Joint Replacement

Arthroplasty: Joint reconstruction

Osteotomy: change bone alignment

Prosthesis: cemented, noncemented

Arthrodesis

Definitions: Bones of joint fuse, no articular cartilage.

Pseudoarthrodesis: fibrous union

When and why would an arthrodesis be done?

Prosthesis

Porous coated– Non-cemented– Better fit– Bone MUST heal– Delay full

ambulation

Non-porous coated– Use

methylmetha-crylate (cement)

– Early ambulation

Cemented or non-porous coated prosthesis

No bone healing for cemented prosthesis

Porous-coated: allows for ingrowth of bone

Joint Replacement

Pre-op– Generally

elective– Assessment– Diagnostic work-

up– Teaching– Discharge

planning

Post-op– Anesthesia– Assessment blood

loss/wound – Blood admin.– Pain management– Prevent

complications

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

Causes of Falls Hip anatomy

– Intracapsular– Extracapsular

Ligaments

Intracapsular– capital– subcapital– basilar– transcervical

Extracapsular– Shortened, externally

rotated, flexed, abducted– Strong abductors

displace– Intertrochanteric

IntracapsularcapitalsubcapitalbasilartranscervicalExtracapsularIntertrochanteric

Hip Fracture/Hip Replacement

Blood supply– Medial circumflex– Lateral circumflex– Fovealar

Blood supply determines healing!

Recognition Hip FracturesShortened, externally rotated, flexed, abductedStrong 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

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

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