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arthroplasty

Arthroplasty
Submitted by:-
Submitted
Arya Kirtiby:_
Lal
B.O.T.Amit
2nd year
Kochhar
Pt. D.D.U. I.P.H
B.O.T. .
2nd year
Pt. D.D.U. I.P.H.
Introduction
 Arthroplasty is the operation for
construction of a new movable
joint.
 It is not applicable to every joint:
in practice, its use is almost
confined to the shoulder, the
elbow, the hip, the knee, certain
joints in the hand, and the
metatarso-phalangeal joints in
Indications
 The indications for arthroplasty
are not well defined, for there is
considerable diversity of opinion
among different surgeons.
 Broadly, it has a use in the
following conditions:
 Advanced osteoarthritis or
rheumatoid arthritis with disabling
pain, especially in the shoulder,
elbow, hip, hand and metatarso-
phalangeal joints;
 For the correction of certain types
of deformity (especially hallux
valgus);
 Quiescent tuberculous arthritis
especially of the elbow or hip;
 Certain ununited fractures of the
neck of the femur. It will be
released that in several of these
conditions arthroplasty is an
Methods of arthroplasty
 Three methods are in general use:
 excision arthroplasty;
 half-joint replacement arthroplasty; and

 total replacement arthroplasty. Each has


its merits; disadvantages and special
applications.
Excision arthroplasty
 In this method one or both of the
articular ends of the bones are
simply excised, so that a gap is
created between them.
 The gap fills with fibrous tissue, or a
pad of muscle or other soft tissue
may be sewn in between the bones.
 By virtue of its flexibility the
interposed tissue allows a reasonable
range of movement, but the joint
 The method is applicable to all the
joints for which arthroplasty is
practicable except the knee and
ankle.
 It is used most commonly at the
metatarso-phalangeal joint of the
great toe, in the treatment of hallux
valgus and hallux rigidus.
 At the hip it may be used as a
salvage operation after failed
replacement arthroplasty.
Half-joint replacement
arthroplasty
 In half-joint replacement arthroplasty
one only of the articulating surfaces
is removed and replaced by a
prosthesis of similar shape.
 The prosthesis is usually made from
metal (as in replacement of the
femoral head), occasionally from
silicone rubber (as in replacement of
A carpal bone); and when
appropriate it may be fixed into the
 The opposing, normal articulating
surface is left undisturbed.
 The technique has its main
application at the hip, where
prosthetic replacement of the head
and neck of the femur is commonly
practiced for femoral neck fracture in
the elderly.
 It has rather a limited use elsewhere,
an example being the replacement of
the lunate bone by a silicone-rubber
Total replacement arthroplasty
 In this technique both of the opposed
articulating surfaces are excised and
replaced by prosthetic components.
 In the larger joints one of the components
is normally of metal and the other of high-
density polyethylene, and it is usual for
both components to be held in place by
acrylic 'cement'.
 In small joints such as the metacarpo-
phalangeal joints a flexible one-piece
prosthesis made from silicone rubber may
be used.
 Total replacement arthroplasty has proved
very successful at the hip and to a lesser
extent at the knee.
 It has been extended, so far with only
moderate success, to many other joints
including the shoulder, elbow, ankle,
metacarpo-phalangeal joints and
metatarso-phalangeal joints.
 A disadvantage which applies also to half-
joint replacement arthroplasty-is that
there is a tendency for the prosthesis to
work loose after a variable time that
cannot be predicted.
 A well-fitted replacement joint may,
Arthroplasty in hip
fracture
A comprehensive study
General Anatomical Overview
 The hip is one of your body's largest
weight-bearing joints.
 Consists of two main parts:
 a ball (femoral head) that fits into a
rounded socket (acetabulum) in your
pelvis.
 Ligaments connect the ball to the socket
and provide stability to the joint
 The bone surfaces of your ball and socket
have a smooth durable cover of articular
cartilage that cushions the ends of the
bones and enables them to move easily.
Hip Anatomy
More…

