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20.2 Joint Arthroplasty: Advances in Surgical Management and Rehabilitation
Table of Contents

HIP ARTHROPLASTY

Abstract:

CONTENT: In the monograph, Dr. Heislein first reviews the anatomy and biomechanics of the hip as an introduction to indications and prevalence for hip joint arthroplasty. Physical examination considerations and the role of imaging in hip osteoarthritis follow. Conservative intervention strategies are then reviewed along with prognostic indicators for hip arthroplasty. Common surgical procedures and approaches are then explained in the context of advantages and disadvantages of each procedure and their implications on rehabilitation. Dr. Heislein also informs the reader of potential complications following arthroplasty procedures. Preoperative and postoperative rehabilitation strategies and guidelines on exercise and functional progression are then discussed. The remaining portion of the monograph addresses common outcome measures for hip arthroplasty and also the author's opinion on future directions in this area. The content of this work will enable readers to update their current level of knowledge concerning factors that guide rehabilitation and provide an appreciation for the role of effective communication and teamwork among health care providers, the patient, and their family. Despite the assumption that all postoperative arthroplasty rehabilitation is protocol driven, the unique needs and individual characteristics of each patient will ultimately influence the success of the specific rehabilitation program that is developed. CASE ANALYSES: Three case studies assist in applying the information presented in the monograph. The first case presents a patient who has undergone a total hip arthroplasty. The second case discusses hemiarthroplasty following hip fracture, and the third case illustrates the impact of complications for a revision total hip arthroplasty.

Keywords:​

joint replacement, arthritis, surgery

References:

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SURGICAL MANAGEMENT AND REHABILITATION OF KNEE ARTHROPLASTY

Abstract:

CONTENT: Conservative and surgical management for the patient with knee osteoarthritis are discussed. The surgical section also includes surgical alternatives to knee arthroplasty as well as indications, contraindications, and prognostic indicators to knee arthroplasty. A very detailed discussion of the various surgical procedures and how they impact rehabilitation programs are emphasized. This is followed by an important section on potential complications from knee arthroplasty including infections, deep venous thromboembolism, peripheral nerve injuries, component loosening, extensor mechanism rupture, and the stiff knee. Common outcome measures and return to function considerations are discussed. A very comprehensive section on rehabilitation follows which takes the reader through the perioperative considerations, home health physical therapy, and outpatient physical therapy services. The authors have done an excellent job taking a wealth of information on the broad topic of knee arthroplasty and created a very practical and easy to follow learning resource for the physical therapist. CASE ANALYSES: Two case reports conclude the monograph. The first case describes a 69-year-old male who was seen before surgery, but was also followed for 8 weeks after unilateral total knee arthroplasty. The second case describes a 54-year-old male who receives outpatient physical therapy 3 weeks after a primary, unilateral total knee arthroplasty.

Keywords:​

joint replacement, arthritis, surgery

References:

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MINIMALLY INVASIVE TOTAL HIP AND KNEE ARTHROPLASTY: RATIONALE, TECHNIQUES, AND FORTHCOMING DEVELOPMENTS

Abstract:

CONTENT: In the monograph, Dr. Mears discusses conventional surgical approaches for total hip and knee arthroplasty and leads the reader into the rationale behind minimally invasive total hip and knee arthroplasty in terms of shortened hospital stay, decreased global cost, and accelerated return to gainful employment, and other activities. Minimally invasive surgical techniques are also further described in terms of assets, liabilities, risks, complications, and educational needs. Specific attention is paid to the recent advances in anesthesia for total hip and knee arthroplasty during the preoperative and intraoperative periods and current strategies for postoperative pain management. Dr. Mears then discusses patient factors that influence outcome and would render certain patients to be suited or less suited for shorter stay in hospital and an accelerated recovery associated with minimally invasive surgery. One of the strengths of the monograph is how Dr. Mears not only provides insight into the technical aspects of the surgery but how he frames his explanation of the importance a hospital administration plays in establishing a minimally invasive surgical unit. This also includes specific features of a physical therapy program that are needed for the rapid recovery unit. Future directions including newer implantable materials, implant designs, and surgical techniques, such as surgical navigation and robotic procedures along with topics for further research are also discussed. After reading the monograph the reader will have an objective and insightful perspective on minimally invasive surgery and all the factors that can influence its outcome. CASE ANALYSES: Dr. Mears concludes the monograph with 2 case studies. The first is a 61-year-old man who presents with a 4-year history of insidious onset of pain in the right hip and groin. The other is a 78-year-old woman with a 10-year history of insidious onset of pain in her left hip and left knee. In both cases clinical decisions are highlighted and postoperative timelines and outcomes are discussed.

