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

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

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

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

Porous-coated: allows for ingrowth of bone

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

Exercises PREVENT INFECTIONS Precautions Rehabilitation Exercises PREVENT INFECTIONS Precautions

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

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

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

Normal and diseased knee joint

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

Porous-coated components needed for knee replacement

Identify post-op knee replacement patient care priorities!

Hip, Hip Hooray!

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

Intracapsular Extracapsular capital subcapital basilar transcervical Intertrochanteric

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

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

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

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

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

Preparing for Insertion of the Prosthesis

Total Hip Replacement Total hip replacement, patient guide

Describe the surgical process of insertion of hip prosthesis.

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!

Why is this called a total joint replacement?

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