Week 9 - Arthroplasty Flashcards
What is arthroplasty?
Joint replacement where diseased parts of the joint are removed and replaced with a new artificial parts (prosthesis)
What are the goals/purpose of arthroplasty?
Decrease pain
Increase function
Improve ROM
Decrease deformity
When is arthroplasty indicated?
When it will improve quality of life.
What conditions can cause the need for arthroplasty?
OA RA Trauma Damage to articular cartilage Congenital deformity Avascular necrosis Bone tumours Osteoporosis Arthritis
What are the goals of a total hip arthroplasty?
To improve mobility, increase ROM, reduce pain and improve hip joint function
What does surgical management involve for THA?
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
What are the 2 main types of hip prosthesis?
Thompsons
Austin Moore
What materials are used for hip prosthesis?
Metal and ceramic
What are the 2 most common approaches for THR?
Posterolateral
Anterolateral
What is the average hospital stay for THR?
3-11 days
When do THR undertake physiotherapy?
Day one
When do THR undertake OT?
Day 4-5
What is the hip precaution period?
3 months
What is to be avoided during the hip precaution period?
Hip flexion beyond 90 degrees Internal rotation Adduction Pressure - heavy lifting etc Pressure on the wound
What are potential complications of THR?
Hip dislocation Inflammatory reaction Infection Peri-prosthetic fracture Prosthesis failure Blood clots (DVT) Leg length discrepancies
What is the most common indication for TKR?
Symptomatic degenerative arthritis (OA) of the knee joint, RA and TA
What is the aim of TKR?
Improve mobility
Increase ROM
Reduce pain
Maintain alignment and stability of the knee joint
What are the 3 considerations of TKR surgery?
Approach
Type of prosthesis
Cemented/uncemented
How long does a TKR take?
2-3 hours
What are the 3 types of TKR prosthesis?
Unicompartmental
Bicompartmental
Tricompartmental
How long is the hospital stay for TKR>
5-7 days
When do TKR see PT?
Day 1
When do TKR see OT?
Day 4/5
What is the length of knee precautions?
3 months
What should be avoided in TKR precaution periods?
Kneeling Excessive flexion Heavy lifting Sudden jolts Pivoting/Twisting operated leg Jumping even from low surfaces Gaining weight Slips or falls
What complications can arise from TKR?
Prosthetic failure Peri-prosthetic fracture Knee dislocation Inflammatory reaction Infection Blood clots (DVT)
What are the other types of arthroplasty apart from TKR and THR?
Shoulder replacement
Elbow replacement
MCP joint
PIP joint
What is the most important prognosticating factor for improved outcomes?
Pre-morbid function and mobility
What should pre-operative programs include?
Preparation for surgery - strengthening ADL training, home assessment, education
Recovery from Surgery - Precautionary periods
Exercises and post-op procedures, use of mobility aids
What psychological factors need to be considered pre-operatively?
Ageing process Life threatening nature of surgery Loss of role/occupation Anxiety Chronic pain Reduced self esteem
What does ACI stand for?
Autologous Chondrocyte Implantation
What is ACI?
Autologous chondrocyte implantation is a biomedical treatment that repairs damages in articular cartilage.
What is mosaicplasty?
Cylindrical plugs of healthy bone and cartilage are inserted into holes in the damaged part of the knee
When is mosaicplasty indicated?
For people with chondral and osteochondral lesions
