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Joint Replacement n Arthroplasty: Joint reconstruction n Osteotomy: change bone alignment n Prosthesis: cemented, noncemented.

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Presentation on theme: "Joint Replacement n Arthroplasty: Joint reconstruction n Osteotomy: change bone alignment n Prosthesis: cemented, noncemented."— Presentation transcript:

1 Joint Replacement n Arthroplasty: Joint reconstruction n Osteotomy: change bone alignment n Prosthesis: cemented, noncemented

2 Arthrodesis Definitions: Bones of joint fuse, no articular cartilage. Pseudoarthrodesis: fibrous union When and why would an arthrodesis be done?

3 Prosthesis n Porous coated –Non-cemented –Better fit –Bone MUST heal –Delay full ambulation n Non-porous coated –Use methylmetha- crylate (cement) –Early ambulation

4 Cemented or non-porous coated prosthesis No bone healing for cemented prosthesis

5 Porous-coated: allows for ingrowth of bone

6 Joint Replacement n Pre-op –Generally elective –Assessment –Diagnostic work- up –Teaching –Discharge planning n Post-op –Anesthesia –Assessment blood loss/wound –Blood admin. –Pain management –Prevent complications

7 Rehabilitation Exercises PREVENT INFECTIONS Precautions

8 Common Joint Replacements n Fingers n Shoulder –Dec. pain, inc. mobility –Slow rehabilitation –Post-op care

9 Shoulder Post-op Care n Assessment CMS n Pain Management n Wound Drainage n CPM n Infection Prevention n EXERCISE

10 KNEE REPLACEMENT n Pre-Post-op care –Pain management –Assess CMS, drainage –Prevent resp. complications, DVT –EXERCISES Knee replacement, patient guide

11 Normal and diseased knee joint

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

13 Porous-coated components needed for knee replacement

14 Identify post-op knee replacement patient care priorities!

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16 Hip, Hip Hooray!

17 Hip Fracture/Hip Replacement n Causes of Falls n Hip anatomy –Intracapsular –Extracapsular n Ligaments n Intracapsular –capital –subcapital –basilar –transcervical n Extracapsular –Shortened, externally rotated, flexed, abducted –Strong abductors displace –Intertrochanteric

18 Intracapsular capital subcapital basilar transcervical Extracapsular Intertrochanteric

19 Hip Fracture/Hip Replacement n Blood supply –Medial circumflex –Lateral circumflex –Fovealar n Blood supply determines healing!

20 Recognition Hip Fractures Shortened, externally rotated, flexed, abducted Strong abductors displace! Pain, swelling, ecchymosis *Type fracture, displacement effect

21 Initial Assessment for Hip Fracture n What factors should your assess? n What is Priority? n Treatment Options: –ORIF: pins, plates, screws –Femoral head replacement –Maybe total joint replacement n Pre-op Care

22 Post-op Care: ORIF/Joint Replacement n Post-op ORIF –Blood loss –Pain –Positioning –Tissue perfusion –Complications –Exercise

23 Repair of Hip Fractures; ORIF or Prosthesis Compare the nursing care of patient with joint prosthesis and Joint Replacement.

24 Total Hip n Types of Prosthesis n Pre-op Preparation n Intra-op considerations: approach, methylmethracrylate n Post-op Nursing Care: –Complications: blood loss –Neurovascular integrity –Potential dislocation: Prevent hip flexion, internal rotation –Weight bearing –Prevent DVT –Heterotrophic ossification

25 Preparing for Insertion of the Prosthesis

26 Total Hip Replacement Total hip replacement, patient guide

27 Describe the surgical process of insertion of hip prosthesis.

28 Critical Pathways! n 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!

29 Why is this called a total joint replacement?

30 Keys to Care n Prevent dislocation! n Progressive activity n Prevent infection! Long term considerations n ? If little or no drainage post-op, what to do?

31 Discharge Instructions Total Hip n Do Not –Force hip more than 90 degrees –Force into adduction –No internal rotation –Put on own shoes, stockings for 8 wks n Do –Use elevated toilet seat –Sleep with pillow between legs for 1st. 8 wks –Keep hip neutral –Use prophylactic antibiotics –EXERCISE

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