Post surgical Rehab Flashcards
Total Hip Replacement
90% last 20 Years
Average stay of 1-2 fdays
Cause is often arthritic degeneration
most common joint replacement
Posterior hip arthroplasty approach
most commonly used
provides exposure to acetabulum/ proximal femur
no nerve crossing
Recovery: 6-12 weeks
Anterior hip replacement approach
Provides exposure to hip joint and ilium anteriorly
higher risk due to femoral nerve
No muscles cut
Recovery: 2-8 weeks, less length and more rapid return to normal activities
Factors impacting rehab after hip arthroplasty
Age/health
Cognition
ability to comply to precautions
ability to comply with bracing prior to surgery
Living situation
ability to use walker/ crutches
Hip hemiarthroplasty
replacement of femoral head
often following hip fracture when blood supply has been disrupted
Generally follows same rehabilitation program as THA
Weight-bearing precautions
Non-weight bearing- no weight on the limb at all
Toe-touch or touch-down weight bearing- only about 2% for balance, no actual weight
Partial weight bearing- 25% or 50%, not seen very often
Weight bearing as tolerated/ full weight bearing
Consequences of non-compliance of weight-bearing precautions
device failure, re-injury, and repeat surgery
Dislocation, hip adductor brace, possible repeat surgery
Dislocations
Posterior Hip surgery precautions
Don’t bend the operated hip past 90 degrees
Do not cross your legs
Do not turn your operate leg inward
No swivel when turning
Anterior Hip surgery precautions
No hip extension or external rotation beyond neutral
if backing up lead with non-surgical leg
no lying on stomach
no abduction without assistance
no extreme hip movements
Education after hip surgery
use of adaptive equipment
Dressing and bathing equipment to help stay within precautions
Adapted functional mobility after hip surgery
transferring techniques
kitchen tasks and moving in small spaces to avoid pivoting on one leg
Reinforce safe standing techniques
Looking a chair and surface heights
Household chores after hip surgery
use long-handled equipment
Use a reacher unless instructed a safe way to bend
no vacuum or sweeper
community function after hip surgery
need to wait to drive until precautions are lifted
avoid vehicles with low seats
total knee arthroplasty
Always both bones
typically done due to pain and degeneration
performed after conservative tx don’t work anymore
purpose is to improve quality of life, decrease pain, maintain knee function
Post surgical risks for total knee arthroplasty
DVT (wear compression socks)
infection
stiffness (need to get up and move day after surgery and do bed exercises)
Early failure
Differences between THA and TKA
Really no precautions
Return to normal ADL’s and driving within 6 weeks
Intervention focuses on adapted techniques if necessary
OT’s often don’t see
LE dressing after TKA
often don’t need AE if client has hip mobility
If stiffness/edema continue they may need AE
Functional transfers after TKA
avoid torquing the knee
pick up LE, no pivoting on the leg
square of all transfers
Important info after TKA
Dress surgical side first
lead with the walker then surgical leg
extend surgical leg out when going to sit or stand
push up from handrails when standing
What joint replacement has the highest failure rate
Shoulder Arthroplasty
Types of shoulder arthroplasty
total replacement
Reverse total replacement
Resurfacing hemiarthroplasty
Reverse shoulder replacement causes
Insufficient RTC musculature
Arthritis
Failed previous surgery
Shoulder fx
even less success of recovery
Reason for resurfacing hemiarthroplasty
Arthritis
better recovery rate
General guidelines after shoulder replacement
sling continuous for 4-8 weeks
do not allow elbow to go posterior of midline for 6-8 months
Avoid AROM
no lifting or pulling
No WB
no driving for 3 weeks
Dressing after shoulder replacement
move clothing to arm not arm to clothing
wear clothing size or two larger than normal
button down or loose v neck shirts are the best
no movement of shoulder while dressing
Mobility/ balance concerns after shoulder replacement
can not use a cane on surgery side
can not use a walker
Progressive motion and strengthening exercises
pendulum exercises
PROM as prescribed by MD
Progress to more active when prescribed by MD
