Arthroplasty
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arthroplasty Arthroplasty Submitted by:Submitted Arya Kirtiby:_ Lal
B.O.T.Amit 2nd year Kochhar Pt. D.D.U. I.P.H . B.O.T. 2nd year Pt. D.D.U. I.P.H.
Introduction
Arthroplasty is the operation for construction of a new movable joint. It is not applicable to every joint: in practice, its use is almost confined to the shoulder, the elbow, the hip, the knee, certain joints in the hand, and the metatarso-phalangeal joints in
Indications
The indications for arthroplasty are not well defined, for there is considerable diversity of opinion among different surgeons. Broadly, it has a use in the following conditions:
Advanced osteoarthritis or rheumatoid arthritis with disabling pain, especially in the shoulder, elbow, hip, hand and metatarsophalangeal joints; For the correction of certain types of deformity (especially hallux valgus); Quiescent tuberculous arthritis especially of the elbow or hip; Certain ununited fractures of the neck of the femur. It will be released that in several of these conditions arthroplasty is an
Methods of arthroplasty
Three methods are in general use: excision arthroplasty; half-joint replacement arthroplasty; and total replacement arthroplasty. Each has its merits; disadvantages and special applications.
Excision arthroplasty
In this method one or both of the articular ends of the bones are simply excised, so that a gap is created between them. The gap fills with fibrous tissue, or a pad of muscle or other soft tissue may be sewn in between the bones. By virtue of its flexibility the interposed tissue allows a reasonable range of movement, but the joint
The method is applicable to all the joints for which arthroplasty is practicable except the knee and ankle. It is used most commonly at the metatarso-phalangeal joint of the great toe, in the treatment of hallux valgus and hallux rigidus. At the hip it may be used as a salvage operation after failed replacement arthroplasty.
Half-joint replacement arthroplasty
In half-joint replacement arthroplasty one only of the articulating surfaces is removed and replaced by a prosthesis of similar shape. The prosthesis is usually made from metal (as in replacement of the femoral head), occasionally from silicone rubber (as in replacement of A carpal bone); and when appropriate it may be fixed into the
The opposing, normal articulating surface is left undisturbed. The technique has its main application at the hip, where prosthetic replacement of the head and neck of the femur is commonly practiced for femoral neck fracture in the elderly. It has rather a limited use elsewhere, an example being the replacement of the lunate bone by a silicone-rubber
Total replacement arthroplasty
In this technique both of the opposed articulating surfaces are excised and replaced by prosthetic components. In the larger joints one of the components is normally of metal and the other of highdensity polyethylene, and it is usual for both components to be held in place by acrylic 'cement'. In small joints such as the metacarpophalangeal joints a flexible one-piece prosthesis made from silicone rubber may be used.
Total replacement arthroplasty has proved very successful at the hip and to a lesser extent at the knee. It has been extended, so far with only moderate success, to many other joints including the shoulder, elbow, ankle, metacarpo-phalangeal joints and metatarso-phalangeal joints. A disadvantage which applies also to halfjoint replacement arthroplasty-is that there is a tendency for the prosthesis to work loose after a variable time that cannot be predicted. A well-fitted replacement joint may,
Arthroplasty in hip fracture A comprehensive study
General Anatomical Overview
The hip is one of your body's largest weight-bearing joints. Consists of two main parts: a ball (femoral head) that fits into a rounded socket (acetabulum) in your pelvis. Ligaments connect the ball to the socket and provide stability to the joint The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.
Hip Anatomy
More…
All remaining surfaces of the hip joint are covered by a thin, smooth tissue called synovial membrane. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint. Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.
Total Hip Replacement
A prosthetic hip that is implanted in a similar fashion as is done in people. It replaces the painful arthritic joint. The modular prosthetic hip replacement system used today has three components – the femoral stem, the femoral head, and the acetabulum. Each component has multiple sizes which allow for a custom fit. The components are made of cobalt chrome stainless steel and ultra high molecular weight polyethylene. Cementless and cemented prosthesis systems are available.
Statistical Overview
First performed in 1960. Since then, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of this surgery.
Subjective Assessment
Pain localized in hip region Exaggerated gait pattern (limp) Increase in pain when weight barring Reduction in the degree of ROM As the degeneration of the joint worsen, individual may be awakened at night with pain Bone spurs may occur
Objective Assessment
Gait pattern – Adaptive walking pattern that reduces pressure on the affected side. Muscle atrophy – Muscles in affected area are not used as much due to pain, therefore, use-it-or-lose-it applies. Active Range Of Motion – Limited ROM, stiffness Passive ROM – End feels causes severe pain X-ray – clear degeneration of the bone MRI – determines underlying
Common Causes of Hip Pain and Loss of Hip Mobility Osteoarthritis
Usually occurs after age 50 and often in an individual with a family history of arthritis. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.