 All remaining surfaces of the hip joint are


covered by a thin, smooth tissue called
synovial membrane. In a healthy hip, this
membrane makes a small amount of fluid
that lubricates and almost eliminates
friction in your hip joint.
 Normally, all of these parts of your hip
work in harmony, allowing you to move
easily and without pain.
Total Hip Replacement
 A prosthetic hip that is implanted in a
similar fashion as is done in people.  It
replaces the painful arthritic joint. 
 The modular prosthetic hip replacement
system used today has three
components – the femoral stem, the
femoral head, and the acetabulum. 
Each component has multiple sizes
which allow for a custom fit. 
 The components are made of cobalt
chrome stainless steel and ultra high
molecular weight polyethylene.
Cementless and cemented prosthesis
systems are available.
Statistical Overview
 First performed in 1960.
 Since then, improvements in joint
replacement surgical techniques and
technology have greatly increased
the effectiveness of this surgery.
Subjective Assessment
 Pain localized in hip region
 Exaggerated gait pattern (limp)
 Increase in pain when weight barring
 Reduction in the degree of ROM
 As the degeneration of the joint
worsen, individual may be awakened
at night with pain
 Bone spurs may occur
Objective Assessment
 Gait pattern – Adaptive walking pattern
that reduces pressure on the affected
side.
 Muscle atrophy – Muscles in affected area
are not used as much due to pain,
therefore, use-it-or-lose-it applies.
 Active Range Of Motion – Limited ROM,
stiffness
 Passive ROM – End feels causes severe
pain
 X-ray – clear degeneration of the bone
 MRI – determines underlying
Common Causes of Hip Pain
and Loss of Hip Mobility
Osteoarthritis
 Usually occurs after
age 50 and often in
an individual with a
family history of
arthritis. In this form
of the disease, the
articular cartilage
cushioning the bones
of the hip wears
away. The bones
then rub against
each other, causing
hip pain and
stiffness.
Causes (cont’d)
Rheumatoid Arthritis
 a disease in which
the synovial
membrane becomes
inflamed, produces
excessive synovial
fluid, and damages
the articular
cartilage, leading to
pain and stiffness.
Causes (cont’d)
Traumatic Arthritis
 Can leads to a serious
hip injury or fracture.
A hip fracture can
cause a condition
known as avascular
necrosis. The
articular cartilage
becomes damaged
and, over time,
causes hip pain and
stiffness.
Osteoarthritis Fracture
Post-Surgery Complications
 Thrombophlebitis
 the blood in the large veins of the leg
forms blood clots within the veins.
 If the blood clots in the veins break
apart they can travel to the lung.
 Infection in the joint
 Dislocation of the joint
 Loosening of the joint
Treatment by OT/PT-Early
Postoperative Exercises-
 Regular exercises to restore your normal
hip motion and strength and a gradual
return to everyday activties.
 Exercise 20 to 30 minutes a day divided
into 3 sections.
 Increase circulation to the legs and feet to
prevent blood clots
 Strengthen muscles
 Improve hip movement
Exercise Prescription
Early Stage
OT/PT Role (cont)
 The patient is released few days after the
surgery
 A list of Do’s and Don’ts
 Hip is sore and weak
 Start with light exercises
 Ergonomics: Rearrange furniture in the
house to make using crutches easier.
Setup a ‘recovery centre’, a table where u
put phone, remote control, radio,
medication and other essential things that
you need. It makes it more accessible.
Educate Clients
- Do’s and Don’ts -
 To avoid hip dislocation:
 Using 2-3 pillows between your legs when
sleeping (roll onto your ‘good side’
 Not crossing your legs
 Use chairs with armrest
 Not bending forward past 90 degrees
 Using a high-rise toilet seat if necessary
 Avoid pronation the legs
 To avoid stairs, sleep in the living room
Exercise Prescription
- Later Stages -