Musculoskeletal Lecture Notes: Arthritis and Total Joint Arthroplasties

Introduction to Musculoskeletal Lecture 4

• Presenter: Miss Buchanan

• Topics Covered:

  • Arthritis

  • Total Joint Arthroplasties (TJA)

Agenda Overview

• Collaborative care and interprofessional teams for promoting mobility in patients with arthritis.

• Application of anatomy, physiology, and pathophysiology in evidence-based care for arthritis patients.

• Organization of care communication and transition management for patients undergoing total joint arthroplasties.

• Utilizing clinical judgment to devise evidence-based nursing care aimed at reducing pain and inflammation in patients with arthritis.

Overview of Arthritis

• Definition: Inflammation of one or more joints.

• Categories:

  • Non-inflammatory arthritis

  • Inflammatory arthritis

• Common Types:

  • Osteoarthritis (OA):

    • Non-inflammatory, localized disorder affecting mobility.

  • Rheumatoid Arthritis (RA):

    • Systemic autoimmune inflammatory disorder.

• Both OA and RA can lead to pain and stiffness in joints, potentially leading to surgical interventions when conservative methods fail.

Total Joint Arthroplasties (TJA)

• Definition: Surgical creation of a synovial joint using implants (e.g., total knee replacement, total hip replacement).

• Indications:

  • Severe joint pain limiting daily activities.

  • Slow loss of cartilage due to:

  • Rheumatoid arthritis

  • Osteoarthritis

  • Trauma

  • Osteonecrosis (bone death).

• Common Surgical Procedures:

  • Total joint replacements for various joints including hips, knees, shoulders, and ankles.

• Material Used:

  • Typically consists of metal (e.g. titanium) and high-density polyethylene components.

Indications for TJA

• Debilitating joint pain that hinders daily activities.

• Diseases or Conditions:

  • Osteoarthritis, rheumatoid arthritis, congenital deformities, trauma, sepsis, and complications from failed previous surgeries.

  • Long-term steroid use is a red flag as it can worsen bone deterioration due to:

  • Activation of cells that break down bone.

  • Reduced calcium absorption.

  • Altered hormonal levels affecting bone health (e.g., estrogen, testosterone).

Preoperative Care for Patients

• Orthopedic Patient Navigator:

  • A specialized nurse coordinating care for orthopedic patients, offering support and advocacy throughout the continuum of care.

• Preoperative Assessment:

  • Assess patient's understanding of surgical process and postoperative expectations.

  • Involve a joint coach (family member) for support.

  • Surgeon should explain the procedure's risks and expectations during office visits.

• Lab Tests and Imaging:

  • Rheumatoid arthritis patients often require cervical spine assessments (due to potential dislocations during surgery).

  • Use of x-rays, CT scans, or MRIs to rule out dislocation risks.

Preoperative Assessment Considerations

• Nutritional status and screening for malnutrition.

• Pain assessment and management strategies for preoperative opioid users.

• Prevention of Venous Thromboembolism (VTE):

  • Education on anticoagulant therapy and mobility.

  • IV antibiotic administration prior to surgery to prevent infection.

  • Use of chlorhexidine gluconate as a pre-surgical antibacterial wash.

Operative Procedures

• Antibiotic Administration:

  • Usually cephalosporins administered within 1 hour before the procedure.

• Anesthetic Techniques:

  • General, neuraxial (spinal or epidural), or regional anesthesia.

• Blood Loss Management:

  • Administering antifibrinolytics (e.g., TXA) to minimize blood loss.

Postoperative Care

• Typical Hospital Stay:

  • Total hip arthroplasty usually requires a 3-day stay; young patients may discharge overnight.

• Complications to Monitor:

  • Hip dislocations, VTE, infections, pain, and decreased mobility.

  • Teaching patients about positioning to prevent dislocation.

• Preventing VTE:

  • Early ambulation, use of compression devices, and anticoagulants (e.g., low molecular weight heparin).

• Monitoring Postoperative Recovery:

  • Vital signs, wound care, neurovascular checks, and assessment for infection and excessive drainage.

Pain Management Strategies

• Importance of effective pain control post-surgery:

  • Use of multimodal approaches including opioids, non-opioids, and alternative methods (e.g. ice, elevation, physical therapy).

• Patient Controlled Analgesia (PCA):

  • Immediate post-operative pain management with opioids, transitioning to oral medications.

• Rehabilitation:

  • Importance of early ambulation and structured rehabilitation programs to enhance recovery.

Total Knee Arthroplasty (TKA)

• Increasing Demand:

  • Factors include aging populations and prevalence of obesity contributing to osteoarthritis.

• Unilateral vs. Bilateral Procedures:

  • TKA is typically performed on one knee, but simultaneous bilateral TKAs are also common.

• Preoperative Care:

  • Similar protocols as with hip surgeries; nutritional screening is critical.

Transitional Care Post TKA

• Planning for discharge and post-surgical rehabilitation with emphasis on outpatient physical therapy or home care as needed.

• Assisted Devices:

  • Patients may require adaptive devices for daily living activities after TKA.

Advanced Techniques in TKA

• Peripheral Nerve Blocks:

  • Commonly used to manage postoperative pain effectively and minimize opioid usage.

• Minimally Invasive Techniques:

  • Utilize smaller incisions to reduce tissue damage and promote quicker recovery.

Final Overview of Postoperative Care

• Essential nursing interventions:

  • Observing wound healing, neurovascular integrity, pain control, and mobilization efforts.

  • Environmental considerations such as patient education regarding recovery and adaptive processes at home.

Conclusion and Questions

• Encourage inquiries about the material covered and specific aspects of arthritis and joint replacement surgeries to enhance understanding.