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ARTHROPLASTY EXAM 2024/2025 QUESTIONS
AND ANSWERS
what is it and what are the most common uses?
reconstruction or replacement of a joint to relieve pain, improve or maintain ROM, and correct deformity. The most common uses of arthroplasty are for patients with OA, RA, avascular necrosis, congenital deformities or dislocations, and other systemic problems.
what are three different types?
including surgical reshaping of the bones of the joints, replacement of part of a joint (hemiarthroplasty), and total joint replacement
replacement arthoplasty is available for what?
elbows, shoulders, phalangeal joints of the fingers, wrists, hips, knees, ankles, and feet.
what can a THA be used for?
OA, RA, and other conditions. Partial and total hip replacements are also used to treat hip fractures.
how is a THA done?
prosthesis (implant) replaces the ball and socket joint and upper shaft of the femur
what is the difference between cemented and non cemented THA?
The socket can be "cemented" in place with polymethyl methacrylate, which bonds to the bone. The socket may also be inserted and not cemented ("cementless"). Cementless THAs may provide longer-term prosthesis stability by facilitating biologic ingrowth of new bone tissue into the porous surface coating of the prosthesis.
who is cementless usually done on? like what age group?
Although some surgeons use cementless devices for all patients, they are most often recommended for younger, more active patients and patients with good bone quality where bone ingrowth into the components can be readily achieved.
what is hip resurfacing?
An alternative to hip replacement is hip resurfacing, which allows the femoral head to be preserved and reshaped rather than replaced. (In contrast, in a THA the prosthesis replaces the femoral head.)
-resurfaced femoral head (ball) is then capped by a metal prosthesis
hip resurfacing is perferable in what age groups?
Hip resurfacing is a more favorable option for younger, active patients.
how long do you have to wait after resurfacing to start physical activity again?
after TKA emphasis is placed on what?
PT
Isometric quadriceps setting usually begins the first when?
Isometric quadriceps setting usually begins the first postoperative day
why does the pt progress to straight leg raises and gentle ROM?
The patient progresses to straight-leg raises and gentle ROM to increase muscle strength and obtain 90-degree knee flexion
what does a CPM do?
Active flexion exercises or passive flexion exercises with a continuous passive motion (CPM) machine may promote joint mobility.
full weight bearing is begun before what?
before discharge
HEP includes what?
An active home exercise program involves progressive ROM with muscle strengthening and flexibility exercises.
how does TKA help older patients with OA?
many older patients with advanced OA have shown significant improvement in mobility, motor function tests, and ability to complete daily tasks.
What is used to help restore function in the fingers of the patient with RA? after a finger arthoplasty I guess...
A silicone rubber arthroplastic device is used to help restore function in the fingers of the patient with RA
Ulnar deviation is often present, which results in what?
Ulnar deviation is often present, which results in severe functional limitations of the hand.
The goal of hand surgery is primarily to restore function related to what?
grasp, pinch, stability, and strength rather than to correct cosmetic deformity
what must the patient do before the hand surgery?
Before surgery the patient is instructed in hand exercises, including flexion, extension, abduction, and adduction of the fingers.
If joint replacement is necessary for both elbow and shoulder, the elbow is usually done first because a severely painful elbow interferes with the shoulder rehabilitation program.
Total ankle arthroplasty (TAA) is indicated for who?
RA, OA, trauma, and avascular necrosis
what devices are used for TAA?
several fixed-bearing devices and a mobile-bearing cementless prosthesis. This device more closely imitates natural ankle function.
what is often selected over ankle arthoplasty? why is TAA advantageous?
Ankle fusion is often selected over arthroplasty because the result is more durable. However, the patient is left with a stiff foot and the inability to change heel height
- TAA is advantageous because it achieves a more normal gait pattern
Postoperatively, the patient may not bear weight for how long? how must the ankle be positioned? what should be prevented?
Postoperatively, the patient may not bear weight for 6 weeks and must elevate the extremity to reduce and prevent edema, be extremely careful to prevent postoperative infection, and maintain immobilization as directed by the physician.
Arthrodesis and its indications?
Arthrodesis is the surgical fusion of a joint. This procedure is indicated only if articular surfaces are too severely damaged or infected to allow joint replacement or if reconstructive surgery fails.
Arthrodesis relieves pain but does what to the joint?
