Total Knee and Hip Arthroplasty

Question 1

What is the trend in the incidence of total hip arthroplasty in the United States?

Answer 1

The incidence of total hip arthroplasty has been increasing steadily over the years, across various age groups.

Question 2

Which age group represents the largest number of total joint replacements?

Answer 2

The age group 60 to 79 years old represents the largest number of total joint replacements, including both hip and knee replacements.

Question 3

Which type of joint replacement is more common: total hip or total knee arthroplasty?

Answer 3

Total knee replacements are more common than total hip replacements.

Question 4

How does the prevalence of joint replacements vary by region in the United States?

Answer 4

The greatest prevalence of joint replacements is found in Midwestern states like Iowa, Wisconsin, Montana, and North Dakota.

Question 5

What is the age-specific prevalence of joint replacements based on the duration since the initial procedure?

Answer 5

Most people with joint replacements have had them for less than 10 years, with fewer having replacements for 10-20 years or over 20 years.

Question 6

How has the duration people live with joint replacements changed, and what might this indicate?

Answer 6

More people are living with joint replacements for over 20 years, suggesting improvements in technology and procedure quality.

Question 7

What are the projected growth rates for total hip and knee replacements according to the American Academy of Orthopedic Surgeons?

Answer 7

Total hip replacements are projected to grow by 171%, and knee replacements by 189%.

Question 8

What is a potential consequence of the growth in primary hip and knee replacements?

Answer 8

There will likely be an increase in the number of revision cases as the number of long-term joint replacement patients grows.

Question 9

What is the primary purpose of total hip or knee arthroplasty?

Answer 9

To relieve pain in a joint with end-stage degenerative changes or arthritis, which results in loss of function.

Question 10

What is arthritis?

Answer 10

A general term that describes joint pain or disease, encompassing over 100 different types of arthritic conditions.

Question 11

What is osteoarthritis?

Answer 11

A degenerative type of arthritis characterized by the breakdown of cartilage over time, often leading to joint replacements.

Question 12

What is post-traumatic osteoarthritis?

Answer 12

A type of osteoarthritis that can develop after joint trauma or injury, such as a fracture or ligament tear like an ACL injury.

Question 13

Name some types of inflammatory arthritis.

Answer 13

Rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.

Question 14

What is the significance of “bone on bone” contact seen on X-rays?

Answer 14

It indicates a complete loss of articular cartilage, leading to bone surfaces contacting each other directly.

Question 15

Why is it important not to rely solely on X-rays for determining the need for joint replacement?

Answer 15

X-rays may show significant degeneration, but they do not always correlate with the patient’s pain levels or functional abilities.

Question 16

What are some conservative treatments before considering joint replacement?

Answer 16

Physical therapy, low-impact exercise, activity modification, NSAIDs, prescription medications, and joint injections.

Question 17

What are indications for considering joint replacement?

Answer 17

Non-response to conservative care, chronic pain lasting more than 3 months, impaired joint function, and significant functional limitations.

Question 18

What factors should be considered before a total joint replacement?

Answer 18

Psychosocial factors like depression, preoperative function, pain processing changes, arthritis in other joints, and comorbidities like liver disease or malnutrition.

Question 19

How can preoperative function affect recovery after joint replacement?

Answer 19

A significant preoperative deficit may result in a longer recovery period to regain functional levels after surgery.

Question 20

How can central sensitization affect outcomes in joint replacement?

Answer 20

It can impact the way pain is processed, potentially affecting functional outcomes after surgery.

Question 21

What is the main focus of rehabilitation following total hip arthroplasty (THA)?

Answer 21

The main focus is to manage post-operative range-of-motion precautions, address force demands at the hip joint, and ensure proper muscle activation and control during rehabilitation.

Question 22

What are post-operative range-of-motion precautions?

Answer 22

These are specific movements patients must avoid after THA, such as flexion past 90 degrees, crossing legs, adduction past midline, and internal rotation, which can lead to dislocation of the hip joint.

Question 23

How do the post-operative precautions differ based on surgical approach?

