1. Common Diagnoses

Upper‐Extremity Arthroplasty

• Reverse Shoulder Arthroplasty (RSA)
• Same primary indications as a traditional Total Shoulder Arthroplasty (TSA).
• Preferred when the rotator-cuff (RTC) is significantly torn and non-repairable.
• Prosthesis reverses the ball-and-socket orientation ➜ lengthens the deltoid’s moment arm, giving the muscle a greater mechanical advantage.
• Clinically: allows active elevation despite RTC deficiency, yet overall range of motion (ROM) is generally reduced compared with an anatomic TSA.

Hip Arthroplasty & Fixation Options

• Hemi-Arthroplasty
• Only one half of a joint is replaced.
• Example: Hip hemi-arthroplasty replaces the femoral head while the native acetabulum remains.
• Illustration in transcript highlights the femoral stem, a metallic femoral head, and bone cement anchoring the implant.
• Cemented vs. Cementless Fixation
• Cement (polymethyl-methacrylate) provides immediate fixation ➜ can permit earlier or more aggressive weight bearing.
• Contemporary practice (esp. in North America) has shifted toward press-fit (cementless) fixation because of:
• Faster procedural workflow.
• Historical concern linking cement to osteolysis & aseptic loosening.
• Perceived reduction in thromboembolic risk.
• Journal data (Blankstein et al., 2020, JAAOS 28(14): e586-e594):
• Despite excellent long-term survivorship of fully cemented, hybrid, and reverse-hybrid hips (registry data spanning \approx 60\,\text{years}), cement use has declined.
• Troubling rise in intra-operative and early/late periprosthetic fractures with cementless stems, especially in osteoporotic bone.
• Suggested indications for a cemented stem:
• Age >75 y (particularly women).
• Osteoporotic bone (Dorr C morphology).
• Abnormal proximal-femoral anatomy, conversion of failed fixation, inflammatory arthritis, femoral-neck fracture.
• Cemented acetabular cups considered for elderly or pathologic bone.

Surgical Approaches to Total Hip Arthroplasty (THA)

• Posterior / Posterolateral
• Most common.
• Spares the gluteus medius ➜ more normal gait pattern.
• Highest risk of postoperative subluxation/dislocation.
• Anterolateral
• Very stable; lower dislocation rates.
• Detaches & reattaches hip abductors ➜ initial abductor weakness & gait asymmetry.
• Anterior
• True inter-muscular / internervous plane ➜ no detachment of major muscles.
• Greater technical challenge & limited visualization.
• Less Common
• Direct lateral, transtrochanteric.

Weight-Bearing Terminology (Post-Op Orders)

• \text{NWB} = Non-weight bearing.
• \text{PWB} = Partial weight bearing (specified percentage, e.g., 50\%).
• \text{WBAT} = Weight bearing as tolerated.
• \text{FWB} = Full weight bearing.

Post-Operative Precautions & Knowledge Checks

• Common Motion Precaution after posterolateral THA:
• No hip flexion >90^\circ (most emphasized in clinics).
• Assistive Device most commonly issued immediately after a hip ORIF:
• Rolling walker (front-wheeled walker) ➜ offers stability while permitting some step-through gait.
• True/False Review Item:
• Statement: “Individuals who undergo a total joint arthroplasty MOST often have weight-bearing restrictions following surgery.”
• Transcript tags this as False → many modern protocols allow WBAT or FWB, particularly with cemented fixation.

Pulmonary Condition

Chronic Obstructive Pulmonary Disease (COPD)

• Encompasses Asthma, COPD-chronic bronchitis, and Emphysema.
• Presentation
• Shortness of breath (dyspnea).
• Frequent coughing & wheezing.
• General fatigue & lethargy.
• Often requires supplemental O₂.

Neurologic Disorders

Multiple Sclerosis (MS)

• Autoimmune, demyelinating disease ➜ formation of sclerotic plaques throughout the CNS disrupting communication within the brain and between brain & body.
• Onset: typically 20–50 years.
• Presentation (variable):
• Weakness, impaired mobility, spasticity.
• Sensory loss, visual impairments.
• Heat sensitivity (symptoms worsen with ↑temperature).

