Mechanically Aligned Arthroplasty Results

Mechanically Aligned Arthroplasty
Mechanically aligned total knee arthroplasty (TKA) strives to achieve a neutral mechanical
alignment of the limb (00 hip–knee–ankle angle) and a varus–valgus angle of the tibial component
perpendicular to the tibial mechanical axis. Conventionally, mechanically aligned TKA was assumed
to lead to best implant survival.
However, most of the normal population has a natural alignment of the limb that is not neutral,
neutral mechanical alignment may create dissatisfaction in this group of patients.
In kinematically aligned TKA, the aim is to position the femoral and tibial components so that the
angles and levels of the distal and posterior femoral joint lines and the tibial joint line are each
restored to the patient's natural alignment; not to a neutral limb alignment that is ... Show more
content on Helpwriting.net ...
Hence, kinematic alignment in total knee arthroplasty is developed with the aim to restore the
natural alignment of the patients instead of aiming coronal angle of the tibial component
perpendicular to the tibial mechanical axis.
This technique was shown to provide not only better pain relief2 but also restoring better function3
and range of movement than mechanical alignment technique.
However, in Asian population, tibia vara has been more common and most studies indicate that the
average varus inclination of tibia plateau could range from 20 to 50. 4,5
Performing kinematic alignment in such population may pose challenge to the surgeons as the final
knee alignment could ended up in more varus than expected.
In our study, kinematically aligned total knee arthroplasty showed similar result in restoring knee
alignment as compared to mechanical alignment technique. The incidence of outliers were similar in
both group.
However, the component–tibial angle in kinematically aligned knees tend to be more
... Get more on HelpWriting.net ...

Unicompartmental Knee Arthroplasty Essay
Introduction: Unicompartmental knee arthroplasty (UKA) is gaining popularity due to its less
invasiveness and quicker recovery than total knee arthroplasty (TKA). However, incidence of tibia–
related complications such as tibial component subsidence and fracture has been increased. These
may be due to improper surgical technique selection such as excessive removal of tibia plateau,
including excessive posterior slope, exposing soft metaphyseal bone prone to fracture and implant
subsidence. Mobile–bearing UKA allows minimal tibial bone resection because thinner
polyethylene bearing can be used since there are less concerns about polyethylene wear.
Objectives: We proposed UKA surgical technique for fix–bearing UKA to resect minimal amount of
tibial, mainly to leave hard subchondral bone under tibial component in order to prevent tibial
component subsidence and fracture.
Methods: Retrospective study comparing ... Show more content on Helpwriting.net ...
The subchondral–sparring group were operated during 2010–2013 and consisted of 179 patients.
Other than different mean follow–up period, there was no significant difference regarding patient
demographics. There were 5 tibia–related complications (3 gross component subsidence and
loosening and 2 tibial plateau fracture). All these complications were detected within 6 months after
index surgery. One patient with subsidence and 2 patients with fracture required revision to TKA.
There were no tibia–related complication in subchondral–sparring group. The incidence of tibia–
related complication between the two groups are statistically significant. (Fisher exact test, 5/166 VS
0/179; p=0.025). There was no femur–related complication. Two patients in measure–resection
group require revision to TKA due to progression of disease in lateral compartment at 5 and 7 years
post–op. Clinical outcomes at 2–year when excluding cases with complications were similar in both

Advanced Knee Arthroplasty Essay
Introduction: In case of advanced knee arthritis, Total Knee Arthroplasty (TKA) represents an
effective and reproducible surgical technique. In the last decade, Computer–Assisted Systems (CAS)
have been introduced in TKA to allow more accurate prosthesis component implantation via intra–
operative anatomy–based data tracking of the tibio–femoral joint (TFJ). Particularly, these systems
were expected to result in better post–operative clinical outcomes under loading conditions and
longer implant survivorship than Conventional Instrumentation (CI). This is generally due to more
precise targeted bone cuts and Mechanical Axis (MA) using CAS. Unfortunately, only a few studies
have compared so far TKA via CAS and CI at a long term follow–up in terms of clinical outcomes,
MA alignment and implant survivorship. Objectives: The aim of this study was to compare these
aspects between 2 groups of patients who underwent TKA using CAS or CI, respectively, at a
minimum of 10 years follow–up. Methods: From November 2012 to December 2013, 100 patients
operated for TKA ... Show more content on Helpwriting.net ...
Long–leg. X–ray evaluations were also performed to assess final MA alignment. Values of MA
larger than 3° were considered as outlier. Results: The mean KOOS value was 82.6 and 79.1 in
Group A and B, respectively. Corresponding mean KSS value was 173 and 170, respectively. The
mean MA, this being calculated as the deviation from the ideal MA alignment, i.e. 0 degrees, as
measured on X–Ray images was 1.8 degrees in Group A and 2.2 degrees in Group B. 4 and 3
outliers were found in Group B and Group A, respectively. No statistically significant differences in
terms of clinical KSS and KOOS scores between analyzed groups; this was observed for the
percentage of MA outliers. The percentage of implant revisions was slightly higher in Group B than
in Group