Keywords:​

joint replacement, arthritis, technology

References:

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TOTAL DISK ARTHROPLASTY ADVANCES IN SURGICAL MANAGEMENT AND REHABILITATION

Abstract:

CONTENT: An introductory review of clinical anatomy and biomechanics of the cervical and lumbar spine as it relates to disk arthroplasty surgical procedures and the preservation of intervertebral motion are covered first. Common pathologies that may be best treated through cervical and lumbar total disk arthroplasty are identified and the importance of patient selection by the surgeon to maximize positive patient outcomes is discussed. An informative section on types of artificial disks follows and a detailed description of the surgical procedures associated with cervical and lumbar total disk arthroplasty, as well as revision surgery, is included. Clinicians will find the section on preoperative and postoperative evaluation and treatment planning to be valuable in working with patients within the constraints of tissue healing. Potential intraoperative and postoperative complications that impact recovery and conditions that necessitate physician referral are also discussed. Even though the literature is largely void of functional outcomes data for these procedures, the authors do a good job citing other relevant and important studies in order to provide guidance in framing the literature to realistic patient scenarios. CASE ANALYSES: Two cases involving one level and two level lumbar disk arthroplasty are presented to assist in integrating the content covered throughout the monograph.

Keywords:​

rehabilitation, cervical surgery, lumbar surgery

References:

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REHABILITATION CONSIDERATIONS FOLLOWING TOTAL ANKLE ARTRHOPLASTY

Abstract:

CONTENT: In their monograph, the authors provide a brief review of the anatomy and biomechanics of the ankle foot complex to give the reader an appreciation for the arthrokinematic intricacies that make this structure so challenging to mimic using arthroplasty procedures. The authors then present advantages and disadvantages of total ankle arthroplasty versus the commonly performed ankle arthrodesis procedure for treatment of severe ankle arthritis. Indications for total ankle arthroplasty are then discussed. The 3 most common surgical procedures for total ankle arthroplasty are then briefly contrasted. Examination, postsurgical treatment planning, interventions, and outcomes scales are reviewed in detail to guide the clinician. Since very little research on intervention effectiveness exists in this area, the authors provide useful insight based on their past treatment experience. As ankle arthroplasty technology improves and outcomes data is collected, many clinicians will find this material useful in staying “ahead of the curve” to optimize patient care. CASE ANALYSES: The authors conclude the monograph with the presentation of 2 interesting case studies. The first involves a 69-year-old active female with a previous history of ankle fracture who had developed significant posttraumatic arthritis of her ankle and subtalar joint. This leads to total ankle arthroplasty, subtalar joint fusion, and tendon Achilles lengthening. The other involves a 65-year-old active female who has undergone bilateral total ankle arthroplasty.

Keywords:​

joint replacement, arthritis, arthrodesis

References:

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SHOULDER ARTHROPLASTY

Abstract:

CONTENT: This monograph covers the pathogenesis, evaluation, and surgical considerations involved in the replacement of the glenohumeral joint. Particular emphasis is placed on understanding the surgical technique for hemiathroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty. Preoperative and postoperative rehabilitation guidelines are discussed based on an understanding of the bony and soft tissue status of the patient and the surgical procedure performed. Surgical precautions during treatments and appropriate rehabilitation assessments to determine proper progression during postoperative rehabilitation are well highlighted. The authors also make the reader aware of the potential surgical and postsurgical complications following shoulder arthroplasty. CASE ANALYSES: Two case studies complete the monograph. The first case describes management of a patient with osteoarthritis of the glenohumeral joint. The second case discusses the evaluation and rehabilitation of a patient following reverse total shoulder arthroplasty.

Keywords:​

joint replacement, arthritis, glenohumeral

References:

Click here.

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