Cerebrovascular Accident (CVA = Stroke)

• Types
• Ischemic (≈ 87\% of strokes)
• Thrombotic – clot originates in a cerebral artery.
• Embolic – clot forms elsewhere, lodges in cerebral vasculature.
• Hemorrhagic – intracerebral bleeding damages tissue.
• Transient Ischemic Attack (TIA) – temporary blockage; “mini-stroke.”
• Presentation
• Unilateral arm/leg weakness.
• Coordination deficits, dizziness, sudden severe headache.
• Aphasia or dysarthria.
• Vision deficits.
• Possible loss of consciousness.

Spinal Cord Injury (SCI)

• Any traumatic or disease-related disruption of spinal cord function.
• Common Levels Described
• C4 tetraplegia, C6 tetraplegia, T6 paraplegia, L1 paraplegia.
• Symptoms below injury level:
• Motor & sensory loss, altered muscle tone, bowel/bladder/sexual dysfunction.
• Autonomic issues – respiratory compromise (higher levels) & cardiovascular instability.
• Psychological impact: frequent depression.
• Presentation
• Poor balance & mobility below level of lesion.
• Cardiovascular volatility with positional change.
• Upper extremities bear extra load for mobility & ADLs.

Traumatic Brain Injury (TBI)

• Caused by external force (impact, acceleration/decoration, penetrating object).
• Anoxic brain injury (similar presentation) results from hypoxia/ischemia.
• Symptoms (highly variable):
• Cognitive, perceptual, memory & emotional deficits.
• Sensory alterations, pain, speech/language impairment.
• Motor control & balance difficulties, tone abnormalities, seizure risk.
• Presentation
• Poor balance & motor control; safety awareness deficits.
• Impulsivity, social/emotional instability.

Cerebral Palsy (CP)

• Developmental neurological movement disorder due to early brain injury (in utero, perinatal, or within 2 yr of life).
• Presentation (mild → severe):
• Delayed motor milestones; posture & tone abnormalities.
• Variable cognition (normal → profound impairment).
• Balance, coordination, sensory & motor dysfunction.

Musculoskeletal Considerations

Amputation

• Loss of limb through congenital anomaly, trauma, cancer, infection, or vascular compromise (often diabetes/peripheral vascular disease).
• Levels (common terminology):
• Transtibial (BKA), Transfemoral (AKA), Transhumeral, Transradial.
• Symptoms
• Surgical/incisional pain, ischemic pain, prosthetic pressure pain.
• Phantom limb pain or sensation.
• Balance & functional challenges; ↑load on remaining limbs.
• Emotional sequelae – grief, depression.
• Presentation & Rehabilitation
• Education on weight shifting, safety, skin integrity.
• Without prosthesis: often requires wheelchair, walker, or crutches.
• With prosthesis: training in donning/doffing, fit adjustment, gait & functional use.

Metabolic & Systemic Disorders

Diabetes Mellitus (DM)

• Chronic defect in insulin production or utilization ➜ impaired glucose regulation.
• Acute manifestations
• Nausea, vomiting, dehydration → risk of coma/death if untreated.
• Chronic manifestations
• Fatigue, weight changes, polydipsia, polyuria.
• Poor wound healing, peripheral neuropathy, visual deficits, altered mental status.

End-Stage Renal Disease (ESRD)

• Kidneys fail to adequately filter blood ➜ accumulation of toxins & fluid.
• Untreated failure ➜ seizures, coma, death.
• Symptoms / Presentation
• Altered urination patterns.
• Generalized weakness & fatigue.
• Peripheral edema (notably lower limbs).
• Shortness of breath, pruritus (itching).
• Management
• Lifelong dialysis or renal transplant.

Quick Reference ‑ Key Numerical & Terminology Reminders

• Hip flexion precaution after posterolateral THA: <90^\circ. • Common postoperative weight-bearing abbreviations: \text{NWB}, \text{PWB (\%)}, \text{WBAT}, \text{FWB}. • Age threshold often cited for cemented stem consideration: >75 years.