Arthroplasty Essay
Background: Total knee arthroplasty is associated with moderate to severe postoperative pain and
effective analgesia is essential for postoperative recovery and rehabilitation. The challenge of
analgesic regimes is to obtain adequate pain relief and maximum muscle control to enable the
patient to mobilize and rehabilitate early without troublesome side effects. Local Infiltration
Analgesia (LIA) is widely thought to be effective and is frequently applied as part of a multimodal
pain strategy due to its simplicity and apparent safety in multiple types of surgery. However, the
optimal dose, technique and best composition in perioperative consummated pain medication are not
known.
Objectives: The goal of this prospective randomized clinical trial ... Show more content on
Helpwriting.net ...
Results: The four groups were comparable for patient characteristics, preoperative NRS pain scores
and operating time. The mean LOS for the entire cohort was 2.3 nights (1–6), adequate pain relief
was achieved in all patients before discharge. GEE analysis revealed a significant difference
between group A and B (p = 0.021) with group B experiencing higher pain scores post–operatively
than group A. No differences between group A and C (p=0.451) and group A and D were found
(p=0.059). Secondly there was a significant difference between group A and B using rescue
medication found with GEE (p = 0.003) with group B using more medication. No differences
regarding LOS, adverse effects, wound leakage, operating time and destination of discharge were
found between the four groups.
Conclusions: The results of this study show that local infiltration with 300mg (150ml) ropivacaine
might be more effective for pain management than 150mg (75ml) ropivacaine. Furthermore,
alteration in the dose of gabapentin appears not to have influence on the course of pain after TKA.
The percentage of adverse effects seems comparable for all

Total Knee Arthroplasty
1. Empiricist Methodology
Research Question: Does a Multicomponent Discharge Planning Program improve patient and
hospital outcomes in older adults undergoing total knee arthroplasty?
Method:
Design: Quaxi–experimental two group pretest–posttest design. Sample: Participants both older men
and women who admitted at orthopadeic units for total knee arthoplasty will be recruited in the
study. The inclusion and exclusion criteria will be applied for the recruitment of the study
participants. The sample size will be calculated by using effect size and power for statistic test. The
participants will be randomly assigned into the experimental or control groups. The experimental
group will be given a multicomponent discharge planning program during their admission while the
control group will receive usual care. Study Outcomes: Patient outcomes include physical function
and satisfaction to service, and hospital outcome are length of hospital stay, infection, and joint
stiffness. The questionnaires, lab test, and patient documents will be employed for data collection at
baseline, 2 and 4 week after patient discharge. Validity and reliability of all measures will be tested
prior to data ... Show more content on Helpwriting.net ...
Sample: The participants will be recruited by purposive sampling (Staff at the ED, hip fracture
patients and their caregivers). The process of the study will promote the ED's staff to involve in
planning, doing, checking, acting (PDCA) to improve the care in the ED at the secondary hospital
by using descriptive observations and in–depth interviews both individual interviews as well as
group interviews. Outcome Measures: Patients and family's satisfaction to service care, waiting time
reduction, incident report reduction, and happiness in the work place of the ED staff. Data
Collection: The study will use surveys or questionnaires for data collection. Data Analysis:
Descriptive statistical and content analysis will use to analyze the

