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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

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
slide4

Cemented or non-porous coated prosthesis

No bone healing for cemented prosthesis

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

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
slide18

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
slide20

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
slide23

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
slide26

Total Hip Replacement

Total hip replacement, patient guide

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!
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