Surgical Interventions for Arthritis Flashcards
Arthrodesis
Surgery that fuses the joint and prevents motion.
Most common sites are ankle, knee, and hip.
Hemiarthroplasty
One-sided replacement of a joint.
Meniscectomy
Removal of any damaged areas of meniscus and any fragments of meniscus floating within the joint.
Osteotomy
Procedure in which a cut is made in the bone. Performed to realign bones when there is a deformity.
Resection Arthroplasty
Removal of a joint. Can be performed for several joints in the body (ex. sternoclavicular or hip).
Total Joint Arthroplasty
Both articulating surfaces of the joint are replaced (ex. hip, knee, or shoulder).
Life of a prosthesis is 10-20 y.
Total Hip Arthroplasty (THA or THR)
Uncemented prostheses work well with younger, more mobile patients because non-weight-bearing (NWB) is required for 6-8/52 after surgery.
Muscles cut in posterolateral approach: glute M, TFL, piri, gemellus sup and inf, obt int, and quadratus femoris. Therefore, dislocation risk higher in flex+add+IR.
Total Hip Arthroplasty (PT intervention for post-lat approach)
- Do NOT flex hip >90º.
- Do NOT cross affected leg > midline.
- Do NOT cross your legs.
- Do NOT lie on unaffected side (produces flex+add+IR of hip).
- Do NOT sit in a low chair or a soft one.
- Do NOT bend over to pick something up off the floor.
- Use an abd wedge between legs at night for the 1st few weeks.
- Sit in a firm, fairly high chair (hip < 90º).
- Get in and out of bed using abd wedge or keeping legs together and straight.
- Use a raised toilet seat over existing toilet.
- When standing from a chair, lean more toward unaffected leg.
- Transfer from one surface to another leading with unaffected leg.
- Get up out of bed at least twice a day on Day 1 or 2 after surgery.
- Ambulate with a walker or crutches for 1st few weeks even if allowed FWB. Progress to a cane in opposite hand for approx 6/12.
- If noncemented prosthesis, use a walker with toe-touch weight-bearing only for up to 8/52, then a cane for 6/12.
- Perform your ex’s at least twice/day.
- Go upstairs with unaffected leg leading (Good up to heaven) and go down with involved leg leading (Bad down to hell).
Total Knee Arthroplasty (TKA or TKR)
THA has a limited “life expectancy”.
Recovery is a painful process, and the PT need to provide encouragement and advice to pt.
90º of flex must be achieved to return to normal, fx life.
Total Knee Arthroplasty (PT intervention)
Starts Day 2 after surgery and knee flexion must be initiated immediately.
Emphasize to pt the need to mobilise to 90º within the 1st 2/52 to prevent adhesions and return of fx flex.
Include: > Active and passive knee ext ex's. > Active and passive knee flex ex's. > Progressive strengthening ex's. > Wound care. > Progressive ambulation training. > Fx activities.
If prosthesis is noncemented, pt will be NWB for 6-12/52 and the ex’s must be also NWB.
With cemented, pt can usually weight bear as tolerated (WBAT) immediately after surgery.
Total Shoulder Arthroplasty (TSA or TSR)
Indications are similar to those for THA and TKA.
Reversed shoulder arthroplasty: good ROM even if rot cuff are damaged.
Most patients do NOT usually return to FROM, so main reason for surgery may be to relieve pain.
Total Shoulder Arthroplasty (PT intervention)
Pt must keep sh immobilised in a sling for 1st 2/52 in between sessions of passive stretching, and also at night for approx 1/12.
Lifting restrictions apply for 6/52.
Gradual, progressive, active ex’s 2/52 after surgery.
Full rehab may take several months to restore fx motion and strength.
Gentle passive and isometric ex’s performed several times/day from Day 1.
In 2nd week, Codman’s pendulum ex’s can start, with a gradual progression to resisted ex’s after 6/52.
