Professional Documents
Culture Documents
Fracture
INTRODUCTION
DEFINITION OF TERMS
Types of Knee Arthroplasty
Number of Compartments Replaced
Unicompartmental: only medial or
lateral joint surfaces replaced
Bicompartmental; entire femoral and
tibial surfaces replaced
Tricompartmental; femoral, tibial
and patellar surfaces replaced
Implant Design
Degree of constraint
o Unconstrained: no inherent
stability in the implant design;
used
primarily
with
unicompartmental arthroplasty
o Semiconstrained:
provides
some degree of stability with
little compromise of mobility;
most common design used for
total knee arthroplasty
o Fully constrained: significant
congruency of components;
most inherent stability but
considerable
limitation
of
motion
Fixed bearing or mobile-bearing
design
Cruciate-retainingexcising/
substituting
Surgical Approach
Standard/ traditional or minimally
invasive
Quadriceps-splitting or quadricepssparing
Implant Fixation
Cemented
Uncemented
Hybrid
o
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EPIDEMIOLOGY
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ANATOMY/PHYSIOLOGY/KINESIOLOGY
ETIOLOGY
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PATHOPHYSIOLOGY/MECHANISM OF INJURY/PATHOLOGY
Nonunion
fracture,
deformity of the hip
instability
Gaucher's disease
Hemoglobinopathies (sickle cell disease)
Hemophilia
Hereditary disorders
Legg-Calve-Perthes disease
(LCPD)
Osteomyelitis (remote, not active)
Hematogenous
Postoperative
Osteotomy
Renal disease
Cortisone induced
Alcoholism
Slipped capital femoral epiphysis
Tuberculosis
or
Bone tumors
Failure of conservative management or
previous joint reconstruction procedures
(osteotomy,
resurfacing
arthroplasty,
femoral stem hemiarthroplasty, primary
THA)
Absolute
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Relative
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PATHOPHYSIOLOGY/MECHANISM OF INJURY/PATHOLOGY
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DIAGNOSTIC TOOLS/TEST
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DIFFERENTIAL DIAGNOSIS
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MANAGEMENTS
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PHARMACOLOGICAL MANAGEMENT
Features of Minimally
Total Hip Arthroplasty
Invasive
location
and
muscles
Fracture
Tibiofemoral
joint
mobilization
techniques to increase knee flexion or
extension may or may not be appropriate,
depending on the design of the prosthetic
components. It is advisable to discuss the
use of these techniques with the surgeon
before initiating them.
Postpone unsupported or unassisted
weight-bearing activities until strength in
the quadriceps and hamstrings is sufficient
to stabilize the knee.
Prevent vascular
complications.
Patient presentation
Fracture
and
pulmonary
Muscle-setting
exercises
of
the
quadriceps
(preferably
coupled
with
neuromuscular
electrical
stimulation),
hamstrings,
adductors.
and
hip
extensors
and
Active
assisted
ROM
(A-AROM)
progressing to assisted ROM (AROM) of the
knee while seated and standing for
gravity-resisted
knee
extension
and
flexion, respectively.
As weight bearing on the operated lower
extremity permits, wall slides in a standing
position, mini-squats, and partial lunges to
develop control of the knee extensors and
reduce the risk of an extensor lag.
Regain knee ROM.
Heel-slides in a supine position or while
seated with the foot on the floor to
increase knee flexion.
Neuromuscular facilitation and inhibition
technique, such as the agonist-contraction
technique , to decrease muscle guarding,
particularly in the quadriceps, and
increase knee flexion.
Gravity-assisted knee flexion by having
the patient sit and dangle the lower leg
over the side of a bed.
Gravity-assisted knee extension in the
supine position by periodically placing a
rolled towel under the ankle and leaving
the knee unsupported or in a seated
position with the heel on the floor and
pressing downward just above the knee
with both hands.
Gentle inferior and superior patellar
gliding techniques to prevent restricted
mobility.
P R E C A U T I O N : Avoid placing a pillow
under the knee while lying supine or while
seated with the operated leg elevated to
Fracture
Pain assessment
Joint effusiongirth
ROM
Patellar mobility
Gait analysis
Goals
Reduce swelling
ROM 0110 or more
Full weight bearing
4/5 to 5/5 strength
Unrestricted ADL function
Adherence to home exercise program
Interventions
Patellar mobilization
LE stretching program
Closed-chain strengthening
Limited range PRE
Tibiofemoral joint mobilization, if
appropriate and needed
Proprioceptive training
Stabilization exercises
Gait training
Protected
aerobic
exercise
swimming, cycling or walking
muscular
Fracture
activities
while
on
Minimum Protection/Return
Phases: Beyond Week 8
to
Function
Patient presentation
Pain assessment
Muscular strength
Patellar alignment/stability
Functional status
Goals
Improve
cardiopulmonary
endurance/aerobic fitness
Interventions
If
Experienced
Before
Road cycling
Speed/power walking
Low-impact aerobics
Cross-country skiing (machine or
outdoor)
Table tennis
Doubles tennis
Rowing
Bowling, canoeing
Not Recommended***
Jogging, running
Basketball
Volleyball
Singles tennis
Baseball, softball
High-impact aerobics
Stair-climbing machine
Handball, racquetball, squash
Football, soccer
Gymnastics, tumbling
Water-skiing
Highly Recommended*
Stationary cycling
Swimming, water aerobics
Walking
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Precautions
ADL
Do not cross the legs.
Posterior/Posterolateral Approaches
ROM
Avoid hip flexion 80 to 90 and adduction and
internal rotation beyond neutral.
ADL
Traditional THA
of
flexion,
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and
Minimum
Protection
and
muscular
Open-chain
exercises within
the
permissible ranges in the operated leg
against
light
resistance.
Emphasize
increasing the number of repetitions
rather than the resistance to improve
muscular endurance.
Bilateral closed-chain exercises such as
mini-squats against light-grade elastic
resistance or while holding light weights in
both hands when unsupported standing is
permitted.
Nonimpact
aerobic
conditioning
program, such as progressive stationary
cycling, swimming, or water aerobics.
Reduce contractures while adhering
to motion precautions.
Gravity-assisted supine stretch to neutral
in the Thomas test position. Pull the
uninvolved knee to the chest while
relaxing the operated hip. (At least 10 of
hip extension beyond neutral is needed for
a normal gait pattern.)
Resting in a prone position for a
prolonged passive stretch of the hip flexor
muscles when rolling to prone-lying is
permissible and is also tolerable.
Integrate gained ROM into functional
activities.
P R E C A U T I O N : Check with the
surgeon before initiating a stretch of the
hip
flexors
to
neutral
or
into
hyperextension
if
the
patient
has
undergone an anterolateral approach.
Improve postural stability, balance,
and gait.
Emphasize use of a cane (in the hand
contralateral to the operated hip) and
progressive weight bearing on the
operated limb.
While using a cane, walk over uneven
and soft surfaces to challenge the balance
system.
Integrate posture training during
ambulation, emphasizing an erect trunk,
vertical alignment, equal step lengths, and
a neutral symmetrical position of the legs.
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Accelerated Rehabilitation
After Minimally Invasive THA
Preoperative activities.
Prior to surgery, educate the patient
about
the
surgical
procedure
and
postoperative
rehabilitation
program,
wound care, and the home exercise
program. Initiate gait training (weight
bearing as tolerated) using crutches and a
cane.
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REFFERENCES