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NMSK1 - physio 1 > total hip and knee replacement > Flashcards

total hip and knee replacement Flashcards

1
Q

what is an arthrotomy?

A
  • the joint is opened up
  • exploration surgery
  • less common
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2
Q

what is arthroscopy?

A
  • insertion of a fibreoptic scope or camera into the joint
  • used for investigation
  • repair
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3
Q

what is the aim of a arthroplasty?

A
  • create or reshape joint
  • to perform a total or hemi joint replacement
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4
Q

what is the function of an osteotomy?

A
  • to correct bone deformity and realign bone
  • ‘surgical fracture’
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5
Q

what is arthrodesis?

A
  • surgery that fuses 2 bones together
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6
Q

what is a total hip replacement?

A

the replcament of the femoral and acetabular component of the hip

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7
Q

what part of the hip does a hemi-arthroplasty replace?

A

the femoral head

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8
Q

what is the ‘birmingham’ hip replacement?

A
  • 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
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9
Q

what are the indications of THR?

A
  • osteoarthristis
  • rheumatoid arthritis - RA
  • juvenile RA
  • fracture or dislocation
  • avasculalr necrosis
  • bone tumour
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10
Q

what are the main desired outcomes of a THR?

A
  • pain relief
  • return to function
  • improved quality of life
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11
Q

what are the 3 main methods of surgical approach for THR?

A
  • incision posterior to greater trochanter
  • longitudinal incision over greater trochanter
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12
Q

which surgical approach are there higher risks of dislocation vs lower rates?

A
  • the posterior approach - increased rates
  • lateral approach - reduced rates
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13
Q

what are the critical post op THR precautions for 6-12 weeks?

A
  • 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
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14
Q

what are the post op instructions on day 0 (day of THR) for a physio?

A
  • precautions - things to be careful about
  • education
  • mobilise
  • gentle bed mobility
  • NB be aware of patients pain
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15
Q

what must a physio do on day 1 of THR post op (ie day after op)

A
  • check pain NB
  • mobilise
  • review night status
  • transfer education
  • gait with aid
  • review exercises
  • discuss discharge plan
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16
Q

what must a physio do on days 2-3 post THR op?

A
  • progress independent rehabilitation
  • all stading exercises
  • stairs trial - see how patient walks up steps
  • plan for discharge
17
Q

what are mobility tips for bed transfers?

A
  • 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
18
Q

what are good mobility tips for stairs mobility?

A
  • good leg up
  • bad leg down
  • step around
  • use handrail
19
Q

what are examples of exercises do you think are recommened post THR?

A
  • glute bridge in bed
  • sit to stand
  • isometric quad exercises
  • knee extension and flexion on chair
  • squat against the wall
20
Q

what is hip resurfacing?

A
  • a surgical alternative to THR
  • younger patients
  • getting rid of small damaged cartilage etc
  • shorter recovery but similar rehab to THR
21
Q

what does the total knee replacment surgical procedure involve?

A
  • medial parapatellar incision
  • knee exposed
  • incise extensor mechanism
  • ligaments reattached to prosthesis
  • wound drain and closure
  • antibiotics and analgesia
  • fluids
22
Q

what are the indications for TKR?

TKR - femoral and tibial components

A
  • osteoarthritis
  • rheumatoid arthitis
  • post trauma eg RTA
  • unstable knee
  • AVN - death of bone tissue that occurs due to loss of bone blood supply
23
Q

what must a physio do on day 0 of TKR?

A
  • education
  • swelling advice
  • mobilise
  • gait re-education with aid
  • gentle bed mobility
  • be aware of patient pain
24
Q

what does swelling education involve?

A
  • normal part if recover but management is important
  • POLICE - protect, optimal loading, ice, compress and elevate
25
Q

what must a physio do on day 1 post op TKR?

A
  • check pain NB
  • review night status
  • mobilise
  • transfer education
  • gair re-education with aid
  • review exercises
  • discuss discharge plan
26
Q

what must a physio do on day 2-3 of TKR post op?

A
  • progress independent rehab
  • push straight leg raise and ROM
  • all standing exercises
  • stairs trail
  • plan for discharge
27
Q

what is the post op criteria for TKR?

A
  • 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
28
Q

what are examples of post op exercises for TKR?

A
  • stairs
  • walking
  • sit to stand and stand to sit
  • knee extension

NMSK1 - physio 1 (36 decks)

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