Total Joint Arthroplasty

what are joints covered by?

articular cartilage

degenerative joint disease (DJD)

affects the joint, erodes the cartilage, causes pain

total joint arthroplasty

means that all joint surfaces are replaced

what is it called when components use cement and non-cemented for joint arthroplasty?

hybrid

Polymethyl methacrylate (PMMA)

bone cement, composed of 2 parts- liquid and powder, handed up to table fairly liquid, exothermic as it hardens

what is cement mixed in?

“mixevac” where fumes are suctioned away

templating

establishes implant sizes that need to be available at the time of arthroplasty surgical procedure

commonalities of joint arthroplasty include:

always use metals of the same alloy, handle as little as possible, trialing of implants and images are used before opening the real implant, irrigation always before cementing, joints are always put through range of motion before closure

why are joints irrigated before commencing occurs?

this opens the pores of the bone, allowing for a better more secure bond

varus

deformity of the knee, the distal part of the leg below the knee is deviated inward (below joint), resulting in bow legged appearance

valgus

deformity at the knee, results in a knock-kneed appearance, with the distal part of the leg deviated outward (below joint)

total hip arthroplasty (posterolateral approach)

patient is lateral, surgery is upper 1/3 of leg, involves a curved incision over greater trochanter ( cut tensor fasciae latae (TFL), gluteus maximus and hip external rotator muscles)

total hip arthroplasty (anterior approach)

patient is in supine position on fracture OR table, incision is lateral and distal to anterior superior iliac spine toward femoral head through the TFN fascia-longitudinally between muscle fibers

surgical procedure steps for a total hip arthroplasty

incision made, retract under femoral head, excise femoral head, reaming of acetabulum, reaming of femur steam and head, irrigation, placement of components, and closure

advantages of anterior hip total arthroplasty

less damage to muscles, less postoperative pain, faster recovery

modular hip prosthesis

a type of hip replacement implant with interchangeable components (femoral, femoral head/neck, and acetabular)

acetabular reamers

surgical tools, typically with a hemispherical or dome shape, used in total hip arthroplasty to prepare/enlarge/or reshape the acetabulum (hip socket) for the implantation of a prosthetic hip cup

cemented components

slightly rough, textured posterior surface and polyethylene cup

non-cemented components

have porous surface on posterior surface and polythylene cup (more expensive, but are around the same price when you add it price of cement and mixer)

hemiarthroplasty prosthesis

this prothetis will replace the femoral head, is composed of a metal stem inserted into reamed femoral, it also has a metal ball that fits into the socket of the hip joint (acetabulum)

hip hemiarthroplasty

partial hip replacement to treat hip fractures, replaces half of the hip joint (hemi=half), best option if the acetabulum is healthy

surgical procedure for hip hemiarthroplasty

incision made (posterior or anterior approach), femoral head is removed from the acetabulum, femoral head is excised, femoral canal is reamed, femoral stem is sized and inserted into femoral canal

what are the two types of femoral heads that can attach to the femoral stem?

unipolar and bipolar

unipolar femoral head

solid metal ball to replace the femoral head (prosthesis)

bipolar femoral head

femoral head that swivels where it attaches to the stem, designed to reduce wear and tear on the articular cartilage inside the acetabulum

robotic technology used for a total hip arthroplasty

robotic arm guides preparation of hip socket, more accurate implant replacement, and precision with less human error (precise cuts)

what are possible complications of a total hip arthroplasty

reaming with a femoral broach that is too big (could shatter the femur)

total knee arthroplasty

supine tourniquet used, components are usually tricompartmental, may correct varus or valgus

what are the tricompartmental components of knee arthroplasty

femoral (metal), tibial (stem and polyethylene insert), patellar (polyethylene)

unicompartmental knee arthroplasty

arthroplasty on only one side of joint

what does revision of femoral component require?

long femoral stem

what position is used for a total shoulder arthroplasty?

semi fowlers

what does a total shoulder arthroplasty include?

humeral head and glenoid

total shoulder arthroplasty

replace the diseased or damaged ball and socket joint of the shoulder with a prosthesis. The ball is the proximal head of the humerus, and the socket refers to the concave depression of the scapula (the glenoid)

partial shoulder replacement (shoulder hemiarthroplasty)

the upper bone in the arm (humerus) is replaced with a prosthetic metal implant, the glenoid or socket is left intact

radial head arthroplasty

replaces the head of radius or elbow joint with an implant, often performed for complex fractures of radial head in which other fracture management doesn’t work, also an option for arthritis management

metacarpal (MCP) and proximal interphalangeal (PIP) arthroplasty for what?

rheumatoid arthritis, systemic lupus, osteoarthritis, it relieves pain or when digit deformity is inferring with hand function and activities of daily living

what material can be used for metatarsal arthroplasty implants?

metals, silicone, silastic, or combination

what implants are used for ankle arthroplasty?

tibia and talus

wrist arthroplasty

for severe arthritis when patients do not use the wrist to meet heavy demands, performed to relieve pain, maintain function of the wrist and hand, not intended for those who put a lot of stress in their daily life

wrist arthroplasty implants?

one component for radius, carpal component (1 long stem, 2 shorter stems), plastic spacers that goes between the components that allows for wrist movement

what is a cell saver utilized with?

total hip arthroplasty

cell saver

blood recovery system, introduced in 1970s, utilized with medium to high volume blood loss, to re-infuse patient’s own blood, filters the blood, and decreases the need for blood transfusions (not recommended for cancer patients)

paget’s disease

of bone disrupts normal recycling of bone, the gradual replacement of bone tissue with new bone tissue (becomes brittle), occurs in pelvis, skull, spine, and legs

infectious arthritis

joint inflammation caused by bacteria, virus, or fungus, occurs after an infection elsewhere in the body, ability to destroy a joint in days, artificial joints are at higher risk

gout

complex form of arthritis, severe attacks of pain, redness, and tenderness of the joint (often at base of big toe), caused when higher than normal levels of uric acid in the blood forms crystals

how do you treat gout?

nonsteroidal anti inflammatory, steroids, or colchicine

bursitis

painful condition that affects the small fluid-filled pads (bursae) that act as cushions for the bones, tendons, and muscles near your joints, occurs when bursae become inflamed, often occur near joints that perform repetitive motions

treatment of bursitis includes (flare ups are common)

conservative measures (rest, ice, pain reliever), medication (antibiotic), physical therapy, injection (corticosteroid drug), and surgery (drain or remove bursa)