Introduction: Total Joint Rehabilitation: Matching Intervention to Knee and Hip Impairment — A Lecture (33:39)

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Objectives of this course include evaluating treatment methods for types of degenerative joint disease, 3-D Gait Analysis, cost analysis, and determining patient outcome measures. Total joint replacements are expensive and difficult to schedule at the appropriate time. Review disease progression of osteoarthritis and rheumatoid arthritis for the knee and hip.

Treatment Options (22:52)

Options prior to total joint replacement surgery include bio-logics, acupuncture, hyaluronic injections, selective cox II, orthotics, physical therapy, and weight management. The Food and Drug Administration (FDA) does not regulate supplements. Ask fall risk victims about their eyesight.

Supplements (11:14)

Consider advocating changing eating habits and exercising before resorting to medication. Supplement options include Glucosamine, chondroitin, and Methylsulfonylmethane (MSM). The FDA does not regulate nutritional supplements.

Hyaluronic Injections (07:37)

Prescription medications include Synvisc and Orthovisc. Do not use if allergic to chicken or egg products. This treatment can postpone total knee replacements for years.

Selective Cox II's (12:36)

Meloxicam, Celebrex, Bextra, and Lodine stop enzyme cascade. Side effects include nausea, vomiting, headaches, and constipation. Cox one inhibits the bleeding via platelet aggregation; medication affects people differently.

Physical Therapy (16:08)

The American College of Rheumatology dictates that physical therapy and occupational therapy are effective in combating degenerative joint disease. Facebook can violate HIPAA policies. Increase aerobic activity, postural training, and muscle gain prior to surgery.

Good Total Joint Outcomes (21:44)

Of all functional activities, stepping in and out of the bathtub and sitting to standing from a low chair require more than 110 degrees of motion. Medicare pays for a shower chair but not a commode. Improve flexibility, aerobic capacity, postural reflexes, stabilize the joint, and strengthen the muscles.

Joint Rehabilitation (23:22)

Stretching depends on the patient's range of physical activity. Consider using hamstring and quad balances when providing PT on a total knee replacement; Pain refers between the hip, lumbar spine, pelvis, and knee. There is a seven percent less chance a person will go on disability if they walk for an hour a day.

When It Is Time for Surgery (08:58)

Reasons to have total joint replacement surgery include loss of functional range, lack of baseline function, inability to perform desired activity, and loss of vital mobility. If an individual possesses one Activities of Daily Living (ADL) impairment he or she is likely to die five years sooner. Obesity is shown to have no bearing on functional outcomes after a total knee replacement.

Physical Exam Criteria (11:06)

Address pain, range of motion loss, and quality of life measure outcomes when assessing a patient. Consider a total knee replacement if a patient exhibits pain in the knee, is over 50-years-old, has stiffness for over an hour, or exhibits tenderness or a bony enlargement. Women are more verbal than men and decide where the couple spends their money.

Prehab Benefits (13:30)

Outpatient clinics can only provide individualized care and cannot give group classes. Benefits include improved patient knowledge and preparedness, reducing anxiety and hospital time, exercise introduction, and decreased chance of returning to the doctor. Adjust the walker to function so the patient is standing upright.

Treatment Outcomes (14:29)

Chad Thompson reviews the Lower Extremity Functional Scale (LEFS), Time Up and Go (TUG), Minimal Detectable Important Change (MDIC), Wong Borg Facial, and Minimal Detectable Change (MDC) Tests. Consider having a conversation with a client if scores do not improve. Patients who do not receive their medication in a timely manner have an increased risk of falling.

Critical Pathways for Hospital (14:37)

Guidelines for best practice after surgery include walking 150 feet, verbalizing precautions, and independent transfers; nurses and surgeons have a different set of standards. Hospitals bill insurance companies $150- $220 for every 15 minutes of operative time. The cost of joint replacements varies by state.

Surgical Procedures, Risks, and Expectations (17:26)

Doctors insert a small stem tibial plate, nylon joint, and a femoral plate during knee replacement surgery. During a total hip replacement, surgeons dislocate the patella and put in a ceramic disk. Patients are sore from the surgery, not walking. It takes a year for patients to fully recover from replacement surgery.

Physical Therapy Goals (17:09)

Studies suggest strengthening the adductor magnus and performing Tigny exercises to improve the vastus medialis. Consider examining a patient's lack of limp, gait pattern, and line of progression for the need of an assisted device. Begin scar care immediately in physical therapy because it reduces the threat receiver and increases skin glide.

Gait Cycle (26:13)

The Ranchos Los Amigos created terminology that examines gait as a process of time segments such as loading response, terminal stance, and pre-swing. Gait varies because of age, body type, occupation, and clothing. Consider that the patient may have had an affected walk for years and it will take time to acquire the new skill; toe extension is essential for an efficient walk.

Identifying Gait Impairments (09:28)

Three dimensional gait and motion analysis is a powerful tool in the development of functional rehab programming. Hudl, Coaches Eye, and Dartfish built apps for smartphones; Qualisys and Viacom cost clinics $100,000. Examine the relationship between a patient's hip, pelvis, knee, foot, and ankle.

Specific Patients (23:16)

Three dimensional gait analysis compares several patients to identify impairments. Sometimes removing assisted devices improves a patient's gait and posture. The Thomas Test assesses the length of muscles involved in hip flexion.

Strength Deficits (15:31)

Knee replacement patients possess a high risk of femoral supracondylar fracture. Consider performing fast twitch exercises to improve quadriceps femoral weakness. Hip abductor strength influences total hip and knee function; a dynamometer provides objective data.

Functional Problems and Treatment Solutions (11:26)

Deficits can include abductor hip weakness, limb length difference, muscle contracture, malalignment, flexion contractures, and quadriceps weakness. Thompson demonstrates how to move skin to improve circulation and scar tissue. The Thomas Test assesses the length of muscles involved in hip flexion.

Rehab Exercises (17:54)

A high-intensity, single leg stance, machine-based, longer treatment program demonstrates better results than traditional methods. Best practice functional exercises include quad extensions, bilateral squats, sideline external rotation, hip abduction, lateral stepping, lunges, dorsiflexion, and plantar flexion. Compare before and after videos of a client who chose PT instead of total knee replacement.

Clinical Goals and Post-Operative exercises (23:40)

Train a patient to have the ability to extend 30% of their body weight. Focus on strength as well as promoting rapid force movements; inform patients that swelling will occur for 12 weeks after surgery. Consider providing eccentric and concentric movements and aquatic exercises after the incision heals.