Week 9 - Arthroplasty

Question 1

What is arthroplasty?

Answer 1

Joint replacement where diseased parts of the joint are removed and replaced with a new artificial parts (prosthesis)

Question 2

What are the goals/purpose of arthroplasty?

Answer 2

Decrease pain
Increase function
Improve ROM
Decrease deformity

Question 3

When is arthroplasty indicated?

Answer 3

When it will improve quality of life.

Question 4

What conditions can cause the need for arthroplasty?

Answer 4

OA
RA
Trauma
Damage to articular cartilage
Congenital deformity
Avascular necrosis
Bone tumours
Osteoporosis
Arthritis

Question 5

What are the goals of a total hip arthroplasty?

Answer 5

To improve mobility, increase ROM, reduce pain and improve hip joint function

Question 6

What does surgical management involve for THA?

Answer 6

Removal of diseased bone and cartilage
Head of femur and acetabulum are replaced with artificial parts.
It can be cemented or uncemented and takes 2-3 hours

Question 7

What are the 2 main types of hip prosthesis?

Answer 7

Thompsons

Austin Moore

Question 8

What materials are used for hip prosthesis?

Answer 8

Metal and ceramic

Question 9

What are the 2 most common approaches for THR?

Answer 9

Posterolateral

Anterolateral

Question 10

What is the average hospital stay for THR?

Answer 10

3-11 days

Question 11

When do THR undertake physiotherapy?

Answer 11

Day one

Question 12

When do THR undertake OT?

Answer 12

Day 4-5

Question 13

What is the hip precaution period?

Answer 13

3 months

Question 14

What is to be avoided during the hip precaution period?

Answer 14

Hip flexion beyond 90 degrees
Internal rotation
Adduction
Pressure - heavy lifting etc
Pressure on the wound

Question 15

What are potential complications of THR?

Answer 15

Hip dislocation
Inflammatory reaction
Infection
Peri-prosthetic fracture
Prosthesis failure
Blood clots (DVT)
Leg length discrepancies

Question 16

What is the most common indication for TKR?

Answer 16

Symptomatic degenerative arthritis (OA) of the knee joint, RA and TA

Question 17

What is the aim of TKR?

Answer 17

Improve mobility
Increase ROM
Reduce pain
Maintain alignment and stability of the knee joint

Question 18

What are the 3 considerations of TKR surgery?

Answer 18

Approach
Type of prosthesis
Cemented/uncemented

Question 19

How long does a TKR take?

Answer 19

2-3 hours

Question 20

What are the 3 types of TKR prosthesis?

Answer 20

Unicompartmental
Bicompartmental
Tricompartmental

Question 21

How long is the hospital stay for TKR>

Answer 21

5-7 days

Question 22

When do TKR see PT?

Answer 22

Day 1

Question 23

When do TKR see OT?

Answer 23

Day 4/5

Question 24

What is the length of knee precautions?

Answer 24

3 months

Question 25

What should be avoided in TKR precaution periods?

Answer 25

``` Kneeling Excessive flexion Heavy lifting Sudden jolts Pivoting/Twisting operated leg Jumping even from low surfaces Gaining weight Slips or falls ```

Question 26

What complications can arise from TKR?

Answer 26

``` Prosthetic failure Peri-prosthetic fracture Knee dislocation Inflammatory reaction Infection Blood clots (DVT) ```

Question 27

What are the other types of arthroplasty apart from TKR and THR?

Answer 27

Shoulder replacement Elbow replacement MCP joint PIP joint

Question 28

What is the most important prognosticating factor for improved outcomes?

Answer 28

Pre-morbid function and mobility

Question 29

What should pre-operative programs include?

Answer 29

Preparation for surgery - strengthening ADL training, home assessment, education Recovery from Surgery - Precautionary periods Exercises and post-op procedures, use of mobility aids

Question 30

What psychological factors need to be considered pre-operatively?

Answer 30

``` Ageing process Life threatening nature of surgery Loss of role/occupation Anxiety Chronic pain Reduced self esteem ```

Question 31

What does ACI stand for?

Answer 31

Autologous Chondrocyte Implantation

Question 32

What is ACI?

Answer 32

Autologous chondrocyte implantation is a biomedical treatment that repairs damages in articular cartilage.

Question 33

What is mosaicplasty?

Answer 33

Cylindrical plugs of healthy bone and cartilage are inserted into holes in the damaged part of the knee

Question 34

When is mosaicplasty indicated?

Answer 34

For people with chondral and osteochondral lesions