THA/TKA Flashcards
common post op issues
altered level of consciousness generalized weakness hypotension depressed respirations decreased Hgb bleeding at surgical site DVT/PE nausea, vomiting, dizziness urinary retention/constipation
hip surgical procedures
ORIF hardware
hemiarthroplasty - usually femoral head, bipolar prosthesis
both - THA and THR
ORIF
open reduction, internal fixation
commonly used after fall fx
typically NWB, sometimes 50% WB
location of break determines approach used
common indications for hip replacement
OA (most common) RA avascular necrosis of femoral head injury to hip bone tumor in hip little to no response to conservative treatment
cemented THA
provides immediately stability
often WBAT/FWB for amb.
generally used for older/less active ptr or w/ poor bone regeneration
cemented THA disad
loosens over time and w/ activity
loosens over time and w/ activity
non cemented THA
prosthesis have aprons metal coat on contact surfaces w/ a chem (hydroxyapatite) to promote bony ingrowth -often NWB/TTWB generally a younger, active population pts w/ good bone regeneration less chance of loosening from wear
hybrid THA
non cemented acetabular component w/ cemented femoral prosthesis
WB status per MD
the most sig risk of THA pts in acute
dislocation
rates increase if it is a revision surgery
posterolateral/posterior
most common appraoch
- no hip flexion past 90
- no IR beyond neutral
- no hip add past neutral
lateral
same as posterolateral
anterior
- avoid hip extension past neutral
- no excessive ER
if trochanteric osteotomy performed, no active hip abduction or passive adduction along w/ WB restriction
total hip precautions
- high remains at high risk for dislocation until joint structures heal and supporting muscles are strengthened
- signs of dislocatoin
- precautions remain til cleared by MD
eval of pt w/ THA pt 1
- thorough chart review - md orders, tests, hx, op report, lab values meds
- check w/ nursing- pt status, meds, clear for Rx
- prep for rx - w/c, AD, hospital socks, gown, oxygen
- subjective questioning- assess cognition, PLF, home set up, pt goals
- education re: precautions and there ex
- ROM w/in precautions
- Strength - BUE, uninvolved LE
eval of pt w/ THA pt 2
- mobility to EOB
- sitting at EOB
- transfers
- gait when appropriate w/ AD
acute
- abduction wedge
- drainage tube
- foley catheter
- TED hose/sequential compression pumps
- bedside/3-in-1 commode
- knoww immobilizer
- initially, use assist as needed
- abduction brace
- care transfers for discharge
THA-PT interventions acute
ed re: precautions and WB status
- increase functional mobility while maintaining precautions
- rom ad strengthening exercises
- pt and fam ed re: assist w/ mobility
- equipment recommendations
- rollow up recommendations
partial knee arthoplasty
replace femoral and tibial articulating surfaces either of medial or lateral compartment
- conservative RX if necrosis is confied
- spares cruciate ligs and patello femoral jt
- normal kinematics of knee preserved
- eventually TKA secondary to continued degernation
- WB per MD
total knee arthroplasty
- femoral condyles, tibial articulating surfaces, dorsal surface of patella
- cemented
- noncemented
- any additional procedures may impact PT w/ ROM limits
- WB per MD
desired outcomes of TKA
- decrease pain
- decrease inflammation
- decrease deformity
- increase joint stability
- increase ROM and mobility
- restore functions
the most common post op complication TKA
inadequate ROM
TKA- PROM
manually assist pt
CPM
continous passive motion machine
- fit to pt leg length
- initial setting usually 0-40 degrees
- generally increase 10/day
- watch for proper positioning
- approximately six-eight hours/day
AAROM
maintain limitation in muscle guarding due to pain/swelling
pt can assist self w/ uninvolved LE
use of contract-relax
