Surgical Management of OA Flashcards
What are the indications for a total knee replacement or total hip replacement?
- patient has been offered ALL non-surgical (core) treatments
- Joint symptoms that have substantial impact on QoL and have not responded to core treatments - e.g. pain, stiffness and reduced function
What are the surgical options for OA hip?
Resurfacing procedure Hip arthroplasty (THR)
What occurs during resurfacing procedures?
femoral head is covered in a polyethylene cup - involves a smaller incision but less efective than the THR
more suitable for younger patients - shorted recovery time
What occurs during the THR?
Acetabulum is replaced with cemented in polyethylene cup
Femoral head is replaced with metal ball attached to a stem which is cemented into the medullary cavity of femur
What are the risks of the THR?
Infections Loosening of the prosthesis DVT PE Chest infections Dislocation
What are the surgical approaches of a THR?
10-20cm incision:
- Antero-lateral (between TFL and glutes)
- Posterior (through posterior JC)
- Posterolateral (between glutes and vastus lateralis)
- Lateral (by the detachment of the greater trochanter - which is then wired back in)
Why is there a risk of dislocation following THR?
Division of the joint capsule and surrounding musculature - must heal and repair (which takes 6-12 weeks) - until this point there is a risk of dislocation
What positions increase the risk of dislocation?
adduction, flexion and rotation
How soon following THR can a patient WB?
As soon as possible - On the day or day 1 post op - with zimmer or elbow crutches (depending on pre-op mobility)
When will a patient be discharged after a THR?
Once able to independently mobilise including stairs (usually day 3 or 4)
How should physiotherapy be progressed?
Start with mobilisation - no agressive ROM as risk of dislocation
Main aim is to strengthen hip abd and ext & obtain good mobility
Gait re-education with walking aids
Advice and education
when can full ROM be obtained?
after 6 weeks
What advice and education should be given?
care of the THR wound care swelling management appropriate levels of activities GEP stairs
What are the surgical options for OA knee?
Arthroscopic wash out
tibial osteotomy
arthroplasty - uni- or bi- compartmental
Arthrodesis
What is an arthroscopic wash out?
key hole surgery to debride the joint - i.e. remove the flakes of cartilige and other debris
What is a tibial osteotmy?
removal of a chunk of tibial bone - to try and realign the joint surfaces and improve weight distribution
What is arthrodesis?
fusion of the joint into extension
What are the different types of knee replacement?
uni-condylar or bi-condylar - with a patella button (resurfacing of the posterior surface)
What are the three linkage methods of a knee replacement?
unconstrained - no linkage - least stable
semi-constrained - partial linkage
constrained - linkage of the components - hinged - less ROM but most stable
What is the surgical approach of a knee replacement?
medial parapatellar inscision
ACL is removed (sometimes PCL)
tibial component is cemented
why is a medial parapatellar approach used?
the least disruption to the extensor mechanism - quads and patellar tendon
What are the complications of the TKR?
No risk of dislocation
Risk of prosthetic loosening over time due to rotatory forces
what is the post-operative care of the TKR?
Compression in the first 48 hrs for swelling
Mobilisation on day of surgery or day 1 - once sufficient quads control
Gait re-education, ROM and quads strengthening
What quads exercises are appropriate?
Static quads, inner range quads, straight leg raises
When will a patient be discharged after a TKR?
by day 3 - when able to mobilise independantly with E/C or sticks
What ROM should be acheived following TKR?
0-100 degrees
What is a CPM?
continuous passive movement machine - used to progressively increase knee flexion
Should only be used in conjunction with active strengthening
What advice and education should be given following TKR?
Wound Care
Swelling management
HEP
Progressive increase in activity (i.e. walking distance)
Stair climbing
Checking for complications - e.g. DVT or chest infections
