1) Total Joint Replacement

what ages is it most common for THA

65+ years

is the incidence of THA increases or decreasing

increasing

The rate of total knee arthroplasty (TKA) is increasing or decreasing

increasing

is it more common for women or men to get TKA

women

are TKA or THA more common

TKA

Is it common to get another joint replacement on the contralateral side after getting the first one?

yes, usually under 10 years after

the purpose of arthroplasty is to

relieve pain associated with osteoarthritis and restore joint function

The goal of improving joint function is to improve the patients'

function and ideally help with pain

clincial symptoms of OA

pain with loading (weight-bearing)

AM stiffness is less than 30 min

loss of motion

swelling

creptius/locking

join malalignment

quad weakness

functional limitations of adults with OA

stoop/bend

walk

climb

radiographic OA does not =

symptomatic OA

Oral NSAIDs and oral acetaminophen for management of OA

strong recommendation

Recommended to improve pain and function

Hyaluronic acid for the management of OA

moderate recommendation

not recommended for routine use in the treatment of symptomatic OA

Intra-articular corticosteroids for the management of OA

moderate recommendation

could provide short term relief for patients with OA

Arthroscopy with lavage

is not recommended

partial meniscectomy for management of OA

can be used for the treatment of meniscal tears in patients, who have failed PT or other non-surgical treatments

weight loss intervention for OA

This is recommended to improve pain and function in overweight and obese patients with knee OA

when is it time for a TKA or THA

- radiographic evidence of OA

- conservative management plateau

- pain causing functional decline and reduced quality of life

3 component/compartments of TKA

tibial

femoral

patellar

After a TKA, the surgeons use imaging to make sure

The pieces are cemented in place

after TKA what do we expect

quad weakness

on the plastic space in TKA what are we sparing

PCL

due to sparing the PCL what might a person lose

flexion

after a TKA when is the first outpatient PT appointment

one week post op

inpatient "hospital" PT

assistive device ed

walking, transfers, stair training

range of motion "0-90 degrees"

outpatient PT

rehab focus similar

pain, inflammation, and impairment focused

what is the timeline for outpatient PT

6 weeks to 6 months

success of TKA

reduces knee pain

corrects deformity

improves ROM

improves function

treating acute inflammation in patients with TKA

police

cryotherapy

in the first 10 weeks what ROM do we want our patient to get to

full range: 0-120 degrees

mechanisms of motion

pain

swelling (edmea)

joint contracture

component sizing

kinesiophobia

walking flexion

60-70 degrees

sit in chairs flexion and ascend stairs flexion

90-100 degrees

don socks flexion

100+ degrees

descend stairs flexion

110-120 degrees

force impairments

quad weakness

muscle inhibition

muscle atrophy

pain and prior disuse

with quad weakness there is strong association with

compensatory use of the opposite limb

when quads are strong there is a strong association

with improved physical function

motor control issues

persistant gait deviations

balance deficits

avoidance of surgical limb and overload of nonsurgical limb

people with TKA energy; they have a hard time

reaching recommended amounts of physical activity

they have reduced 30 walk distance compared to their peers

THA posterior approach

most commo

posterior THA goes through

the piriformis and joint capsule

rehab will be modified due to

the surgical technique and what tissues had to be cut through

motion timeline for THA

6 weeks

ROM precaution for the posterior approach

do not go into:

90 degrees of hip flexion, hip IR, hip ADD

Functional precaution for the posterior approach

crossing legs, pivoting into IR, bending to the floor, low chairs

ROM precautions for anterior approach

hip extension and hip ER

functional precaution for the anterior approach

large stepping, pivoting into ER

hip muscle rehab focus, posterior approach

deep external rotators, abductors, extensors

hip muscle rehab focus anterior approach

hip flexors, hip abductors, extensors

motor control indications after THA

gait deviations

- surgery induced

- chronic history

energy pre op

limited due to pain

energy post op

improves, can walk for longer time

at 6 months, VO2 max is still

limited compared to peers

- more than pain can limit physical activity

both THA and TKA groups do not reach their

recommend physical activity amounts

after TKA people prioritize participation in life situations that are meaningful and self-fufilling, however

It is probably a very low-intensity physical activity

- not reaching higher physical activity goals

use of assistive devices after surgery

Safety

gait

pain

prior function

progressing physical activity

in the 12 weeks of PT what is the progression we want for AD

walker

cane

hopefully no AD

complications of arthroplasty

deep vein thrombosis (DVT)

infection

dislocation

joint contracture

in TKA which complications are most common

DVT

infection

joint contracture

what is the most common complication for THA

dislocation

DVT

The highest risk is in the first week

infection is an integral part of

examination

- skin integrity (incision healing, drainage, redness, skin temp)

dislocation is more common with what approach for THA

posterior approach

What is a joint contracture?

A condition where scar tissue is laid down, leading to stiffness in the joint.

What is a common symptom of joint contracture?

Stiff knee.

What is the range of motion (ROM) limitation associated with joint contracture?

Lack of 10 degrees or more of extension ROM.

people at risk for joint contracture

diabetes

RA

smoker

prior surgery

limited ROM post op