ARTHROPLASTY

PRESENTED BY,
ARATHY K.M
INTRODUCTION

• Arthroplasty is a reconstructive procedure to restore the joint motion and function and to
relieve pain. It generally involves the replacement of bony joint structure by prosthesis

• Types :

Hemiarthroplasty

Total replacement
HEMIARTHROPLASTY (Partial joint replacement)

• This means replacing only one side of a joint. Hemiarthroplasty is

indicated in situations where only one half of the joint is affected.

• e.g., fracture neck of the femur in the elderly.

• A variety of prostheses are used – it could be a single piece

(monopolar) or two piece (bipolar) prosthesis.
TOTAL JOINT REPLACEMENT

• This means that both the components of the joint are replaced – e.g., the head as well as
the acetabulum are replaced in a total hip replacement operation. This procedure is often
required in patients suffering from arthritic afflictions of the joint.
SHOULDER ARTHROPLASTY

• The shoulder complex, also including the clavicle and scapula, has sacrificed stability for
mobility, which makes it vulnerable and susceptible to injury, dysfunction and instability.

• The most common indication for an arthroplasty is pain that has not responded well to
conservative management or a severe fracture.

• Depending upon the mechanism of dysfunction or injury a shoulder arthroplasty can

either be a partial or total replacement.
CAUSE

Several conditions can cause shoulder pain and disability, and lead patients to consider
shoulder joint replacement surgery.
• Osteoarthritis
• Rheumatoid Arthritis
• Post-traumatic Arthritis
This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder
or tears of the shoulder tendons or ligaments may damage the articular cartilage over time.
This causes shoulder pain and limits shoulder function.
• Rotator Cuff Tear Arthropathy
A patient with a very large, long-standing rotator cuff tear may develop cuff tear
arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear
may lead to arthritis and destruction of the joint cartilage.
• Avascular Necrosis (Osteonecrosis)
Avascular necrosis, or osteonecrosis, is a painful condition that occurs when the blood
supply to the bone is disrupted. Because bone cells die without a blood supply,
osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis.
• Severe Fractures
• A severe fracture of the shoulder is another common reason people have shoulder
replacements. When the head of the upper arm bone is shattered, it may be very difficult
to put the pieces of bone back in place. In addition, the blood supply to the bone pieces
can be interrupted. In this case, a surgeon may recommend a shoulder replacement.
TYPES

• Hemiarthroplasty
Hemiarthroplasty involves the humeral articular surface being replaced with a stemmed
humeral component coupled with a prosthetic humeral head component.
Hemiarthroplasty is indicated when either the humerus alone is implicated, or the glenoid is
not fit to support a prosthetic.
• Total Shoulder Arthroplasty
Total shoulder arthroplasty, or TSA, is a procedure used to replace the diseased or damaged
ball and socket joint of the shoulder with a prosthesis made of polyethylene and metal
components.
• Reverse Total Shoulder Arthroplasty (rTSA)
A reverse total shoulder arthroplasty, or rTSA, refers to a similar procedure in which the
prosthetic ball and socket that make up the joint are reversed to treat certain complex
shoulder problems. rTSA involves a stemmed-humeral component containing a
polyethylene humero-socket replacing the humeral head, and a highly polished metal ball
known as a gleno-sphere replacing the socket, or glenoid. One can think of this as the “ball
and socket” components being switched.
Complications
• Total shoulder arthroplasty can involve lots of complications including:
• Component Loosening
• Glenohumeral Instability
• Rotator cuff tears
• Fractures
• Infection
• Neural injury
PHYSIOTHERAPY MANAGEMENT

General Guidelines
• Sling use and duration directed by surgeon in postoperative
instructions.
• Immediate postoperative passive and active assistive ROM, sawing
movements, and elbow ROM instructed following hospital discharge.
Postoperative Weeks 1–4
• Modalities to decrease pain and inflammation.
• Passive range of motion initiated with no limitation in flexion,
abduction, or internal rotation.
• NO EXTERNAL ROTATION
• Elbow, wrist, and forearm ROM/stretching.
• Manually applied scapular resistive exercise for protraction/retraction
and submaximal biceps/triceps manual resistance with shoulder in
supported position supine.
• Codman’s pendulum exercise
Postoperative Weeks 2–4
• Initiation of active-assistive ROM using pulley for sagittal plane flexion and
scapular plane elevation.
Postoperative Weeks 4–6
• Continuation of previously outlined program.
• Initiation of submaximal multiple angle isometrics and manual resistive exercise
for shoulder external rotation, abduction/adduction, and flexion/extension.
• Upper body ergometer (UBE).
• External rotation isotonic exercise using weight/tubing with elbow
supported and GH joint in scapular plane (towel roll or pillow under
axilla).
Postoperative Weeks 6–8
• Traditional rotator cuff isotonic exercise program.
•Side lying external rotation.
• Prone extension.
•Prone horizontal abduction (limited from neutral to scapular plane position
initially with progression to coronal plane as ROM improves).
• Biceps/triceps curls in standing with GH joint in neutral resting position.
Postoperative Weeks 8–12
• Continuation of resistive exercise and ROM progressions.
• Addition of ball dribbling and upper body plyometrics with small Swiss
ball.
Postoperative Weeks 12–24
• Continuation of rehabilitation.
• Isometric internal/external rotation strength testing
• assessment in neutral scapular plane position.
• Subjective rating scale completion.
•ROM assessment.
ELBOW ARTHROPLASTY

