Arthroplasty

• Surgical removal of a diseased joint and replacement with prosthetics or artificial components made of
metal and/or plastic.
• Total joint arthroplasty (total joint replacement) involves replacement of all components of an
articulating joint.

Total knee arthroplasty

Involves replacement of:
• Distal femoral component.
• Tibia plate.
• Patellar button.
Total hip arthroplasty
Involves replacement of
• Acetabular cup.
• Femoral head.
• Femoral stem.
Hemiarthroplasty
– Half of a joint replacement.
– Fractures of the femoral neck can be treated with the replacement of the femoral component
only.

Indications for Arthroplasty

– Degenerative disease
• Osteoarthritis.
• Rheumatoid arthritis.
– Pain when bearing weight on the joint
• Walking.
• Running.
– Joint crepitus, stiffness, or swelling.
• Goals of both hip and knee arthroplasty
– Eliminate pain.
– Restore joint motions.
– Improve the client’s functional status and quality of life.

Preprocedure:
• Complete blood count (CBC), urinalysis, electrolytes, blood urea nitrogen (BUN), creatinine
– Used to assess the client’s surgical readiness.
– Rule out anemia, infection, or organ failure.
• Chest X-ray
– Used to rule out pulmonary surgical contraindications.
• Electrocardiography (ECG)
– To gather a baseline rhythm to identify cardiovascular surgical contraindications.
• Epoetin alfa can be prescribed preoperatively to increase Hgb.
Preprocedure
• Possible contraindications
– Recent or active infection.
– Arterial impairment to the affected extremity.
– Inability to follow the postsurgery regimen.
– Comorbid condition
• Unstable cardiac or respiratory conditions.

– Risk for venous thromboembolism should also be considered prior to joint replacement surgery
• Previous history.
• Obesity.
• Advanced age.
• Use of medications that increase risk
– Hormone replacement therapy.
– Nonsteroidal anti-inflammatory drugs (NSAIDs).
Intraprocedure
• General or spinal anesthesia may be used.
• Joint components are removed and replaced with artificial components.
• Components may be cemented in place
– Components that do not use cement allow the bone to grow into the
prosthesis to stabilize it.
– Weight-bearing is delayed several weeks until femoral shaft has
grown into prosthesis.
• Artificial joints have a limited life span ranging from 10 to 20 years.

Post Knee Arthroplasty

• Follow precautions to prevent postoperative complications (deep-vein thrombosis, anemia, infection).
• Monitor neurovascular status of surgical extremity every 2 to 4 hr
– Movement.
– Sensation.
– Color.
– Pulse.
• Assess frequently for overt bleeding and signs of hypovolemia
– Hypotension.
– Tachycardia.
• Provide medications as prescribed
– Analgesics.
– NSAIDs.
– Antibiotics.
– Anticoagulants.
• Continuous passive motion machine
– Used to promote motion in the knee and prevent scar tissue formation.
– Usually placed and initiated immediately after surgery.
– Provides passive range of motion from full extension to the prescribed amount of flexion.
• Positions of flexion of the knee are limited to avoid flexion contractures
 – Avoid knee gatch and pillows placed behind the knee.
• Monitor drainage in the autotransfusion drainage system, is used. If the provider prescribes blood
reinfusion, assist Registered Nurse (RN) with monitoring the client according to facility policy.

Post Hip Arthroplasty

• Follow measures to prevent deep-vein thrombosis (DVT) and pulmonary embolism, a life-threatening
complication
– Antiembolism stockings and foot exercises.
• Monitor for other complications:
– Hip dislocation.
– Infection.
– Anemia.
– Neurovascular compromise.
• Check the dressing site frequently, noting any evidence of bleeding.
• Monitor and record drainage from surgical drains.
• Monitor daily laboratory values
– Hgb and Hct can continue to drop 24 to 48 hr after surgery.
• Monitor neurovascular status of the surgical extremity every 2 to 4 hr.
– Movement.
– Sensation.
– Color.
– Pulse.

Post Hip Arthroplasty

• Provide medications as prescribed
– Analgesics.
– NSAIDs.
– Antibiotics.
– Anticoagulants.
• Early ambulation
– Assistive devices (walker) and adaptive devices (raised toilet seat) as indicated.
• Prevent hip dislocation. Use total hip arthroplasty precautions.
• Weight-bearing status is determined by the orthopedic surgeon
– Cemented prosthesis
• Usually partial/full weight bearing as tolerated.
– Non cemented prosthesis
• Usually only partial weight bearing until after a few weeks of bone growth.

Post Hip Arthroplasty

• Do
– Use elevated seating/raised toilet seat.
– Use straight chairs with arms.
– Use an abduction pillow between the legs while in bed and with turning
– Externally rotate the toes.
• Don’t
– Avoid hip flexion greater than 90°.
– Avoid low chairs/seating.
– Do not cross legs.
– Do not internally rotate the toes.

Client Education
• Knee and hip arthroplasty
– Physical therapy to regain mobility.
– Monitor for manifestations of incisional infection.
– Monitor for manifestations of DVT, pulmonary embolism, bleeding.
• Knee arthroplasty
– Dislocation is not common.
– Kneeling and deep-knee bends are limited indefinitely.

• Hip arthroplasty
– Follow all position restrictions to avoid dislocation.
– Arrange for and instruction regarding raised seating and care items designed
to prevent bending past 90°.

Complications
• Monitor the client for symptoms of pulmonary embolism
– Acute onset of dyspnea.
– Tachycardia.
– Pleuritic chest pain.
• DVT prophylaxis
– Pharmacological management.
– Antiembolic stockings and sequential compression devices.
– Ankle exercises while in bed.
– Early mobilization with physical and occupational therapy.
• Because the muscle surrounding the hip joint has been cut to expose and replace the diseased joint,
the client is at risk for hip dislocation
– Monitor for symptoms of dislocation
• Acute onset of pain.
• Client’s report of hearing a “pop.”
• Internal rotation of the affected extremity.
• Shortened affected extremity.