TOTAL JOINT ATHROPLASTY

Question 1

types of anaesthesia

Answer 1

• regional anaesthesia
• femoral block
• adductor canal block

Question 2

arthritis - symptoms

Answer 2

• Pain begins with weight-bearing on the knee
• Loss of ROM
• Joint swelling
• Grinding sound during movements
• Giving way and locking
• Night pain

Question 3

Ostenecrosis

Answer 3

Bone in the head of the femur dies when the blood supply to the femoral had is disrupted.

Question 4

Post OP management THR

Answer 4

• Mobilise WBAT (unless stated otherwise) with crutches (or
  frame if necessary)
• Teach and practice supine and standing ex’s
• Education on hip precautions ++
• Review on stairs/step
• General post-op recovery education and advice
• Referral by facility protocol

Considerations

• Glut tendon repair
• Lateral – avoid active abduction exercises ??
• Pain coverage

Question 5

Pre-op management

Answer 5

Very good evidence

• Allows the PT to gain important information about the patient (physical and mental)
• Allows the patient to meet the PT and allows for development of rapport
• Opportunity to ensure the patient has an appropriate post-op plan for D/C (including transport!!)
• Enables OT to do pre-op home visit if required and provide equipment
• Allows PT to explain management of post-op pain and general recovery principles
• Allows the patient and carer to ask questions
• Teach patient crutches (if appropriate) and gives time for practice
• Allows PT to flag to ward any potential issues (poor cognition, mental health, bariatric etc)
• Helps to reassure the patient

Question 6

Rehab exercises - TKR

Answer 6

Supine exercises

• Knee flexion/extension with slideboard
• Knee ext on bolster
• Eccentric strengthening ++ if no SLR or Quads lag
• Inner Range Quadriceps

Seated and standing exercises

• Active/active-assisted knee flexion/ext on chair
• Knee stretches (sliding body fwd/backwards on chair)
• Knee flexion in standing (hamstring curls)
• Knee flexion on step
• CPM if struggling with ROM or anxious to move but not
  routine!!

Question 7

rehab exercises - THR

Answer 7

Standing exercises

• Hip flexion
• Abduction (not for Lateral or Anterolateral approach)
• Extension
• Knee flexion
• No evidence for the prescription of supine exercises for
  THR
• Education++ on hip precautions

Question 8

Discharge criteria

Answer 8

Discharge Criteria

• Independent transfers in/out bed (with assistance of leg lifter if needed)
• Independent transfer STS
• Independent ambulation with aid (crutches or frame) ~20-30m
• Nil issues with wound
• Pain well controlled with analgesia
• Knee ROM ~10-80° for TKR
• Good quads controlAim for D/C
  • Day 2-3 for THR
  • Day 3 for TKR