Lec 7 Flashcards
Types of arthroplasty
Resection arthroplasty
Interposition arthroplasty
Replacement arthroplasty
True or false
The hip was the 1st joint to be successfully replaced.
True
Classification according to the part replacement
- Total arthroplasty (full joint replacement):
replaces both sides of the joint e.g. acetabulum & head of the femur. - Hemiarthroplasty (partial joint replacement): restore the aspect of the joint that is damaged
N.B. all partial replacements may be upgraded to a full replacement at a future date if necessary.
Classification according to stability
- Constrained: there is a link between the two components and all anatomical movements are restricted to a greater or lesser extent.
( high stability, restrictive movement) - Semi-constrained: some movement is allowed in all planes.
(Allow stability and movement) - Unconstrained: permits free movement in all anatomical planes. The joint is prone to dislocation until 6 weeks post-operation
( low stability, free movement)
Material of the prosthetic parts
Prosthetic parts are made out of inert metals of low friction coefficient
(6 times > natural joint) e.g.
1. Stainless steel
2. Chrome-cobalt-molybdenum alloys
3. High density polyethylene
Indication for Prosthetic
- Pain
- Loss of function
e.g. OA, RA, post-traumatic joint stiffness, avascular necrosis
N.B. the recommended age is 60+
Fixation by Acrylic cement
can sustain compressive stress
well but cannot control shear or torsional stress.e.g. Thompson hemiarthroplasty.
(Early partial weight bearing )
Fixation by Bioingrowth
relies on natural growth of bone
around or through the prosthetic implant and no cement is used.e.g. Austin More hemiarthroplasty.
Non-cement technique need a period of non or partial weight bearing to allow stabilization of the component.
Cementless technique is preferred in younger patients under 65 years
Incision sites for prosthetic
- Anterolateral: between tensor fascia lata and glutei
- Posterolateral: through the posterior capsule
- True lateral: greater trochanter is excised and re-atttached with wire fixation
Common complications
- Dislocation
- Venous thrombi
- Fracture
- Postoperative thigh pain
- Failure
- infection
Dislocation
Anterolateral & true lateral:
hip will dislocate if placed in excessive extension, external rotation, and adduction or a combination of all three
- Posterolateral: hip will dislocate in excessive flexion, internal rotation & adduction or a combination of all
three. - 6-12 weeks these positions should be avoided.
- Anteriorly Dislocated hip is shorter, externally rotatedand in extension
Posteriorly dislocated hip is shorter, flexed and internally rotated
Treatment of the dislocation
relocation of the hip under general
anaesthesia & traction for 6 weeks
Rehabilitation
Both cemented & uncemented replacements follow a similar regime except for time of weight bearing.
- Uncemented prosthesis will remain partially or non-weight bearing for 6-12 weeks.
- Cemented prosthesis begins weight bearing 1st day postoperatively.
Abduction pillow or wedge should be used while patient is lying supine or on the non-operated side
True or false
SLR is courage until full quadriceps and iliopsoas control has returned
False
SLR is discouraged until full quadriceps and iliopsoas control has returned
Treatment goals
Restoration of :
1. Joint motion
2. Muscle strength
- Maintainance of:
1. Vascular function
2. Respiratory function - Education about:
1. Joint preservation techniques
2. Bed mobility
3. Weight bearing
Weight bearing
Patient with lateral or posterolateral incisions can start weight bearing from day 1
Patients with anterolateral incision is delayed 2 days postoperatively.
Start of sitting is delayed for patients with posterolateral incision to prevent dislocation
In cemented joints weight bearing is increased until minimal assistance is required from a walking aid.
Uncemented prosthesis will remain on cruthes or a frame for 6-12 weeks.
Patient should avoid until 6 weeks postoperatively
- Excessive extension, external rotation & adduction
with anterolateral & true lateral incision. - Excessive flexion, internal rotation & adduction with posterolateral incision
- Sitting in low chairs (less than 53 cm in height)
- Bending forward to put on shoes , socks, cut toenails, etc
- Crossing the legs in sitting or lying
- Twisting the legs in sitting or lying
- Driving
- Jumping or running
- Contact sports
Preoperative training session
Safe transfer technique
Proper use of assistive devices
Postoperative exercises e.g.
1. Ankle pumps
2. Quadriceps sets
3. Gluteal sets
4. Active hip and knee flexion
(heel slides)
5. Isometric hip abduction
6. Active hip abduction
Goals of day of the surgery
A- protect healing tissues,
B- prevent postoperative complications,
C- improve volitional control of involved lower extremity
- Respiratory exercises
- Ankle pumps
- Quadriceps sets
- Gluteal sets
- Repositioning of the patient every 2 hours with the abductor pillow in place
Postoperative day one
- Same previous exercises
- Upper extremity exercises
- Transfer training from supine
to sitting, and from sitting to
standing, while observing precautions and emphasize the use of upper extremity in shifting weight, avoid pivoting on the affected leg - If not complaining of excessive
pain, fatigue, or dizziness, gait
training may begin.
Postoperative day 2
- Hip ROM exercise
- Heel slides
- Isometric or active assisted hip abduction
- Active assisted short arc quadriceps sets
- Gait training (front wheeled walker for older patients & 3-point crutch pattern for younger patients) start with 50% of body weight or less
Day 3 to 7 until discharge
Goal: improve UL & LL strength
- Heel slides
- Hip abduction
- Terminal knee extension
- Resisted shoulder exercises
- Stair training (upstairs with unaffected & downstairs with
affected)
Discharge criteria
- Patient is able to demonstrate & state precautions
- Independent with transfers
- Independent with the exercise program
- Independent with gait on level surfaces to 100 feet
- Independent on stairs
1-6 weeks after discharge
Goals:
A- improve strength of LL
B- improve balance
C- promote return to activities
1. CKC exercises
2. Pool therapy
3. Treadmill
4. single point cane. (starts 3-4 weeks after surgery & discontinued after 3-4 more weeks)).
5. Step over step stair climbing
6. Driving is allowed 3-4 weeks after surgery
Sports recommended after joint replacement
Low-impact non-contact sports
- Sailing
- Swimming
- Cycling
- Golfing
- bowling
Prohibited sport ممنوعه
High-impact or contact sports
- Running
- Water-skiing
- Football
- Basketball
- Hockey
- Martial arts
Myofascial release
Involves traditional effleurage, pétrissage, and friction massage strokes with stretching of the muscles and fascia to obtain relaxation of tense and/or adhered tissues
Stretch + breaks adhesion tissue
The technique of myofascial
Basic technique involves pulling the tissues in opposite directions,
stabilizing the proximal or superior position with one hand while applying a stretch with the opposite hand,
Or using the patient body weight to stabilize the extremity or the body part while a longitudinal stress is applied
