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PTRS 746 Musculoskeletal > Joint Arthroplasty > Flashcards

Joint Arthroplasty Flashcards

1
Q

Joint Replacement Rehab Goals (4)

A
  • Restore joint function
  • Increase strength/muscle control
  • Decrease pain
  • Return patient to previous level of function!!!!
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2
Q

Primary Indications for Joint Replacement (6)

A

- Disabling pain

- Decreased function

  • Marked impairment in ROM
  • Instability/deformity
  • Recurrent dislocations
  • Failure of previous interventions
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3
Q

Absolute Contraindications of Joint Arthroplasty (5)

A
  • Infection
  • Severe/uncontrolled hypertension
  • Progressive neurological disease
  • Dementia (not always a contraindication)
  • Renal or respiratory insufficiency
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4
Q

Relative Contraindications of Joint Arthroplasty (3)

A
  • Obesity
  • Diabetes
  • Age 90
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5
Q

Complications of Joint Replacement (12)

A
  • DVT/PE
  • Infection
  • Arthrofibrosis
  • Complex regional pain syndrome
  • Arthroplasty loosening/failure
  • Allergic reaction
  • Pneumonia
  • Hematoma
  • Surgical fracture
  • Prosthesis ma-lalignment
  • Heterotropic Ossification (HA)
  • Dislocation
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6
Q

Bearing Surface Types (3)

A
  • Metal on polyethylene (most common)
  • Metal on metal
  • Ceramic on ceramic
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7
Q

Fixation Types (2)

A
  • Cemented
  • Uncemented
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8
Q

Cemented Advantages (3)

A
  • More stable
  • Better short/mid term outcomes
  • Less residual pain
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9
Q

Cemented Disadvantages (3)

A
  • Longer operation time
  • Difficult to revise later
  • Allergic reaction/infection
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10
Q

Uncemented Advantages (3)

A
  • Lower risk of stroke, DVT and PE
  • Conserves bone mass
  • Better long-term outcomes
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11
Q

Uncemented Disadvantages (3)

A
  • Expensive
  • Increased risk of peri-prosthetic fracture
  • Lack of outcome data
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12
Q

Mini-Incision Arthroplasty

A
  • Uses smaller incision (1-2in)
  • Possibly reduces pain, bleeding and time to discharge
  • Technically demanding
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13
Q

Metal on polyethylene Advantages (3)

A
  • Less expensive
  • Most supported by evidence
  • Predictable survivability
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14
Q

Metal on polyethylene Disadvantages

A
  • Polyethylene debris may cause sepsis and loosening
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15
Q

Metal on metal Advantages (2)

A
  • Low friction and wear
  • Lower risk of dislocation
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16
Q

Metal on metal Disadvantages (2)

A
  • Metal poisoning
  • Metal ions may have carcinogenic effects
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17
Q

Ceramic on ceramic Advantages (2)

A
  • Low friction and wear
  • Non-toxic material
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18
Q

Ceramic on ceramic Disadvantages (3)

A
  • Most expensive
  • High amount of surgical expertise required
  • Joint may make noise
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19
Q

Total Hip Resurfacing (THR)

A
  • Metal implants just cover the surface of the acetabulum and femoral head to make the joint smoother.
  • Good treatment for younger/active adults
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20
Q

THR Advantages (4)

A
  • Bone conserving
  • Lower friction/wear
  • Lower risk of dislocation
  • Quicker recovery/return to high level activities
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21
Q

THR Disadvantages (4)

A
  • Higher failure rate
  • Metal on metal implant may cause metal poisoning
  • Not supported by much data
  • Surgery is harder to perform
22
Q

Total Hip Arthroplasty (THA)

A

Surgical metal implants completely replace femoral head and neck and articulate with a new metal acetabulum.

23
Q

THA Advantages (4)

A
  • Highly supported by evidence
  • Easier to perform than THR
  • Used on variety of patient/age groups
  • Better long-term outcomes
24
Q

THA Disadvantages (2)

A
  • Higher risk of dislocation
  • Harder to revise due to lack of bone conservation
25
Q

Posterior hip precautions

A
  • Adduction past neutral
  • Hip flexion greater than 90 degrees
  • Internal rotation
26
Q

Anterior hip precautions

A
  • Extension
  • External rotation
  • Abduction
27
Q

Hip Arthroplasty Dislocation Risk Factors (8)

A
  • Neuromuscular impairment
  • Fracature
  • Cognitive dysfunction
  • Posterior approach
  • History of surgery
  • Small femoral head size
  • Prosthetic alignment
  • Surgeon’s experience
28
Q

Interventions to prevent recurrent hip dislocations

A
  • Hip braces
  • WBing restrictions
  • Communication with patient, family and caregivers
29
Q

High Tibial Osteotomy

A
  • Wedge is created on one side of the tibia to correct joint alignment
  • Used to correct unicompartmental disease or angular deformities
30
Q

Unicompartmental Arthroplasty

A

Small implants placed on one side of the tibial plateau and one femoral condyle to make joint smoother/more congruent on involved side of the knee joint.

