Arthroplasty

Question 1

What are the goals of a hip arthroplasty?

Answer 1

• Pain relief
• Restoration of structure within joint
• Mobility
• QOL

Question 2

What are the different types of hip arthroplasty?

Answer 2

• Hybrid cemented THA
• Resurfacing arthroplasty for avascular necrosis (head of femur)
• Noncemented modular THA

Question 3

What are the indications for hip arthroplasty?

Answer 3

• OA
• Avascular necrosis
• Inflammatory arthritis (RA, AS, JCA)
• Non union of neck of femur #
• TB
• Tumour

Question 4

What does a physio need to be concerned with following arthroplasty?

Answer 4

• Weight bearing status

- What structures were cut during the surgery (i.e. need rehab)

Question 5

What structures are cut during a hip arthroplasty?

Answer 5

• Skin
• Fascia
• Glutes split
• Sciatic nerve retracted
• Short external rotators divided
• Capsule exposed & opened

Question 6

What are the complications of hip arthroplasty?

Answer 6

• Blood loos & shock, anaemia, confusion
• Thromboembolism
• Dislocation
• Femur/acetabular #
• Infection
• Loosening
• Wear

Question 7

What does appropriate rehabilitation need to recognise and address?

Answer 7

• Patient’s home & environment
• Pre op history & impairments
• Surgical history & technique
• Surgeon’s assessment of the tissue status upon finalisation of the surgery

Question 8

What are the common restrictions following hip arthroplasty?

Answer 8

• Active/passive ROM
• ROM limits
• Weight bearing status

Question 9

What are some of the common issue around the hip when people have chronic dysfunction?

Answer 9

• OA
• Tendinopathy
• Bursitis
• Core strength

Question 10

What are some of the things that should be taught to the patient before a THR (phase 1)?

Answer 10

• Ankle pumps
• Quadriceps sets
• Gluteal sets
• Active hip & knee flexion (heel slides)
• Isometric hip abduction
• Active hip abduction

Question 11

What are the typical THR goals for the first 5 days post op?

Answer 11

Day 1:

• Sit out of bed
• Knee & hip exercises
• Chest physio
• Abduction pillow

Day 2:

• Assisted walking
• Lots of exercises

Day 5:

• Home
• PT at home (stairs, step)

Question 12

What movements typically should be avoided post THR?

Answer 12

• Internal rotation
• Adduction
• Hip flexion past 90 deg

Question 13

What are the precautions post hip arthroplasty?

Answer 13

• Prevent DVT
• Prevent dislocation (avoid FADIR - low chairs, roll in bed)
• Prevent infection

Question 14

What are the general principles for post op stage 1 for arthroplasty?

Answer 14

• Treatment & exercise
• Mobility
• Comfort
• Hygiene
• Clothing/dressing
• Safety education
• Other joints health
• Education re future progression
• Discharge planning

Question 15

What are the typical goals for phase 2a of a THR (1-2 days post op)?

Answer 15

• Prevent complications
• Increase muscle contraction
• Improve control of affected leg
• Help patient sit up for 30 mins
• Reinforce THR precautions

Question 16

What are the typical goals for phase 2b of a THR (3-7 days post op)?

Answer 16

• Promote transfer & gait independence
• Reinforce THR precautions
• Discharge

Question 17

What are the typical goals for phase 3 of a THR (1-6 weeks post op)?

Answer 17

• Evaluate safety of the home
• Assure patient independence
• Plant patient’s return to work

Question 18

What are the essential components of discharge?

Answer 18

• Home exercises
• Understanding of progressions & restrictions
• Team (OT, nurse, GP)
• Appointment for follow-up with physio

Question 19

What are the indications for knee arthroplasty?

Answer 19

• OA
• RA
• Post-traumatic arthritis
• When joint dysfunction is causing a loss in QOL

Question 20

What are the surgery goals for knee arthroplasty?

Answer 20

• Restore QOL
• Relieve pain
• Provide motion with stability
• Correct deformity (e.g. valgus/varus)

Question 21

What are the different designs of knee arthroplasty?

Answer 21

• Unicompartmental (medial/lateral)
• Unconstrained (dep on ligament integrity)
• Semi constrained (most common)
• Fully constrained (rotating hinges)

Question 22

What are the complications of knee arthroplasty?

Answer 22

• Thromboembolism
• Poor wound healing
• Infection
• Joint instability
• Fractures
• Patella tendon rupture
• Peroneal nerve injuries
• Component loosening
• Wear

Question 23

What are the typical knee arthroplasty goals for the first 5 days post op?

Answer 23

Day 1:

• Sit out of bed
• Continuous passive motion
• Knee exercises
• Chest physio

Day 2:

• Assisted walking
• CPM, exercises

Day 5
- Home, PT at home

Question 24

What are the precautions for knee arthroplasty?

Answer 24

• Wound care
• Prevention of DVTs
• Early motion is essential

Question 25

What are the indications for shoulder arthroplasty?

Answer 25

- OA - Rotator cuff arthropathy - Fracture/disclocation - RA - Avascular necrosis - Other inflammatory arthritis - Instability - Tumour

Question 26

What are the complications of shoulder arthroplasty?

Answer 26

- Infection - Dislocation - Loosening of a component - Periprosthetic humeral & glenoid fractures - Nerve injuries - Fractures of prosthetic component - Heterotrophic ossification

Question 27

What are the typical rehab protocols for shoulder arthroplasty?

Answer 27

- Abduction pillow 1-6 weeks - Or sling & swathe bandage Neer program - Day 5: assisted ROM - Day 7: active assisted - Day 14: active assisted exercises sitting & standing - Day 21: isometric & active progression of exercises

Question 28

What are the precautions for shoulder arthroplasty?

Answer 28

- Prevent tear of rotator cuff suturing | - Prevent dislocation (horizontal abduction not permitted until flexion at 140 deg)