Glossary

Glossary
ORIF – Open reduction internal fixation THJR/THR – Total hip joint replacement TKJR/TKR – Total knee joint replacement TAQ’s – Toe’s, Ankle’s, Quad’s exercises Quads Lag – Able to extend knee but falls into a degree in flexion on SLR or IRQ Quads Lack – Pt unable to fully extend knee and remains in this degree of flexion during Useful reading!
David J. Dandy – Essential Orthopaedics and Trauma (616.7 DAN) T. Duckworth – Orthopaedics and Fractures (616.7 DUC) McRae and Kinninmonth – Orthopaedics and Trauma (616.7 MACR) Analgesia
Anti Emetic
Subjective Examination
The subjective examination can mostly be taken from the patients notes and usually briefer than one in an out patient setting. This is due to the fact that the patient has already been referred for a joint replacement. The main aim of a pre-op assessment is to find out the length of time the patient has had this complaint, present mobility status and ROM (active and passive). This gives an indication of muscle shortening, altered gait or need of a walking aid and any capsular pattern. During this the physiotherapist should also ask about any previous joint replacements and the success of it. PC – Constant pain and loss of function. HPC – How long they have had present complaint, DH – Analgesia and any other medication Stairs and how many, bed and bath on same level. Objective Examination of the HIP
Active and passive ROM
Muscle Power (Grade I-V)
Alignment Test
Leg length discrepancy – The test is performed with the patient lying supine, with hips in line and as flat as possible. Measurement is taken from the ASIS to the medial malleolus on both sides. A difference signifies a leg length discrepancy. Special tests
Thomas Test – This test is to rule out of confirm a hip flexion contracture. The test is performed with the patient lying supine on the plinth. One knee brought to chest and the other straight. Make sure the lower region of the lumbar spine remains Ely’s Test – To assess for tightness of the rectus femoris. It is performed with the patient lying supine with the knees hanging over the edge of the plinth. The unaffected leg is brought to the chest stabilizing the pelvis and back. Extension of the test Trendelenburg’s Test – To test pelvic stability maintained by the hip abductor muscles. The patient stands on the test leg and raises the other off the floor. The test is abnormal if the pelvis drops on the non-weight-bearing side. Contraindications
• Twisting operated leg. The hip is put at risk if swivelled when turning, • Bend the operated leg past 90°, bending to pick something off the floor when seated or leaning forward from the waist. • Avoid kneeling for the first four months. Getting in and out of bed
1. Sit up and step legs towards edge of bed, operated leg must lead, as this reduces the risk of operated leg passing mid line. For patients with a posterior incision they must keep the knee of the operated leg straight and their trunk and operated 2. Sitting on the edge of the bed with unoperated foot flat on the floor and the other 3. Place hands on the bed at either side and push up to stand drawing the operated leg back. When the patient is standing and well balanced, they should they take GETTING BACK INTO BED IS THE REVERSE PROCEDURE OPERATED Active/assisted, hip/knee extension only. No re-education boards. These are only guidelines and therefore may alter if conditions changed. Post-op regime for revision of total hip replacement will require modification and patient may require to Teach deep breathing and circulatory exercises Chest care i.e. deep breathing exercises Commence active/ assisted hip/knee flexion/extension exercises either Exercises as day one plus abduction exercises with re-education board Depending on check x-ray or on doctors instruction, transfer out of bed and Continue as day two but increase mobility Encourage mobility with elbow crutches, stair practice with elbow crutches and Patient can progress to two walking sticks or continue with elbow crutches Outpatient follow-up only if required. Non-standard procedure Guidelines for Total Knee Replacement
PoD 1 & PoD 2, patient may wear Buchanan splint (Monklands Hospital) until wound checked and if satisfactory, then patient can commence knee flexion exercises. Patient allowed to mobilise with splint in-situ. This can be discontinued once wound checked and patient can SLR. At other sites, the post –op regime will vary and splints may not be used. However, almost always, the check x-ray will be done before mobilising the These are only guidelines and therefore may alter if conditions changed. Post-op regime for revision of total knee replacement will require modification and patient may require It can be very easy to become focused on the degree of knee flexion. This is easier to achieve than knee extension, which is very important for gait. Remember to work on extension too! A few examples are – long sitting or sup lye with a rolled up towel under the ankle. This allows gravity to act on the knee, letting it stretch into extension. This can be uncomfortable for the patient so use only for short periods throughout the day. Another way to increase extension is to position the leg as above, with the ankle elevated on a rolled up towel and passively stretch the knee into extension or perform SQ’s in this Teach deep breathing and circulatory exercises Chest care i.e. deep breathing exercises Circulatory exercises – TAQ’s and gluts Commence active/ assisted hip/knee flexion/extension exercises either Depending on check x-ray or on doctors instruction, transfer out of bed and Chair transfer and up to sit, leg usually elevated Exercises as PoD 1, encourage active work and SLR If patient not mobilised on PoD 1, patient usually mobilised PoD 2 If drain is removed and dressing reduced commence use of cryocuff or ice pack, compression bandage (TED stockings) must be applied when cryocuff/ice pack If not already progressed changed from ZWA to E/C or 2x walking sticks Continue to evaluate and modify treeatment. Continue modify and increase exercises i.e. modified PNF Encourage mobility with elbow crutches/sticks, stair practice with elbow crutches/sticks and rail or with elbow crutches/sticks only. Types of hip replacements
The Thompson and the Austin-Moore hemiarthroplasties are the commonest types of hip replacements used in the UK. The total hip replacement replaces the damaged head of femur with a stainless steel ball mounted on a stem and relines the acetabulum with a special plastic polyethylene socket. The components are usually attached to the bone with a type of cement called Methyl Methacrylate, shown in figure A. Figure B shows a prosthesis applied with no cement, the type of prosthesis used is to the discretion of the

Source: http://healthsciences.qmuc.ac.uk/LEARNING-RESOURCES/PH3/Orthopaedics.pdf