Arthritisis teatmet
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- Unicondylar knee replacement=
- done when only one knee compartment (medial or lateral) is involved, shorter recovery time and easier revision than total joint replacement
- Pt information form AAOS websit DO'S=
- Do deep the leg facing forward at all times, do deep the operated leg in front as you sit or stand, do use a high kitchen or bar stool in the kitchen, do use ice to reduce pain and swelling, but remember that isce will diminish sensation, do apply heat befor exercising to assist with ROM. Usie a heating pad or hot pad, damp towel for 15-20 min
- Othe treatment, Glucosamine and Chondrotin Sulfate=
- bothe are naturally found in the body, and supplements come from animal sources, have bothe been used in Europe for several years with few reported side effects, short term studies have shown benefit for pain relief, but ther is not yet evidence tha these supplements repair or restore articular cartilage
- Chondrotin sulfate =
- prevents body enzymes from attacking the building blocks of articular cartilaage
- Surgical interventions Resection=
- removal of tissue (in this case-bone). Done in the feet, wrist, thumbs or elbows to improve function and relieve pain
- Precautions following hip replacemtn surgery=
- Pt. should avoid hip flexion past 90 degrees, hip IR and hip ADD pat neutral, Alwlays be aware of the current WBing status of your pt., pt's should put pillows or a sedge brtween their knees when lying on their side to prevent ADD past midline, Pt's should sit in chairs with arms and use cushions to rais the seat height. they should aslo use an elevated toilt seat for 8 weeks
- Surgical Interventions Arthrodesis=
- joint fusion,typically done at the ankles, wrist,fingers or thumbs, relieves pain in unstable parts
- Joint replaement surger=
- hip, knee, and shoulder replacements are the most common because relief of pain is the most consistent result of surgery, pain is the primary indication for surgery
- Surgical interventions Total joint replacement (Arthroplasty)=
- typically, done at the knee, hip or shoulder, replaces joint surfaces with metal, ceramic and plastic parts. , excellent success rates for decreasing pain and increasing function
- Factors that decrease the success of surgey=
- obesity, infection, poor general health, poor nutrition, inadequate motor control (paresis or paralysis), inadequate bone stock, emotional instability
- Hospital stay=
- Pt will be in hospital few days, Pt. wil have a drain inserted into the joint to remove fluid buid up,CPM may be used th promote ROM, deep breathing/coughing is important for preventing Pnemonia, medications, compression (support hose or inflatable boots) are important to prevent DVT's, calf pain, chest pain and SoB are signs of a possible blood clot, Patint education is very important
- Surgical interventions Osteotomy=
- Involves cutting and repositioning bone to improve joint alignment and decrease deformity
- Surgical interventions Synovectomy=
- removal of inflammed synovial lining,usually done with RA,reduces pain and swelling and slows down joint destrucition
- Pateint information from AAOS website DONT's=
- DONT cross your legs for t least 8 weeds, Dont bring your knee up higher than your hip, dont lean forward while sitting or as you sit down, Dont try to pick up something on the floor while you are sittin, dont turn you feet ecessively inward or outward, Dont reach down to pick up blankets when lying in bed, dont bend at the waist beyond 90 degrees, dont stand pigeion toed, dont use pain as a guid for what you may or may not do, dont apply icd directly to the skin, use an ice pack or wrap it in a towel,
- Autolojus chondrocyte implantation=
- arthroscopic surgery is used to harvest the pt. healthy , NWBing chondrocytes from the knee. they are then allowed to multiply in a lab so they can be used to patch the area of damaged cartilage
- Microfracture=
- small holes are created in the subchondral bone, which stimulates th healing process. the area of damage articular cartilage is replaced with a fibrocartilage scar, not hyaline cartilage
- Techniques to restore articular cartilage=
- Osteochondral Auto/allo graft, Autologous chondrocyte implantation, Mirofracture, Mesenchymal stem cell regeneration
- objectives of treatment for arthritisis
- control pain, pt.education about disease process and self management, increase or maintain flexibility and stretch, maintain CV fitness, protect joints and conserve energy,
- Recovery at home=
- Good nutruion, keep incision clean and dry, contact Dr if infection is present (redness, heat, drainage, fever), continue ice and compression and elevation, swelling in normal for 3-6 months after surger. Staple revomed 1-2 weeks, driving should not be resumed until pt has good muscle control for braking and acceleration (weeks), Avoid High impact activities for life, tell dentist about replacemt due to risk of infection with dental work, need antibiodics prior
- Viscosupplementaion=
- Hyaluronic acid is normally found in the synovial fluid and acts as a lubricant, People with OA have reduced levels of hyaluronic acid in their affectd joints. Treatment involves injections of hyaluronic acid into a joint (usually knee) in a series of 3-5 shots over several weeks, approved by FDA in 1977 for treatment of OA of the knee, treatment is expensive and effects are temporary (several months)
- Revision joint surgery=
- replacement or an artificial joint, 5-10% of hip replacements need to be revised within 10 years, recovery is longer and more difficult than the 1st joint replacement
- Osteochorndral auto/allograft=
- for small defects, th srgeion removes plugs of bone and cartilage from a non-WB ing area to patch a damaged WBing area, for large decfectsc cadavar tissue is use
- Rehabiliation following surger to restore atricular cartilage involves =
- prolonged periods of limited WBing . High impact activitis (running, jumping) should be avoided for several months
- surgical interventions Arthroscopy=
- surgery using 3 small incisions- one for an arthroscope (tiny camera) , one for pumping water into the joint, and one for inserting instruments. the instruments are used to debride the joint for people with arthritis
- Glucosamine =
- stimulates the formation and repair of articular cartlialge
- indications for joint replacement=
- the pt. pain is not being controlled with conservative treatment. the Pt. is experiencing significant functional limitations
- Mesenchymal ste cell regeneration=
- still development, MSC's can be harvested from bone marrow, these relatively undifferentiated cells can be stimulated in the lab to grow into articular cartilage