PE) –> most common of joint replacements
    - everyone should receive prophylaxis or risk increases
    60% DVT & 20% chance of PE w/o &
    5% DVT & 25, a-fib, anemia, depression & history of DVT
    - Use WELLS Score
17
Q

Early Post-op Rehab for Knee Arthroplasty

A
  1. Ice & positioning
  2. ROM - discharge goal of 0deg extension & 90deg flexion (including AAROM)
    * *must document!
  3. Strengthening - isometrics –> isotonic & closed chain/functional activities asap
  4. Mobility - focus on normalizing gait (reinforce achieve functional ROM for walking)
  5. Education
  6. Edema & pain management
  7. Discharge planning & recommendations
18
Q

Late Post-op Rehab for Knee Arthroplasty

A

Chronic stage

  1. Emphasize functional activity & normalization
  2. Increase ROM using modalities & soft tissue mobilization
  3. Strengthening, muscle control & balance
  4. Limit high impact or activities w/ heavy rotational forces
19
Q

What is Pre-hab & Fast Tracking

- 4 areas of focus

A

dynamic process that ensures best outcome w/ faster early functional recovery & reduced morbidity by giving best clinical treatment

  1. Pre-op education:
    reduce anxiety, pain, post-op pain management & reduce length of stay
  2. Nutritional supplementation:
    malnutrition associated w/ infection & delayed wound healing; anemia associated w/ LOS & infection
  3. Pain management:
    spinal anesthesia + NSAIDS w/ acetaminophen
  4. Early mobilization:
    earlier & higher intensity of activity, prescribed according to physiological principles (not 3 sets of 10), & should be targeted, documented & well described
20
Q

Outcomes of Fast Tracking

A 
more rapid return to function
reduced opiod consumption
shorter LOS
reduced risk of blood transfusion
reduced mortality

no changes in rates of readmission, falls or adverse affects

21
Q

Types of Shoulder Arthroplasty

A
  1. Conventional
    - cemented or un-cemented
    - indicated for OA & intact RTC
    - NORMAL anatomical alignment
  2. Reverse
    - indicated if RTC is torn, cuff tear arthropathy is present, or hx of failed replacement
    - REVERSE anatomical alignment - concave humeral head and convex glenoid fossa
    - allows for the the deltoid to lift the arm instead of RTC
22
Q

Plan of Care for Total Shoulder Arthroplasty

A

Phase I (2-4weeks) - PROM/AAROM

  • No AROM or flexion >120, ER >30, or abd >45
  • immobilization

Phase II (4-6 weeks) - AAROM/AROM

  • PROM into full ER, flexion <140, but no OP
  • initiate AROM esp into flexion

Phase III (6-12weeks +) - AROM/Strengthening

  • AROM into flexion & ER
  • strengthen shoulder girdle
  • avoid overhead activity & forceful stretching

Musculoskeletal I (11 decks)

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