Answer 23

Precautions can vary depending on whether a posterior or anterior approach was used. For example, a posterior approach requires avoiding flexion, while an anterior approach may have different restrictions related to extension and external rotation.

Question 24

Why is it important to consider forces at the hip joint during rehabilitation?

Answer 24

The hip joint experiences significant forces during activities such as walking (up to three times body weight), necessitating strength and control training to prepare patients for functional activities post-surgery.

Question 25

What are the four main principles of rehabilitation after THA?

Answer 25

1) Control pain and protect the joint.
2) Reestablish muscle activation.
3) Control forces through strengthening and neuromuscular re-education.
4) Sustain forces for endurance in functional activities.

Question 26

What types of exercises are used to reestablish the ability to generate force post-THA?

Answer 26

Exercises include prone hip extension, clamshells, bridging, and resisted terminal knee extension to activate hip and thigh muscles.

Question 27

How do patients transition from muscle activation to control of forces during rehab?

Answer 27

Patients progress to exercises like sidestepping with resistance bands, mini squats, hip hiking, and single-leg bridging to improve control of forces while moving.

Question 28

What is a compensated Trendelenburg, and why might it occur after THA?

Answer 28

A compensated Trendelenburg is a postural adaptation where the patient leans towards the surgical side due to weakness in the hip abductors, often resulting from prior injuries or conditions like hip fusion.

Question 29

What outcomes did the patient with a history of hip fusion achieve after six months of rehabilitation?

Answer 29

The patient reported no pain, improved range of motion, ability to ride a stationary bike, perform low-impact exercises, and ambulate independently, despite a slight Trendelenburg lean.

Question 30

Why is patient education on post-operative precautions important?

Answer 30

Proper education helps prevent dislocation and ensures patients understand how to protect their hip joint as it heals, facilitating a successful rehabilitation process.

Question 31

What is the main focus of rehabilitation following total knee arthroplasty?

Answer 31

Restoration of function and returning patients to their optimal level of activity.

Question 32

What are the known persistent deficits after knee replacement surgery?

Answer 32

Quadriceps weakness, functional deficits in walking, stair climbing, and moving from sit to stand.

Question 33

Why is postoperative rehabilitation important after a knee replacement?

Answer 33

It is crucial for restoring joint function and overall patient performance, though the optimal approach remains under study.

Question 34

What are the four main principles of rehabilitation following knee replacements?

Answer 34

1. Pain control and edema management
2. Restore range of motion
3. Restore force-generating capacity
4. Control of forces during functional activities

Question 35

What device may patients use at home for pain and edema control post knee replacement?

Answer 35

Devices that provide compression and cryotherapy, such as the Game Ready device.

Question 36

Why is patellar mobility important in postoperative rehabilitation?

Answer 36

It helps to restore knee flexion and extension range of motion.

Question 37

Name two exercises to help restore knee flexion.

Answer 37

1. Seated supported knee flexion
2. Supine heel slide with a towel

Question 38

What should be avoided during knee flexion exercises post-surgery?

Answer 38

Forceful, aggressive flexion that causes significant pain, as it can lead to complications like arthrofibrosis.

Question 39

Describe one exercise to help restore knee extension.

Answer 39

Prone hang or passive extension using a towel to pull the knee into extension.

Question 40

How can patients begin to reestablish muscle force-generating capacity after knee replacement?

Answer 40

Through isometric exercises such as quadriceps squeezes, glute squeezes, and hamstring squeezes.

Question 41

What is an example of an exercise for hip abductors in postoperative rehabilitation?

Answer 41

Side leg raises or resisted clamshell exercises.

Question 42

What functional activities should be included in the rehabilitation program?

Answer 42

Gait training, step-ups, step-downs, and exercises for cardiovascular endurance like walking, biking, and hiking.

Question 43

What outcomes were achieved by the patient after following a principle-based rehabilitation program?

Answer 43

Restored neutral knee alignment, no pain, able to walk without assistive devices, and return to low-impact activities.