Causes (cont’d) Rheumatoid Arthritis a disease in which the synovial membrane becomes inflamed, produces excessive synovial fluid, and damages the articular cartilage, leading to pain and stiffness.
Causes (cont’d) Traumatic Arthritis
Can leads to a serious hip injury or fracture. A hip fracture can cause a condition known as avascular necrosis. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.
Osteoarthritis
Fracture
Post-Surgery Complications
Thrombophlebitis the blood in the large veins of the leg forms blood clots within the veins. If the blood clots in the veins break apart they can travel to the lung.
Infection in the joint Dislocation of the joint Loosening of the joint
Treatment by OT/PT-Early
Postoperative ExercisesRegular exercises to restore your normal hip motion and strength and a gradual return to everyday activties. Exercise 20 to 30 minutes a day divided into 3 sections. Increase circulation to the legs and feet to prevent blood clots Strengthen muscles Improve hip movement
Exercise Prescription Early Stage
OT/PT Role (cont)
The patient is released few days after the surgery A list of Do’s and Don’ts Hip is sore and weak Start with light exercises Ergonomics: Rearrange furniture in the house to make using crutches easier. Setup a ‘recovery centre’, a table where u put phone, remote control, radio, medication and other essential things that you need. It makes it more accessible.
Educate Clients - Do’s and Don’ts
To avoid hip dislocation: Using 2-3 pillows between your legs when sleeping (roll onto your ‘good side’ Not crossing your legs Use chairs with armrest Not bending forward past 90 degrees Using a high-rise toilet seat if necessary Avoid pronation the legs To avoid stairs, sleep in the living room
Exercise Prescription - Later Stages -
B.O.T.Amit 2nd year Kochhar Pt. D.D.U. I.P.H . B.O.T. 2nd year Pt. D.D.U. I.P.H.
Introduction
Arthroplasty is the operation for construction of a new movable joint. It is not applicable to every joint: in practice, its use is almost confined to the shoulder, the elbow, the hip, the knee, certain joints in the hand, and the metatarso-phalangeal joints in
Indications
The indications for arthroplasty are not well defined, for there is considerable diversity of opinion among different surgeons. Broadly, it has a use in the following conditions:
Advanced osteoarthritis or rheumatoid arthritis with disabling pain, especially in the shoulder, elbow, hip, hand and metatarsophalangeal joints; For the correction of certain types of deformity (especially hallux valgus); Quiescent tuberculous arthritis especially of the elbow or hip; Certain ununited fractures of the neck of the femur. It will be released that in several of these conditions arthroplasty is an
Methods of arthroplasty
Three methods are in general use: excision arthroplasty; half-joint replacement arthroplasty; and total replacement arthroplasty. Each has its merits; disadvantages and special applications.
Excision arthroplasty
In this method one or both of the articular ends of the bones are simply excised, so that a gap is created between them. The gap fills with fibrous tissue, or a pad of muscle or other soft tissue may be sewn in between the bones. By virtue of its flexibility the interposed tissue allows a reasonable range of movement, but the joint
The method is applicable to all the joints for which arthroplasty is practicable except the knee and ankle. It is used most commonly at the metatarso-phalangeal joint of the great toe, in the treatment of hallux valgus and hallux rigidus. At the hip it may be used as a salvage operation after failed replacement arthroplasty.
Half-joint replacement arthroplasty
In half-joint replacement arthroplasty one only of the articulating surfaces is removed and replaced by a prosthesis of similar shape. The prosthesis is usually made from metal (as in replacement of the femoral head), occasionally from silicone rubber (as in replacement of A carpal bone); and when appropriate it may be fixed into the
The opposing, normal articulating surface is left undisturbed. The technique has its main application at the hip, where prosthetic replacement of the head and neck of the femur is commonly practiced for femoral neck fracture in the elderly. It has rather a limited use elsewhere, an example being the replacement of the lunate bone by a silicone-rubber
Total replacement arthroplasty
In this technique both of the opposed articulating surfaces are excised and replaced by prosthetic components. In the larger joints one of the components is normally of metal and the other of highdensity polyethylene, and it is usual for both components to be held in place by acrylic 'cement'. In small joints such as the metacarpophalangeal joints a flexible one-piece prosthesis made from silicone rubber may be used.