Case Study: Osteoarthritis with a Total Knee Arthroplasty
Case Study: Osteoarthritis with a Total Knee Arthroplasty
Holly N. Pittman
Missouri State University – West Plains
Patient History DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September
14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical
Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had
increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain
DN was having been due to a history of osteoarthritis and the wear–and–tear on his joints
throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN
was consulted on having his right knee done in the future ... Show more content on Helpwriting.net
...
There was no hearing deficit noted with normal conversation. Patient only had complaints of pain at
surgical site after ambulation, physical therapy or the CPM. Patient was taught he could ask for the
pain medicine prior to these events to hopefully avoid intense pain.
Current Medications Throughout DN's hospital stay he was prescribed medicine to alleviate the pain
caused from the total knee arthroplasty, help prevent any infection that had potential to be a
problem, and prevent any complications. DN's current medications while in the hospital were as
follows: 1.) Docusate–Senna (Trade Name: Peri–Colace) 1 tablet by mouth, twice a day; used for
softening and passage of stool for the relief of constipation caused by post operative anesthesia and
decreased activity (Deglin & Vallerand, 2007). 2.) Enoxaparin (Trade Name: Lovenox) 40 mg
by subcutaneous injection, once every morning; used for the prevention of thrombosis formation
(Deglin & Vallerand, 2007). 3.) Psyllium (Trade Name: Metamucil) 1 tablespoon by mouth,
twice a day; used for relief and prevention of constipation (Deglin & Vallerand, 2007). 4.)
Acetaminophen–Oxycodone (Trade Name: Percocet 5/325) 1–2 tablets by mouth, every four hours;
used for decreasing pain as well as decreasing a temperature (Deglin & Vallerand, 2007). 5.)
Magnesium

Nursing Case Study Left Knee Arthroplasty
Analysis Teaching the importance of activity and exercise has a huge significance to the patient
especially she undergone surgery, left knee arthroplasty. Lack of adequate knee exercise after
surgery will lead to various complications that are dangerous and life threatening such as deep vein
thrombosis, stroke and pulmonary embolism. Another complication that is associated with
inadequate movement of the limbs and extremities is muscle contracture (LeMone et.al, 2011 p
142). Patient has a high risk of developing these complications. We wanted to educate the patient
about these so that we could lower her risk at some point. We believe that even when patient is lying
down on the bed, she can do a lot of things to improved her health and prevent ... Show more
It is a joint disease and commonly the leading cause of pain in older adults. With osteoarthritis, joint
cartilage becomes rough and worn. The damaged tissue causes the cells to release an enzyme which
contributes to breakdown the cartilage. Inflammation is present in synovium, the lining of the joint.
Overtime, the space in the joint becomes narrower. Patient with osteoarthritis experience joint
stiffness and pain with weight bearing and movement. As the disease progresses, pain becomes
extremely severe (VanMeter & Hubert, 2014 p 175). This the reason why patient had left knee
arthroplasty. In left knee arthroplasty, the femoral and tibia component of the knee are replaced with
an artificial material called prosthesis to relieve pain and allow a person to restore performance of
activities of daily living (LeMone et.al, 2014 p 1356). According to Shmerling (2014), the patient's
risk for developing blood clots increases after surgery. Clots can form inside the blood vessels and
this is where it becomes dangerous. Blood clots in the veins will hinder or block the return of blood
to the vital organs of the body such as the heart. Due to the patient's inactivity the flow of her blood
becomes sluggish and causes the blood to pool commonly at the lower part of the body such as the
leg and could lead to a clot. This is often called as Deep vein thrombosis. There is a tendency, that
this clot could travel in the body and lodge in other