31
Q

Unicompartmental Arthroplasty Advantages (3)

A
  • Bone conserving
  • Rehab is shorter than TKA
  • Hardware can last up to 8-10 years on average
32
Q

Unicompartmental Arthroplasty Disadvantages

A
  • Obesity increases rate of failure
33
Q

Total Knee Arthroplasty (TKA)

A

Complete replacement of tibial plateau and femoral condyles.

34
Q

What patients are the best candidates for TKA?

A
  • Patients <180 lbs
  • Patients >60 yrs old
35
Q

TKA Complications (2)

A
  • Infection
  • DVT/PE
36
Q

What is the best way to determine if one of your patients has a DVT or PE? (3)

A
  • Wells Score for DVT/PE
  • DVT score >3 patient at high risk
  • PE score >6 patient at high risk
37
Q

What should knee ROM be after TKA before patient is discharged from the hospital? (2)

A
  • 90 degrees knee flexion
  • 0 degrees knee extension
38
Q

What are the 2 types of shoulder replacement? (2)

A
  • Convention
  • Reverse
39
Q

T/F - In a reverse shoulder arthroplasty the humerus is convex and the glenoid fossa if concave.

A

False - in a reverse shoulder arthroplasty the glenoid fossa becomes convex and the humeral head becomes concave.

40
Q

What are the areas of fast track recovery for joint replacements? (4)

A
  • Pre-op patient education
  • Nutritional supplementation
  • Pain management
  • Early Mobilization
41
Q

T/F: Posterior hip precautions are ER, abduction and flexion greater than 90.

A

False - IR, flexion greater than 90, adduction past neutral

42
Q

What are some of the most common joint replacement complications? A. Infection B. High Blood Pressure C. Acute Compartment Syndrome D. DVT/PE E. Fracture

A

A. Infection

D. DVT/PE

43
Q

T/F: Obesity, diabetes, and age of 90 or higher are absolute contraindications for joint replacement surgery.

A

False - these are RELATIVE contraindications. These patients may still be candidates for the surgery.

44
Q

T/F: THR conserves bone mass but has a higher failure rate than THA.

A

True

45
Q

What are the absolute contraindications for joint replacement?

A. Renal/respiratory insufficiency

B. Cognitive impairment

C. Infection

D. Coronary Artery Disease

E. Uncontrolled hypertension

A

A. Renal/respiratory insufficiency

C. Infection

E. Uncontrolled hypertension

46
Q

Mini-incision arthroplasty has been found to reduce ________ _____ and length of stay but does not increase ability to regain __________.

A

blood, loss, function

47
Q

What does early (acute/subacute) post-op rehab focus on after hip replacement? (7)

A
  • Ice and positioning
  • Education on precautions
  • Strengthening
  • Mobility (bed, transfers, gait, stairs, car transfer)
  • Edema management
  • Equipment recommendations
  • Discharge planning/recommendations
48
Q

What are the late stage rehab goals? (5)

A
  • Emphasize functional activities
  • Strengthen hip flexors, extensors and abductors
  • Use resistance training if possible
  • Wean patient off assistive device
  • Limit high impact/rotational activities
49
Q

Name the factors that may confirm the diagnosis of a PE according to the Wells PE prediction rule. (7)

A
  • Signs/symptoms of DVT
  • PE is the MOST likely diagnosis
  • Pt has has surgery or bedridden for at least 3 days in last 4 wks
  • Previous history of DVT/PE
  • HR >100 bpm
  • Hemoptysis (coughing up blood)
  • Active cancer
50
Q

List the factors associated w/ DVT diagnosis according to Wells DVT prediction rule. (10)

A
  • Active cancer
  • Paralysis, peresis or plaster immobilization of LE
  • Bedridden for at least 3 days or surgery within last 12 weeks
  • Localized tenderness around the deep venous system tracks
  • Entire leg is swollen
  • Calf swelling > 3cm compared to unsymptomatic side
  • Pitting edema confined to symptomatic side
  • Non-varicose collateral superficial veins
  • Previous history of DVT
  • Other possible diagnoses are at least as likely as a DVT
51
Q

When do the majority of THA dislocations occurs?

A

1-6 weeks after surgery

52
Q

T/F: Dislocation of THA are more common after revisions than when they are implemented the first time.

A

True, primary (first time) THA dislocation rate is 0-10%, revision dislocation rate increases to 26%.

PTRS 746 Musculoskeletal (9 decks)

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