BY- NISHANT NARAYAN

Arthroplasty is the reconstruction or reshaping of a

damaged or diseased joint.

This elective surgery most often involves joint

replacement ,the implantation of an artificial jt.

candidates who do not respond to other Rx are apt. Primarily to reduce pain in the jt. and to improve the quality of life - adult and juvenile arthritis may need arthroplasty. falls & osteoporosis often cause hip #s in elders that may require partial or total hip replacement. avascular necrosis of head of femur .

Post traumatic arthritis. Hip dysplasia- abnormal hip growth. Primary bone cancer or

metastasis.
Joint deformity. Sports injury.

1)

Single stage bilateral THA- both corresponding jts. are replaced at the same time. Unilateral THA- one jt. is replaced. Hemiarthroplasty- only one part of the jt. is replaced i.e. head of femur may be replaced leaving the natural acetabulum. Minimally invasive surgery Replacement arthroplasty- when a jt. prosthesis wears out or becomes infected another arthroplasty is required to replace it.

2) 3)

4) 5)

6) Interposition arthroplasty- the affected jt is resurfaced with a

piece of patients own body tissue i.e. either a piece of patients skin or tendon is stitched in place between bones of the jt. This keeps the bone from rubbing together and reduces pain.

CEMENTED HIP IMPLANTS- the acetabular as well as the femoral components are fixed with the help of bone cement.(methyl methacrylate). NON-CEMENTED HIP IMPLANTShere bone cement is not used to fix both the components of the hip joint. These are porous & have rough surface area & are coated with osteoconductive substance like HYDROXYAPATITE that encourages the bone to grow and adhere to the implant.

Instead of bone cement the

rough surface of the implant is coated with osteoconductive substance like HYDROXYAPATITE which encourages the bone to grow and adhere into the porous surface.

 PRE-OPERATIVE EVALUATION-

1)
2) 3) 4) 5) 6) 7)

Patients medical history is evaluated. X-ray of both normal & affected hip is taken. Arthrography using a dye can be done to check the blood supply . Bone scan. ECG. Complete blood count(CBC). Urine test.

The patient is 1st taken to the OT & anesthesia is given. Skin around is thoroughly scrubbed with an antiseptic liquid. An incision of appropriate size is then made over the joint
Posterior incision (MOORE). Lateral(HARDING & LIVERPOOL) Anterolateral (WATSON-JONES) Anterior (SMITH-PETERSEN)

The leg is maneuvered until femoral head is dislocated from the socket. A special reamer is then used to remove the damaged cartilage & bone

surface from the acetabulum & the socket is shaped to match the shape of the implant.

REPLACING THE BALL PORTION OF THE JOINT- the implant that replaces the

ball consists of a long metal stem that fits down into the femur.
The metal bar is mounted on top of the stump. REMOVING THE BALL- a special saw is

used to remove the damaged femoral head.

The femoral canal is then drilled & some of the cancellous bone is cleared from the canal & then the inside wall of the canal is molded to fit the shape of the implant stem

The stem implant may be held in

place by either using the special cement for bones or by making it fit very tightly in the canal. Using a special hammer the implant is inserted into the femoral canal tightly.

 When the implants are in place & the ligaments are

properly adjusted, the surgeon sews the layers of tissues back into their proper positions. A plastic suctioning tube may be inserted into the wound to allow liquids to drain from the site during the 1st few hours of surgery.

 Broadly divided into Preoperative,&

Postoperative
PREOPERATIVE REGIME- includes 1)evaluation &

2)education of the patient. EVALUATION-the following parameters are used to evaluate the patient(i) pain (ii)deformity including limb length. (iii)ROM at hip & other related jts. (iv)muscle power & muscle atrophy. (v)ambulation & gait.

 The exact regime of physiotherapy to be followed in

the early postoperative period must be taught. The following regime must be educated to the patient preoperatively(1)deep breathing exercises & coughing to be able to get rid of the post-anesthetic secretions. (2)strong & sustained isometric contractions to the glutei, quadriceps & the hamstrings to improve strength & endurance. (3)guidance in ROM and strengthening exercises for both the limbs to avoid stiffness & incoordination.

 (4)resistive exercises for the ankle & foot on the

affected side & for wt. bearing muscle groups of both the arms, to facilitate early ambulation with walking aids. (5)to teach the proper limb positioning of the operated leg to avoid hip dislocation in the postoperative period. (6)to teach appropriate techniques of transfers . (7)to mentally prepare the patient for the painful active stage ahead.

(i) chest PT. (ii) vigorous toe & ankle movements. (iii) isometrics to quadriceps.

(i) sitting by gradually raising the back rest. (ii) bed transfers. (iii) standing, walking with PWB or TDWB with a walker.

(i) isometrics to glutei. (ii) assisted hip flexion(heel drag) & hip abduction. (iii) initiate prone lying. (iv) Thomas stretch. (v) relaxed passive hip movements.
active hip flexion, knee extension.

PWB walking on crutches with free swinging of the operated leg.

(i) ped-o-cycle or static bicycle(possible free ROM) (ii)staircase climbing going up with GOOD LEG first. Coming down with OPERATED LEG first. (iii) initiate leg rotation in supine & progress to against gravity & against resistance. gradually increase hip abduction and rotation in supine and bed side sitting.

as the stability of prosthesis is achieved within 15 mins of surgery ,weight bearing can be started on a walker immediately on the second day. *Progress to crutch walking up to 6 weeks. *use a cane for 4-6 months. *PWB or TDWB on walker for 6 weeks. *progress to crutch walking & continue upto 12 weeks. *use cane for 4-6 months.

*avoid early initiation of hip adduction & rotation. *use pillow between the legs in resting ,sitting, while turning in bed or weight transfers. *hip flexion ROM to restricted to 80degrees

*initiate Thomas stretch within 2-3 days of surgery. *frequent periods of prone lying.
*initiate isometrics to glutei. *avoid SLR or hip abduction against gravity. *proper gait training. *continue cane support till the limp persists.

THANK U
MAM