Voluntary Arthroplasty Research
As a new graduate working on the Medical/Surgical floor the use of a Continuous Passive Motion
Machines (CPM) in post total knee arthroplasty (TKA) patients was essential. Seasoned nurses
drilled onto graduate nurses that the patient had to wear the CPM for a minimum of eight hours per
day. As a new nurse, I did not question the why, nor did I ask if there was data supporting the
importance of using CPM machines.
With evidence based nursing, there is now data conflicting the efficacy of using CPM machines on
post TKA patients. This prompted me to ask the question: In post, total knee arthroplasty patients,
does the use of continuous passive motion improve mobility/flexibility versus not having continuous
passive motion? In a controlled ... Show more content on Helpwriting.net ...
The top of the pyramid encompasses filtered resources. This section contains systemic reviews,
critically–appraised topics and critically–appraised individual articles. The bottom of the pyramid
contains unfiltered information. This section contains randomized control trials, cohort studies,
case–controlled studies, case series, and case reports. I used both sections of the pyramid to conduct
my search. From the filtered information, I used Database of Abstracts of Reviews of Effects
(DARE) using the search terms CPM; continuous passive motion; total knee arthroplasty; TKA; and
Rehabilitation. In the CINAHL Plus with Full Text search engine of the unfiltered data I again used
the terms CPM; continuous passive motion; total knee arthroplasty; TKA; and Rehabilitation
(Walden University Library

Total Hip Arthroplasty ( Tha )
Introduction:
Total hip arthroplasty (THA), commonly known as hip replacement, is a reconstructive orthopedic
procedure that involves the surgical excision of the head and proximal neck of the femur and
removal of the acetabular cartilage and subchondral bone(A). The damaged joint is replaced with an
implant that mimics the motion of the natural joint and is made from combinations of metal, plastic
and/or ceramic components(D).
Joint replacement is one of five priority areas targeted for shorter wait times in Canada. Ontario's
current wait time is 207 day.(F) The number of THAs in Canada increased 11% between 2006–2007
and 2010–2011. In 2013–2014, there were 49,503 hospitalizations for hip replacements(B). THA has
been used to manage conditions in which the hip joint has responded poorly to less–invasive
treatments(D). The most common of which is severe osteoarthritis of the hip joint, which affects
more than 10% of Canadians aged 15 or older(G), and accounts for 70% of cases. The procedure has
proved to be remarkably successful in eliminating pain and restoring function in hips severely
involved with diseases, improving mobility, daily functioning and quality of life(A,D,G). THA
provides pain relief and improves physical function and quality of life in patients with end–stage hip
osteoarthritis. The incidence of THA is expected to increase due to the growing elderly population.
Nevertheless, THA is becoming more common in younger populations because of the improvements
in

Hip Arthroplasty
Hip arthroplasty is the replacement of the hip joint with a prosthesis, and is one of the most common
reconstructive operations (Huo et al 2008). Hip arthroplasty may be performed when irreversible
damage has occurred to the joint; this damage often causes pain, dysfunction and reduced quality of
life. The pre–operative nursing considerations begin with patient education. This should begin at the
time the decision is made to have the surgical procedure performed. It is important that the patient
understand the preoperative requirements, the surgical procedure, postoperative care and the
necessary home/activity modification. The patient should be instructed in self–preparation,
including mental and emotion readiness and having a ... Show more content on Helpwriting.net ...
The color, sensation, movement and pedal pulses of the operated leg should be assessed regularly to
observe for any circulatory or neurological impairment. Pain assessments should be noted at regular
intervals, since patients who have their pain well controlled following surgery are able to mobilize
more quickly and easily, which helps reduce the risk of post–operative complications such as deep
vein thrombosis, pulmonary embolism and respiratory infection. Prolonged and inadequate post–
operative pain may result in higher mortality and morbidity rates, increased length of hospital stay
and greater healthcare expenses (Eid and Bucknall 2008). The nurse can work closely with the
hospital physiotherapists on specific exercises and to assess whether individuals require mobility
aides. The patients should be encouraged to participate in foot exercises such as rotation, flexion and
extension of the ankle to encourage venous return and to help prevent pooling of blood in the calf
muscles (Temple 2004). Since nurses spend more time with patients than other allied health
professionals, it is essential that the nursing staff are aware of the nature and benefit of post–
operative exercises and are able to instruct and support patients in performing these exercises
frequently throughout the day. In conclusion, hip arthroplasty is a common procedure that frequently
results in increased levels of independence

Unicompartmental Knee Arthroplasty: A Case Study
Introduction Unicompartmental knee arthroplasty (UKA) had been a common surgical treatment1
for single compartment osteoarthritis (OA) other than total knee arthroplasty (TKA) and high tibial
osteotomy (HTO). The outcome of UKA is comparable with total knee arthroplasty2; with having
the advantages of lesser bone resection, lower risk of infection, lesser thromboembolic event,
reduced length of hospitalization3 and early functional recovery4. Furthermore, preservation of the
anterior and posterior cruciate ligaments with intact patellofemoral joint and meniscus may allow
the operated knee mimicking near normal knee kinetics5, 6. Despite having such reported
advantages, patients who underwent UKA surgery were known to have a higher risk of revision

