ARTHROPLASTY (HIP AND KNEE)

1
ARTHROPLASTY (HIP AND KNEE)
2

• Definition
• An operation to regain or maintain motion in a
  chronically painful joint (degenerative joint
  disease) by means of replacing one or both joint
  surfaces.
• Replacement arthroplasty
• Replacement of one (hemiarthroplasty) or both
  joint surfaces (total joint arthroplasty) or
  prosthetic joint replacement.

3

• N.B Arthrodesis (not a type of
  arthroplasty)
• when a single joint is severely damaged and
  painful, or completely unstable and disabling,
  and when loss of its motion would not interfere
  significantly with the patient's function, it can
  be fused by producing bony union across it's
  surfaces in the optimum position of function.
• Indications of replacement
• Severe intolerable pain
• Loss of function
• Severe deformities
• Contraindications
•  Absolute gt gt gt gt children
• Relative gt gt gt gt young adults
• Problems
•  Loosening
• Wear and tear

4
Rehabilitation of Patients AfterTotal Joint
Replacement

• A-Before Surgery
• The patient should be instructed in use and
  protection of the affected hip in respect to the
  specific surgical procedure.
• The patient should be instructed in all
  postoperative exercises to be performed.
• These may include coughing and breathing
  exercises, ankle range of motion exercises, bed
  mobility exercises and lower limb strengthening
  and range of motion activities. Proper
  positioning of the joint should be stressed.

5

• B-After the Surgery
• The exercises and activities learned
  preoperatively should be performed in a
  progressive manner in accordance with the
  patient's tolerance, the surgical procedure
  performed, and the surgeon's judgment.
• Physical therapy should be given twice a day.
• A general plan of postoperative treatment
  progression for a patient who has received a
  total hip replacement follows

6

• Day 1
• Use a pillow or wedge to prevent adduction at all
  times.
• Perform breathing exercises.
• Perform active foot and ankle range-of-motion
  exercises.
• Perform strengthening exercises for upper limbs
  and non operated limb.
• Perform isometric exercises of major muscle
  groups on operated side.
• Review proper methods of moving in bed.
• Transfer to built-up chair cautiously.
• Avoid any position of instability.
• Move toward nonoperated side during bed
  activities and transfers.
• Avoid painful movements
• Avoid internal rotation.

7

• Day 2
• Initiate partial weight bearing as tolerated
• Begin active range of motion
• Avoid adduction.
• Limited flexion to 30 degrees.
• Avoid extension if anterior surgical approach was
  used.
• Avoid resisted abduction for 3 weeks if
  trochanteric osteotomy was done
• Day 3
• Continue all previous exercises.
• Begin resisted range of motion noting previous
  precautions.
• Begin home instructions related to transfers,
  automobile transfers, and so forth.

8

• Day 4
• Continue previous activities.
• Progress hip flexion to 60 degrees on day 6 and
  to 90 degrees on day 10. Do not exceed 90 degrees
  of flexion.
• Upon return to home, the patient should be
  instructed to avoid specific activities and
  positions "These include
• Do not sit in low chairs.
• Do not sleep on your side.
• Do not cross your legs.
• Do not flex your hips more than 90 degrees.
• Do not force your hips to bend.
• Do not drive.
• Do not climb into the bath tub.
• Do not squat.
• Do not do exercises not given by the physical
  therapist

9
Rehabilitation of Patients After Total Knee
Replacement

• Total knee replacement (TKR) or Total knee
  Arthroplasty (TKA).
• The rehabilitation of patients who have undergone
  TKA surgery takes place in three phases
• Early motion, moderate protection, and return to
  activity. The goal of these phases is
• To promote a maximal degree of knee joint
  mobility while allowing sufficient bone in growth
  within the intra articular prosthesis to ensure
  sufficient knee joint stability.

10

• I) Early Motion Phase
• This phase begins immediately after surgery and
  emphasizes
• muscle reeducation
• Initiation of knee joint motion,
  and
• Reduction of postsurgical joint swelling.
• Through
• Quadriceps and Hamstrings co contraction
  exercises.
• Electric muscle stimulation could be used.
• Multiple angle isometrics (MAI) within the
  available pain-free range of motion.
• Straight leg raising.
• Continuous passive movement (CPM) to reduce
  swelling and increase range of motion.

11

• 6) Ambulation for cemented knee prosthesis,
  weight bearing is allowed to the level of
  patient's tolerance.
• 7) For cementless knee prosthesis, ambulation
  gradually progresses from non weight bearing to
  toe touch and then one quarter of body-weight
  bearing across the duration of rehabilitation
  phase.
• 8) For both prostheses, assistive device, such as
  crutches, canes, or walkers, are used during
  ambulation.
• 9) The early motion phase ends at the sixth week
  after TKA surgery.

12

• II) Moderate Protection Phase
• This phase, which encompasses postsurgical weeks
  7 to 12, continues the processes of muscle
  conditioning and joint mobilization and also
  emphasizes progressive ambulatory activities
  based on the stages of tissue healing.
• Patients with cemented prosthesis may be
  gradually weaned from dependence on assistive
  devices for ambulatory activities.
• Advanced to bicycle ergometry
• Aquatic therapeutic procedures.

13

• Patients with a cementless knee prosthesis
• (The rehabilitation program must parallel the
  time frame of fracture healing)
• Progress to 50 weight bearing by the end of week
  8.
• Progress to 75 weight bearing by the end of week
  10.
• Progress to 100 weight bearing without the use
  of assistive device by the end of the phase in
  week 12.

14

• III) Return to activity phase
• This phase which begins in the 13th week after
  TKA and lasts until patient's knee function has
  been normalized or optimized, emphasizes
  maximizing full activity for the rehabilitating
  patient.
• Muscle conditioning may advance through
  short-arc, isotonic, isokinetic activities to
  ensure sufficient dynamic stability of the knee
  complex.
• Bicycling.
• Swimming, aquatic therapy.
• Fitness walking to increase the degree of knee
  joint motion and cardiovascular fitness.
• Proprioception activities in a closed kinetic
  chain.
• Work conditioning procedures to prepare the
  patients for successful return to activities of
  daily life.

15
ROM exercises