Total Joint Replacement: Introduction (07:44)
Dr. Terry Rzepkowski only sees orthopedic patients in his practice. This program will examine the biomechanics behind needing a total joint replacement, provide videos of surgeries, and give rehabilitation exercise suggestions. Patients who are afflicted with joint issues tend to become depressed and withdraw from society.
Arthritis: Introduction (10:38)
Rzepkowski describes how different conditions affect joints including osteoarthritis, rheumatoid arthritis, and gout. Insurances want those who are afflicted to attempt conservative measures prior to replacements. Symptoms include hot joints, crackling, pain-related fear, morning stiffness, and fear of falling.
Acute Injuries Lead to Arthritis (16:31)
Rzepkowski describes different injuries that can occur to the elbow, wrist, shoulder, hip, knee, and ankle and how surgeons repair it. The AMA recommends drugs for pain management. The Arthritis Foundation of America suggests lifestyle modification, weight training, and physical therapy.
Determining a Baseline (11:22)
Obtain diagnostic imaging, gait evaluation, deformity measurements, and strength measurements. Rzepkowski provides x-rays of the shoulder, knee, and hip joints afflicted with arthritis. Other assessments include using a goniometer, Apley's scratch, ERL's, compression rotation, hip scour, Trendelenburg, and compressional grind tests.
Prior to Surgery Preparations (12:43)
Consider surgery if a patient's pain control is ineffective, has fallen, has a functional gait assessment under 33 or reports pain on the VAS above 7. Analyze bone density, alcohol intake, smoking habits, BMI, age, and general health prior to scheduling surgery. The anterior hip approach, unicompartmental knees, and TKA can be performed as outpatient surgery.
Anatomy and Structures: Shoulder Replacement (17:59)
Rzepkowski discusses anatomy, kinesiology, and surgical procedures for a reverse total shoulder and a traditional anatomical replacement. Proximal rehabilitation can begin before distal. Types of replacements include unconstrained, semi-constrained, and reverse implant
Videos: Shoulder Replacement Surgery (13:02)
Watch a video about the efficacy of a reverse total shoulder replacement, which provides rotator cuff support. Another video demonstrates the anterior approach where surgeons perform an osteotomy of the humeral head.
Post-operative: Shoulder Replacement Surgery (09:30)
A post-op sling is required for four to six weeks; a recliner is easier to sleep in than a bed. Watch a video on post-operative instructions and positioning. Therapeutic exercises include ball squeezes, shoulder circles, active wrist, pronation, and supination movements.
Videos: Elbow Arthroplasty (10:22)
Rzepkowski discusses anatomy, kinesiology, and surgical procedures for a total elbow replacement. Watch a video demonstrating the procedure. Postoperatively protect the elbow using a range of motion device; consider advocating patients purchase a cold re-circulator.
Rehabilitation: Elbow and Shoulder Arthroplasty (18:09)
Rzepkowski provides therapeutic exercises to give patients after surgery that stretch the upper trapezoids, scapula, and mid-back. Based on PNF, rhythmic initiation and repetitive contractions can strengthen shoulder muscles three to five days post-surgery. Isometric resistance can help active initiation; participants divide into groups to practice the exercises.
Videos: Hip Breaks (12:23)
Rzepkowski discusses anatomy and kinesiology for hip replacements. Watch a video of an intertrochanteric fracture fix using a screw. There are no motion precautions because surgeons do not need to dislocate the joint.
Videos: Posterior Hip Arthroscopy (12:24)
Watch videos of a posterior approach to hip replacement surgeries using a ceramic acetabular cup. Rzepkowski describes the benefits and drawbacks.
Videos: Lateral Hip Arthroscopy (10:12)
Watch videos of a lateral approach to hip replacement surgery using a ceramic acetabular cup. Rzepkowski describes the benefits and drawbacks. The anterior approach requires instruments that are angled differently.
Videos: Anterior Hip Arthroscopy (15:44)
Watch videos of an anterior approach to hip replacement surgeries using the Smith Peterson approach. Rzepkowski describes the benefits and drawbacks.
Anterior Hip Arthroscopy Revision (08:27)
Watch a video describing the procedure. A hip revision has the most amount of restrictions and precautions. Surgeons harvest extra bone mush from the Iliac crest.
Videos: Knee Arthroscopies (16:56)
Surgeons remove the meniscus, labrums, and cruciate ligaments in a total knee replacement. Rzepkowski discusses anatomy and kinesiology. Watch videos of the conventional pair patellar, subvastus, deuce procedure, and unicompartmental surgeries.
Robotic Assisted Procedures (04:56)
Watch videos of a hip replacement using MAKO technology and a knee replacement using GPS.
Videos: Ankle Arthroscopy (07:03)
Watch a video of a total ankle replacement. Physical therapists can perform active range of motion and isometrics on the joint right away as long as it is non-weight bearing.
Early Acute Phase Post-Operative (17:32)
Rzepkowski explains how to adjust canes, front-wheeled walkers, and standard axillary crutches; use skis not tennis balls on walkers. Assess the wound for fever, redness, and excessive draining during dressing changes. Various medications include Exparel, femoral nerve blockers, epidurals, abductor nerve blocks, PCA pumps, NSAIDs, and opioid analgesics.
Rzepkowski explains how to diagnose, grade, and prevent deep vein thrombosis using thromboembolic deterrents hose and muscle pumps. Further evaluation is required if the Well's Scoring is over two. Aprotinin and Tranexamic acid can chemically help combat blood loss.
Surgical Complications (06:31)
Problems associated with joint replacement surgery include infection, cellulitis, wound closure, dislocations, separation, and medication reactions. Rzepkowski describes how to diagnose and treat various issues. A compression dressing can help reduce draining issues.
Acute through Sub-acute Recovery Phase: Shoulder Replacement Surgery (30:46)
Work on proximal stability before focusing on distal mobility. Manage pain without chemicals by applying ultrasound and cold. Rzepkowski demonstrates exercises to teach patients to strengthen the shoulder joint and surrounding muscles.
Acute through Sub-acute Recovery Phase: Gait Abnormalities (13:41)
The stance phase of the gait cycle includes initial heel contact, flat foot, mid-stance, heel off, and toe-off; during the swing phase, the gluteus medius keeps the pelvis level. Rzepkowski explains how to educate patients on the gait cycle and possible interventions. Work on proximal stability before focusing on distal mobility.
Acute through Sub-acute Recovery Phase: Hip Replacement (12:53)
Core abdominal muscles tend to be weak, while lateral hip muscles are tight. Give patients the waving willow exercise early to loosen muscles. Rzepkowski demonstrates several exercises to improve lower extremity muscle strength and joint stability.
Acute through Sub-acute Recovery Phase: Improving Mobility (14:01)
Assess what needs strengthening and what needs stretching. Rzepkowski demonstrates several exercises for the quadriceps, using lunges and Theraband resistance; avoid deep knee bends. Write soft tissue mobilization on PT forms instead of massage.
Out-Patient and Beyond (14:06)
Rzepkowski describes a recent study examining why surgical costs vary so much in joint replacement surgery. Doctors may choose different types of prosthesis.
Future of Joint Replacement and Rehabilitation (24:44)
Recent innovations include the ConforMIS process, cruciate sparing total knee replacements, robotic surgical assistants, 3-D imaging, stem cell, and bio-ingrowth materials. Rzepkowski describes benefits and drawbacks. Watch videos about the new techniques.
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