• Types
• Total replacement
• Hemi replacement
Indication
• rheumatoid arthritis (RA)
• osteoarthritis
• arthritis after elbow injury (post-traumatic arthritis)
• severe fractures
• elbow instability
Contraindications for elbow arthroplasty include the following:
• Absolute
• Active infection
• Open wound with skin and soft tissue defect
• Neuromuscular paralysis with absent flexors or flail elbow
REHABILITATION PROTOCOL AFTER TOTAL
ELBOW REPLACEMENT
Week 1
• Hand and shoulder function encouraged immediately or as soon as the
brachial plexus block has dissipated.
• At 3 days, postsurgical splint and dressings are removed and replaced with a
removable posterior extension splint to allow for gentle active range of
motion.
• Active range of motion exercises for the elbow and forearm are performed
six times a day for 10 to 15 minutes. Posterior extension splint should be
worn between exercise sessions and at night.
Week 2
• Passive ROM exercises may be initiated to the elbow.
• Functional electrical stimulation (FES) may be initiated to stimulate
biceps or triceps or both.
Week 6
• Discontinue elbow extension splint during the day if elbow stability is
adequate.
• Week 8
• Discontinue elbow extension splint at night.
• Initiate gradual, gentle strengthening exercises for the hand and
forearm. Light resistance may be begun to the elbow.
• Perform therapy within the patient's comfort level. The patient is
advised not to lift more than 1 lb during the first 3 months after surgery
and will observe a 5-lb permanent lifetime lifting restriction for the
extremity.
WRIST ARTHROPLASTY

• Wrist replacement, also referred to as wrist arthroplasty is a surgical

procedure in which the diseased or damaged joint is replaced with an
artificial joint- a prosthesis. It aims to create a stable, pain-free joint
with a functional range of movement when conservative treatments
have failed.
The Artificial Wrist
• The radial component: is the part that fits against the end of the radius bone. It is made up
of two pieces- a flat metal piece with a stem that attaches down into the canal of the bone
and a plastic cup that fits onto the metal piece, forming a socket for the artificial wrist joint.

• The distal component: is the part that replaces the small wrist bones. This piece is made
completely of metal. It is globe shaped to fit into the plastic socket on the end of the radius.
It is attached by two metal stems that fit into the hollow bone marrow cavities of the carpal
and metacarpal bones of the hand. The ellipsoidal head simulates the curvature of the
natural wrist and allows for a functional range of movement.
Indications
• Wrist osteoarthritis
• Rheumatoid arthritis
• Post-traumatic arthritis
• Failed wrist fusion
• Advanced avascular necrosis of the carpal bones
Contra-indications
• Infection at the wrist
• Severe ligamentous laxity in form of severe volar subluxation
• Highly active synovitis in patients with RA
• Systemic lupus erythematosus
• Patients with minimally functional hand
• Lack of active wrist extension
Complications of Wrist Arthroplasty
• Instability of the wrist
• Infection
• Dislocation of the wrist
• Loosening of implants
• Damage to the nerves or blood vessels,
• Implant failure
• Peri-prosthetic fractures
Post-Op Rehabilitation
• Regaining function of the hand following TWA is largely dependent on post-
operative physiotherapy. Physical therapy should be started early beginning with
gentle mobilization exercises and gradually progressing to resisted exercises.
0-2 weeks
• post-operative dressing
• wrist is immobilized in neutral alignment
• elevation of the limb to control swelling
• mobilization of adjacent joints- shoulder and elbow joints
3-5 weeks
• removal of post-operative dressing
• static splinting at 50 of flexion(worn during exercise and at night)
• gentle passive and active range of motion exercises for the wrist and
fingers
6-12 weeks
• full PROM at the wrist minimizing radial and ulnar deviation of the wrist
• dynamic splint
• gentle progressive strengthening of the wrist and hand
• gradual return to normal activities
Thank you