Total replacement arthroplasty has proved very successful at the hip and to a lesser extent at the knee. It has been extended, so far with only moderate success, to many other joints including the shoulder, elbow, ankle, metacarpo-phalangeal joints and metatarso-phalangeal joints. A disadvantage which applies also to halfjoint replacement arthroplasty-is that there is a tendency for the prosthesis to work loose after a variable time that cannot be predicted. A well-fitted replacement joint may,
Arthroplasty in hip fracture A comprehensive study
General Anatomical Overview
The hip is one of your body's largest weight-bearing joints. Consists of two main parts: a ball (femoral head) that fits into a rounded socket (acetabulum) in your pelvis. Ligaments connect the ball to the socket and provide stability to the joint The bone surfaces of your ball and socket have a smooth durable cover of articular cartilage that cushions the ends of the bones and enables them to move easily.
Hip Anatomy
More…
All remaining surfaces of the hip joint are covered by a thin, smooth tissue called synovial membrane. In a healthy hip, this membrane makes a small amount of fluid that lubricates and almost eliminates friction in your hip joint. Normally, all of these parts of your hip work in harmony, allowing you to move easily and without pain.
Total Hip Replacement
A prosthetic hip that is implanted in a similar fashion as is done in people. It replaces the painful arthritic joint. The modular prosthetic hip replacement system used today has three components – the femoral stem, the femoral head, and the acetabulum. Each component has multiple sizes which allow for a custom fit. The components are made of cobalt chrome stainless steel and ultra high molecular weight polyethylene. Cementless and cemented prosthesis systems are available.
Statistical Overview
First performed in 1960. Since then, improvements in joint replacement surgical techniques and technology have greatly increased the effectiveness of this surgery.
Subjective Assessment
Pain localized in hip region Exaggerated gait pattern (limp) Increase in pain when weight barring Reduction in the degree of ROM As the degeneration of the joint worsen, individual may be awakened at night with pain Bone spurs may occur
Objective Assessment
Gait pattern – Adaptive walking pattern that reduces pressure on the affected side. Muscle atrophy – Muscles in affected area are not used as much due to pain, therefore, use-it-or-lose-it applies. Active Range Of Motion – Limited ROM, stiffness Passive ROM – End feels causes severe pain X-ray – clear degeneration of the bone MRI – determines underlying
Common Causes of Hip Pain and Loss of Hip Mobility Osteoarthritis
Usually occurs after age 50 and often in an individual with a family history of arthritis. In this form of the disease, the articular cartilage cushioning the bones of the hip wears away. The bones then rub against each other, causing hip pain and stiffness.
Causes (cont’d) Rheumatoid Arthritis a disease in which the synovial membrane becomes inflamed, produces excessive synovial fluid, and damages the articular cartilage, leading to pain and stiffness.
Causes (cont’d) Traumatic Arthritis
Can leads to a serious hip injury or fracture. A hip fracture can cause a condition known as avascular necrosis. The articular cartilage becomes damaged and, over time, causes hip pain and stiffness.
Osteoarthritis
Fracture
Post-Surgery Complications
Thrombophlebitis the blood in the large veins of the leg forms blood clots within the veins. If the blood clots in the veins break apart they can travel to the lung.
Infection in the joint Dislocation of the joint Loosening of the joint
Treatment by OT/PT-Early
Postoperative ExercisesRegular exercises to restore your normal hip motion and strength and a gradual return to everyday activties. Exercise 20 to 30 minutes a day divided into 3 sections. Increase circulation to the legs and feet to prevent blood clots Strengthen muscles Improve hip movement
Exercise Prescription Early Stage
OT/PT Role (cont)
The patient is released few days after the surgery A list of Do’s and Don’ts Hip is sore and weak Start with light exercises Ergonomics: Rearrange furniture in the house to make using crutches easier. Setup a ‘recovery centre’, a table where u put phone, remote control, radio, medication and other essential things that you need. It makes it more accessible.
Educate Clients - Do’s and Don’ts
To avoid hip dislocation: Using 2-3 pillows between your legs when sleeping (roll onto your ‘good side’ Not crossing your legs Use chairs with armrest Not bending forward past 90 degrees Using a high-rise toilet seat if necessary Avoid pronation the legs To avoid stairs, sleep in the living room
Exercise Prescription - Later Stages -
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