total hip and knee replacement Flashcards
what is an arthrotomy?
- the joint is opened up
- exploration surgery
- less common
what is arthroscopy?
- insertion of a fibreoptic scope or camera into the joint
- used for investigation
- repair
what is the aim of a arthroplasty?
- create or reshape joint
- to perform a total or hemi joint replacement
what is the function of an osteotomy?
- to correct bone deformity and realign bone
- ‘surgical fracture’
what is arthrodesis?
- surgery that fuses 2 bones together
what is a total hip replacement?
the replcament of the femoral and acetabular component of the hip
what part of the hip does a hemi-arthroplasty replace?
the femoral head
what is the ‘birmingham’ hip replacement?
- a hip replacement that is performed using a metal on metal hip implant
- resurfacing the head of the femur with a metal ball and fitting a metal cup into the pelvic socket
what are the indications of THR?
- osteoarthristis
- rheumatoid arthritis - RA
- juvenile RA
- fracture or dislocation
- avasculalr necrosis
- bone tumour
what are the main desired outcomes of a THR?
- pain relief
- return to function
- improved quality of life
what are the 3 main methods of surgical approach for THR?
- incision posterior to greater trochanter
- longitudinal incision over greater trochanter
which surgical approach are there higher risks of dislocation vs lower rates?
- the posterior approach - increased rates
- lateral approach - reduced rates
what are the critical post op THR precautions for 6-12 weeks?
- avoid any hip flexion greater than 90 degrees
- avoid adduction
- avoid active straight leg raise
- no twisting or rotation of the hip
- avoid lying on the operated hip
what are the post op instructions on day 0 (day of THR) for a physio?
- precautions - things to be careful about
- education
- mobilise
- gentle bed mobility
- NB be aware of patients pain
what must a physio do on day 1 of THR post op (ie day after op)
- check pain NB
- mobilise
- review night status
- transfer education
- gait with aid
- review exercises
- discuss discharge plan
what must a physio do on days 2-3 post THR op?
- progress independent rehabilitation
- all stading exercises
- stairs trial - see how patient walks up steps
- plan for discharge
what are mobility tips for bed transfers?
- ideally lead transfer on non operated leg
- do not let legs cross over - risk of dislocation with adduction
- NB - check bed height
- patient must be wearing supportive shoes
what are good mobility tips for stairs mobility?
- good leg up
- bad leg down
- step around
- use handrail
what are examples of exercises do you think are recommened post THR?
- glute bridge in bed
- sit to stand
- isometric quad exercises
- knee extension and flexion on chair
- squat against the wall
what is hip resurfacing?
- a surgical alternative to THR
- younger patients
- getting rid of small damaged cartilage etc
- shorter recovery but similar rehab to THR
what does the total knee replacment surgical procedure involve?
- medial parapatellar incision
- knee exposed
- incise extensor mechanism
- ligaments reattached to prosthesis
- wound drain and closure
- antibiotics and analgesia
- fluids
what are the indications for TKR?
TKR - femoral and tibial components
- osteoarthritis
- rheumatoid arthitis
- post trauma eg RTA
- unstable knee
- AVN - death of bone tissue that occurs due to loss of bone blood supply
what must a physio do on day 0 of TKR?
- education
- swelling advice
- mobilise
- gait re-education with aid
- gentle bed mobility
- be aware of patient pain
what does swelling education involve?
- normal part if recover but management is important
- POLICE - protect, optimal loading, ice, compress and elevate
what must a physio do on day 1 post op TKR?
- check pain NB
- review night status
- mobilise
- transfer education
- gair re-education with aid
- review exercises
- discuss discharge plan
what must a physio do on day 2-3 of TKR post op?
- progress independent rehab
- push straight leg raise and ROM
- all standing exercises
- stairs trail
- plan for discharge
what is the post op criteria for TKR?
- active 90 degree knee flexion by 6 weeks
- active straight leg raise - patient doing it on their own without assistance
- full weight bearing by 6 weeks
- wound healing
- swelling controlled
what are examples of post op exercises for TKR?
- stairs
- walking
- sit to stand and stand to sit
- knee extension
