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| JOINT REPLACEMENT:: introduction, components, and muchmoreIntroduction Total joint replacement, or arthroplasty, represents a significant advance in the treatment of painful and disabling joint pathologies.
By: A+ Orthopaedic & Sports Medicine Clinic Total joint replacement, or arthroplasty, represents a significant advance in the treatment of painful and disabling joint pathologies. Total joint replacement can be performed on any joints of the body, including the hip, knee, ankle, foot, shoulder, elbow, wrist, and fingers. Of these procedures, hip and knee total joint replacements, which are the focus of this article, are by far the most common.The number of joint replacements that are performed annually has been increasing steadily.1 In 2004, 234,000 total hip replacements (THRs) and 478,000 total knee replacements (TKRs) were performed in the United States. Treatment of the diseased hip or knee joint does not end with surgical replacement. The ultimate goal is ensuring pain-free function of the joint to improve the patient's quality of life (QOL). Postoperative rehabilitation is of the utmost importance. Terminology • .THR, or total hip arthroplasty (THA) - Replacement of the femoral head and the acetabular articular surface • Hemiarthroplasty - Replacement of only the femoral head • Bipolar hemiarthroplasty - A specific form of hemiarthroplasty in which a femoral prosthesis is used with an articulating acetabular component; the acetabular cartilage is not replaced. The principle of this procedure is to decrease the frictional wear between the femoral head prosthesis and the cartilage of the acetabulum. • TKR, or total knee arthroplasty (TKA) - Replacement of the articular surfaces of the femoral condyles, tibial plateau, and patella; the anterior cruciate ligament is excised. The posterior cruciate ligament may be saved in cruciate-retaining systems. • Unicompartmental knee replacement (unicompartmental arthroplasty) • Cemented joint replacement (cemented joint arthroplasty) Medical Care During Rehabilitation Treatment and monitoring of medical comorbidities During the initial evaluation of the patient, the physician must perform a thorough physical examination, not just an examination of the affected joint. Associated medical conditions also need to be identified and addressed. These comorbidities directly impact the outcome of rehabilitation. Communicating with the patient's primary care physician ensures that there is continuity of treatment of associated medical conditions. Medications may need to be changed or modified, depending on the patient's vital signs and laboratory profiles. Pain control Adequate analgesia for the patient should be a priority during rehabilitation.2 It must be remembered that these patients have undergone a major joint reconstruction and may experience moderate to severe pain. The administration of analgesics should be performed around the clock rather than just on an as needed (prn) basis. With prn dosing schedules, the analgesics are usually given too close to the time that the patients are seen for therapeutic exercises. Patients complain of pain and are not as cooperative as they would have been had they been following a regular pain medication schedule. Determination of the cause of pain is a very important aspect of pain treatment. The physician may want to take the following questions into consideration: Is the patient suffering from pain at the operative site or from joint pain, periarticular pain, or neuropathic or radicular pain? Is the pain associated with fever? Is the pain associated with weight bearing or range of motion (ROM)? Is there evidence of a vascular compromise associated with the pain? Standard precautions given to patients to prevent posterior hip dislocation include the following: • Do not cross your legs. • Put a pillow between your legs if you lie on your side. • Do not turn your leg inward. • Sit only on elevated chairs or toilet seats. • Do not bend over from the hips to reach objects or tie your shoes. • An assistive device or reacher is necessary to safely perform activities of daily living (ADL). • In some patients at risk for hip dislocation, individualized precautions are necessary, and the use of a hip abduction brace may be required. Rehabilitation Exercise Protocols A number of exercise protocols are used by various institutions; • Total hip replacement protocol • Preoperative (1-2 weeks prior to surgery) • Preoperative education about the surgical process and its outcomes • Instruction on a postoperative exercise program • Instruction on total hip precautions - The following instruction points apply to the posterior surgical approach to the hip. With the anterior hip approach, the patient can cross his or her legs and internally rotate the hip, although positions that involve extreme hip extension and external rotation will dislocate the hip. • No hip flexion beyond 90° • No crossing of the legs (hip adduction beyond neutral) • No hip internal rotation past neutral • Assessment of the home environment Total knee replacement exercise protocol Preoperative (1-2 weeks prior to surgery) Education on the surgical process and outcomes Instruction on a postoperative exercise program Assessment of the home environment Postoperative (day 1) Bedside exercises - For example, ankle pumps, quadriceps sets, and gluteal sets Review of weight-bearing status Bed mobility and transfer training - Bed to/from chair Postoperative (day 2) Exercises for active ROM, active-assistive ROM (AAROM), and terminal knee extension Strengthening exercises - For instance, ankle pumps, quadriceps sets, gluteal sets, heel slides, straight leg raises, and isometric hip adduction Gait training with an assistive device and functional transfer training - Such as sit to/from stand, toilet transfers, bed mobility) Postoperative (days 3-5 or on discharge to the rehabilitation unit) Progression of ROM and strengthening exercises to the patient's tolerance Progression of ambulation on level surfaces and stairs (if applicable) with the least restrictive device14 Progression of ADL training Postoperative (day 5 to 4 weeks) Strengthening exercises (seated leg extensions, standing hip abduction and extension, knee bends, short arc quads) Stretching of quadriceps and hamstring muscles Progression of ambulation distance Progression of independence with ADL total joint arthroplasty, knee replacement, hip replacement, arthroplasty, joint replacement, total knee replacement, total hip replacement, knee arthroplasty, hip arthroplasty, total hip arthroplasty, total knee arthroplasty, knee replacement recovery, hip replacement recovery, cemented joint replacement, cemented joint arthroplasty, ingrowth joint replacement, ingrowth joint arthroplasty, cementless joint replacement, cementless joint arthropathy, primary joint replacement, primary joint arthroplasty Contact Details: A+ ORTHOPAEDIC AND SPORTS MED CLINIC C2/5 Safdarjung Development Area (SDA), Aurobindo Marg, New Delhi - 110016 Telephones: 09810852876, 011-26517776 Email: sportsmedicinedelhi@ sportsmedicineclinics@ Website: http://www.sportsmedicineclinicdelhi.com http://www.sportsmedicineclinicdelhi.com/ http://www.sportsmedicineclinicdelhi.com/ For 24 * 7 help line no : 9810633876 # # # A+ sports medicine clinic is a specialized establishment looking after Orthopaedic problems and taking care of need of all in the field of sports and physical activity. Established in 2002 with view to address all the needs of people of all age group. End
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