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
Intertrochanteric

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