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Joint Replacement Arthroplasty: Joint reconstruction

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Presentation on theme: "Joint Replacement Arthroplasty: Joint reconstruction"— Presentation transcript:

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

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

3 Prosthesis Non-porous coated Porous coated Non-cemented
Use methylmetha-crylate (cement) Early ambulation Porous coated Non-cemented Better fit Bone MUST heal Delay full 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 Post-op Pre-op Anesthesia
Assessment blood loss/wound Blood admin. Pain management Prevent complications Pre-op Generally elective Assessment Diagnostic work-up Teaching Discharge planning

7 Exercises PREVENT INFECTIONS Precautions
Rehabilitation Exercises PREVENT INFECTIONS Precautions

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

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

10 KNEE REPLACEMENT 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!


16 Hip, Hip Hooray!

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

18 Intracapsular Extracapsular capital subcapital basilar transcervical

19 Hip Fracture/Hip Replacement
Blood supply Medial circumflex Lateral circumflex Fovealar 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
What factors should your assess? What is Priority? Treatment Options: ORIF: pins, plates, screws Femoral head replacement Maybe total joint replacement Pre-op Care

22 Post-op Care: ORIF/Joint Replacement
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 Post-op Nursing Care: Types of Prosthesis Pre-op Preparation
Complications: blood loss Neurovascular integrity Potential dislocation: Prevent hip flexion, internal rotation Weight bearing Prevent DVT Heterotrophic ossification Types of Prosthesis Pre-op Preparation Intra-op considerations: approach, methylmethracrylate

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

31 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


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