Joint replacement
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Joint Replacement. Arthroplasty: Joint reconstruction Osteotomy: change bone alignment Prosthesis: cemented, noncemented. When and why would an arthrodesis be done?. Arthrodesis. Definitions: Bones of joint fuse, no articular cartilage. Pseudoarthrodesis: fibrous union. Porous coated

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Joint Replacement

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Joint replacement

Joint Replacement

Arthroplasty: Joint reconstruction

Osteotomy: change bone alignment

Prosthesis: cemented, noncemented


Arthrodesis

When and why would an arthrodesis be done?

Arthrodesis

Definitions: Bones of joint fuse, no articular cartilage.

Pseudoarthrodesis: fibrous union


Prosthesis

Porous coated

Non-cemented

Better fit

Bone MUST heal

Delay full ambulation

Non-porous coated

Use methylmetha-crylate (cement)

Early ambulation

Prosthesis


Joint replacement

Cemented or non-porous coated prosthesis

No bone healing for cemented prosthesis


Joint replacement

Porous-coated: allows for ingrowth ofbone


Joint replacement1

Pre-op

Generally elective

Assessment

Diagnostic work-up

Teaching

Discharge planning

Post-op

Anesthesia

Assessment blood loss/wound

Blood admin.

Pain management

Prevent complications

Joint Replacement


Rehabilitation

Rehabilitation

Exercises

PREVENT INFECTIONS

Precautions


Common joint replacements

Common Joint Replacements

  • Fingers

  • Shoulder

    • Dec. pain, inc. mobility

    • Slow rehabilitation

    • Post-op care


Shoulder post op care

Shoulder Post-op Care

  • Assessment CMS

  • Pain Management

  • Wound Drainage

  • CPM

  • Infection Prevention

  • EXERCISE


Knee replacement

KNEE REPLACEMENT

  • Pre-Post-op care

    • Pain management

    • Assess CMS, drainage

    • Prevent resp. complications, DVT

    • EXERCISES

Knee replacement, patient guide


Joint replacement

Normal and diseased knee joint


Joint replacement

Components of knee joint: femoral, tibial (metal tray and plastic tray), patellar (button)


Joint replacement

Porous-coated components needed for knee replacement


Joint replacement

Identify post-op knee replacement patient care priorities!


Joint replacement

Hip, Hip Hooray!


Hip fracture hip replacement

Causes of Falls

Hip anatomy

Intracapsular

Extracapsular

Ligaments

Intracapsular

capital

subcapital

basilar

transcervical

Extracapsular

Shortened, externally rotated, flexed, abducted

Strong abductors displace

Intertrochanteric

Hip Fracture/Hip Replacement


Joint replacement

  • Intracapsular

  • capital

  • subcapital

  • basilar

  • transcervical

  • Extracapsular

  • Intertrochanteric


Hip fracture hip replacement1

Blood supply

Medial circumflex

Lateral circumflex

Fovealar

Blood supply determines healing!

Hip Fracture/Hip Replacement


Joint replacement

  • Recognition Hip Fractures

    • Shortened, externally rotated, flexed, abducted

    • Strong abductors displace!

    • Pain, swelling, ecchymosis

    • *Type fracture, displacement effect


Initial assessment for hip fracture

What factors should your assess?

What is Priority?

Treatment Options:

ORIF: pins, plates, screws

Femoral head replacement

Maybe total joint replacement

Pre-op Care

Initial Assessment for Hip Fracture


Post op care orif joint replacement

Post-op Care: ORIF/Joint Replacement

  • Post-op ORIF

    • Blood loss

    • Pain

    • Positioning

    • Tissue perfusion

    • Complications

    • Exercise


Joint replacement

Repair of Hip Fractures; ORIF or Prosthesis

Compare the nursing care of patient with joint prosthesis and Joint Replacement.


Total hip

Types of Prosthesis

Pre-op Preparation

Intra-op considerations: approach, methylmethracrylate

Post-op Nursing Care:

Complications: blood loss

Neurovascular integrity

Potential dislocation: Prevent hip flexion, internal rotation

Weight bearing

Prevent DVT

Heterotrophic ossification

Total Hip


Joint replacement

Preparing for Insertion of the Prosthesis


Joint replacement

Total Hip Replacement

Total hip replacement, patient guide


Joint replacement

Describe the surgical process of insertion of hip prosthesis.


Critical pathways

Critical Pathways!

  • Fx Hip/ORIF/Partial Hip Replacement

    • Day 1 (ER): 0-4 hrs Eval& schedule surgery; pain control; assess; consults; tests; etc

    • 4-23 hours

    • Day 2 )Post-op Day 1)

    • Day 3 (Post-op Day 2)

    • Day 4 (Post-op Day 3)

    • Day 5 (Post-op Day 4)

    • Discharge by 2 pm!


Joint replacement

Why is this called a total joint replacement?


Keys to care

Keys to Care

  • Prevent dislocation!

  • Progressive activity

  • Prevent infection! Long term considerations

  • ? If little or no drainage post-op, what to do?


Discharge instructions total hip

Do Not

Force hip more than 90 degrees

Force into adduction

No internal rotation

Put on own shoes, stockings for 8 wks

Do

Use elevated toilet seat

Sleep with pillow between legs for 1st. 8 wks

Keep hip neutral

Use prophylactic antibiotics

EXERCISE

Discharge Instructions Total Hip


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