Total Hip and Knee Joint Arthroplasty

By: Bailie Guidry Fall 2013

Indications for Joint Arthroplasty

Osteoarthritis- most common reason. Deals with the
progressive destruction of articular cartilage or the
formation of bone at margins of the joint.
Traumatic injuries
Fractures or breaks in the bone near or at the joint

Signs of Osteoarthritis
Hip:

Painful when internally rotating or flexing.

Morning stiffness

Knee:
Crepitus
Restricted ROM
Bony enlargement
Persistent pain

Exparel
A local analgesic administered during surgery via shot
above and below fascia and subcutaneous tissue. Mainly
helps with soreness from cutting during surgery.
Lasts up to 72 hours post op
Intended to reduce or eliminate opioid usage post op
Patients have more control over there muscles as opposed
to a nerve block
Helps for faster progress in the acute stages of
rehabilitation.

Exparel Cont.
Patients tend to walk further on evaluations and
progress quicker than those on nerve blocks.
Cost efficient-shorter hospital stays due to progression
in therapy and lack of pain.

Before Treatment
Check these lab values:

Hematocrit and Hemoglobin (H&H):

Males: 43-49% & 14.4-16.6

Females: 48-44% & 12.2-14.7

May need blood before treatment if too low.

Heart Rate:60-100 bpm

Physician orders/Progress Notes

If patient had nerve block or Exparel

INR: 2.0 to 3.0

Blood Pressure: 120/80. monitor orthostatic hypotension

when first sitting up.

Total Hip Arthroplasty

Involves replacing the head of the femur and
acetabulum

Total Hip Arthroplasty

Posterior Precautions:

No flexion past 90 degrees

No internal rotation

No adduction

Anterior Precautions: out back

No extension

No external rotation

No abduction

Acute Goals for THR

Promote independence in:

Bed mobility

Dressing

Gait

Chair and toilet transfers

Adaptive device usage (if needed)

Home modifications (if needed)

Practice steps or stairs

Bed side commode

Reaching devices

Tub benches

Acute Phase Exercises

Ankle pumps

Quad sets

Abduction/Adduction (within precaution limits)

Long arc quads

Heel slides

Total Knee Arthroplasty

Arthritis is the most common reason for this surgery.
Involves replacing the femoral condyles and the top of
the tibia.
Inserts metal spacer for gliding.

Total Knee Precautions

Sitting on the floor
Deep squatting
Kneeling
Stressful activities: jogging, running, jumping, heavy
lifting, etc.
Remind patient to keep knee in extension and no
pillows under knees!

Total Knee Arthroplasty

ROM needed for:

Stairs: 90

Low chair: 105

Aim for full extension to 110-120 flexion.

TKR Exercises
Maximal Protection Phase

Ankle pumps

Quad Sets

Straight Leg Raises

Abduction/adduction

Heel slides

Long arc quads

Exercise Progression
Patient specific
Start with 2 sets of 10 or 1 set of 15.
Try to progress by 5 reps each visit, depending on what
the patient tolerates.

Options after discharge

Home Health
Outpatient rehab
Rehab
SNF
All depends on patient preference and progress

Helpful Hints!
Remind the patient to request pain medication 30
minutes to an hour before therapy each day.
Recommend ice for sore patients.

Resources
Melton, J. M. (2011). A retrospective study of an intensive, coordinated postsurgical protocol for total knee replacement patients. (Order No. 3489121,
Central Michigan University). ProQuest Dissertations and Theses, , 121.
Retrieved from http://search.proquest.com/docview/912383039?
accountid=33032. (912383039).
Milidonis, M., Barsoum, W., Gherig, M., Boukis, L., & Klika, A. (2008). RAPID
RECOVERY VS TRADITIONAL PROTOCOL FOLLOWING TOTAL KNEE REPLACEMENT
FOR PERSON WITH ARTHRITIS. The Gerontologist, 48, 142-143. Retrieved from
http://search.proquest.com/docview/210958924?accountid=33032
http://www.physio-pedia.com/Total_Hip_Replacement
http://www.exac.com/patients-caregivers/joint-replacement-surgery/hip-replac
ement/components-hipreplacement
http://www.nlm.nih.gov/medlineplus/ency/article/007256.htm