Arthrodesis relieves pain and provides a stable but immobile joint.
in arthrodesis how is the fusion accomplished?
The fusion is usually accomplished by removal of the articular hyaline cartilage and the addition of bone grafts across the joint surface.
in arthorodesis the affected joint must be immobolized how long?
The affected joint must be immobilized until bone healing has occurred.
athrodesis common areas?
Common areas of fusion are wrist, ankle, cervical spine, lumbar spine, and metatarsophalangeal (MTP) joint of the great toe.
most common complication of joint surgery?
infection second is thromboembolism
Postoperatively, perform what assessment and for what reason?
Postoperatively, perform neurovascular assessment to assess nerve function and circulatory status.
what meds are given after the surgery?
Anticoagulation therapy, analgesia, and parenteral antibiotics are administered
how soon is the affected joint exercised and moved?
In general, the affected joint is exercised and ambulation is encouraged as early as possible to prevent complications of immobility. Specific protocols vary according to the patient, type of prosthesis, and surgeon preference.
post op pain management techniques?
may include epidural or intrathecal analgesia, femoral nerve block, patient-controlled IV analgesia, and oral opioids or NSAIDs. Assess patient comfort frequently during the postoperative period.
The hospital stay after arthroplasty is?
The hospital stay after arthroplasty is 3 to 5 days depending on the patient's course and need for physical therapy.
PT and ambulation enhance what?
enhance mobility, build muscle strength, and reduce the risk of thromboembolism.
If the patient is taking warfarin, therapy starts when?Prothrombin time is measured when?
If the patient is taking warfarin, therapy starts on the day of surgery, and prothrombin time is measured on a regular basis.
For those taking LMWH (e.g., enoxaparin), therapy starts when? how often is everything measured?
For those taking LMWH (e.g., enoxaparin), therapy starts soon after surgery and continues for 2 weeks postoperatively. Daily monitoring of the patient's coagulation status is not necessary when the patient is taking LMWH.
patient must realize what before surgery?
realizes that in some cases surgery will not remove or treat the underlying disease
explain what to the patient before surgery?
Explain postoperative procedures such as turning, deep breathing, use of bedpan and bedside commode, and use of abductor pillows. Provide opportunities for practice.
A preoperative visit from a physical therapist allows what?
what is Synovectomy
Synovectomy (removal of synovial membrane) is used as a prophylactic measure and as a palliative treatment of rheumatoid arthritis (RA).
A synovectomy is best performed when? What does it do to help?
best performed early in the disease process to prevent serious destruction of joint surfaces. Removal of the thickened synovium prevents extension of the inflammatory process into adjacent cartilage, ligaments, and tendons.
can you remove all the synovium in a joint?
no, it is impossible
An osteotomy is whaT?
An osteotomy involves removing a wedge or slice of bone to change alignment (joint and vertebral) and to shift weight bearing, thereby correcting deformity and relieving pain.
post op care for osteotomy?
similar to the treatment of an internal fixation of a fracture at a comparable site. Internal wires, screws and plates, bone grafts, or an external fixator usually fixes the bone in place.
what is debirdement? What is it usually performed on?
removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerated menisci from a joint. This procedure is usually performed on the knee or shoulder using a fiberoptic arthroscope.
debridement: in or outpatient? what is applied after surgery? Weight bearing when? Teach patient what? restrict excessive activity for how long?
-The procedure is usually done on an outpatient basis. -A compression dressing is applied postoperatively. -Weight bearing is permitted following knee arthroscopy.
-Patient teaching includes monitoring for signs of infection, managing pain, and restricting excessive activity for 24 to 48 hours.
typical daignostics?
Xrays
MRI
Disk0gram (cervical issues)
CT
Myelogram
Bone Density Measurements
Bone Scan
Arthroscopy
x4 indications for surgery?
Chronic Pain relief
Improving Joint motion/function
Expected Course of Recovery
Assistive Device Use
Discharge Planning
top three complications?
#1 Infection
#2 Thromboembolism
#3 Neurovascular compromise
home care
Pain Control
Monitor for Infection
Prevent DVT
Anticoagulation (LMWH)
Prophylactic antibiotics for invasive dentist/invasive procedures
pt
Assess ROM
Ambulation
Compliance with the exercise regimen.
main indication for knee arthoplasty?
Unremitting pain and Joint instability
Main indication for procedure