Total Knee Arthroplasty Case Study
Introduction Patient satisfaction is the ultimate goal of all orthopaedic procedures. Total knee
arthroplasty (TKA) has revolutionized the care of patients with end–stage knee arthritis. In spite of
significant advances in primary TKA, various studies show that only 82% to 89% of primary TKA
patients are satisfied. In this paper this issue is re–examined after primary TKAs performed in the
province of Ontario. The patient population, the overall level of satisfaction and the number of
preoperative and operative factors that affect patient satisfaction and dissatisfaction are important
topic to consider comparing with previous study. Patients and Methods This study is based on the
WOMAC score (0–100). WOMAC scores were collected for 2051

Total Hip Arthroplasty Essay
During the weeks of February 7 through February 17, I observed a total hip arthroplasty on a 56–
year–old Caucasian female patient who suffered from a femoral neck fracture and damage to the
acetabulum. The fracture was a result from a car accident where the patient's knees collided with the
dashboard, forcing the femur into the hip and breaking the femur. For this report I will concentrate
on total hip replacement, its components, main surgical technique, and complications. Sir John
Charnley first developed total joint arthroplasty in the 1960s (Skinner 395). In a total hip
replacement "the articular surfaces of the acetabulum and femoral head are replaced" (Lemone
1241). A prosthesis is then used to replace the entire head of the femur ... Show more content on
Helpwriting.net ...
The acetabular components have a "spherical outer surface with at least one hole to permit the
surgeon to determine if the prosthesis is fully impacted into place" (Skinner 399). The inner surface
of the acetabular component then locks the UHMWPE to limit rotation and dissociation (Skinner
399). There are two crucial factors when choosing the implants. First, if the prosthesis is too stiff
then the patient may suffer from proximal osteopenia. Second, the stiffer the prosthesis is the more
likely the patient will experience pain in the thigh. To avoid these two factors the surgeon should
elect to use titanium ally instead of the cobalt chromium alloy.
There are several surgical techniques used for total hip replacement, including the posterolateral
approach, the lateral approach, the anterolateral approach, and others. For this paper I will
concentrate on the posterolateral approach since it is the most common (Skinner 396). The patient is
put into the lateral decubitus position with the affected side superior after anesthesia is administered
and a compression stocking is placed on the unaffected limb. The skin is covered with an adhesive
drape after the incision is outlined (Skinner 396). Then the hip is flexed to 45 degrees so the
"incision can be made in line with the femur from approximately 10 cm proximal to the tip of the
trochanter to 10 cm distal to the tip of the trochanter" (Skinner 396). The incision

Hip Arthroplasty Journey
Through a debilitating scoliosis resultant of poliomyelitis, my grandmother found herself in need of
a total hip arthroplasty. Following her journey and meeting the doctors, surgeons and nurses
responsible for her procedure and recovery offered my first insight into the medical profession. All
members of the team displayed vital interpersonal skills I have since developed in myself, through
work experience and volunteering. They presented information in a clear, understandable fashion,
and were compassionate and attentive; listening to everything she said.
Inspired by the team of physicians, I organised a week of work experience at Musgrove Park
Hospital in Year 11. I learned the joys of successfully nursing patients to good health; shadowing

Ankle Arthroplasty
Although not as common as other joint replacement surgeries, total ankle arthroplasty can be just as
beneficial. There is more to a total ankle arthroplasty than just fixing the problem area. Ankle
arthroplasty, also called a TAA or total ankle replacement, is a surgical procedure that can give a
patient a better quality of life. Being in an orthopedic setting, I have seen numerous total knee
replacements as well as quite a few hip replacements but not one total ankle replacement. As I
started looking more into the topic, I discovered this procedure has an advantage over other ankle
surgeries, such as an ankle fusion. To start off, we will look at what is a total ankle arthroplasty,
(TAA) and what is done during surgery. The patient will ... Show more content on Helpwriting.net ...
Physical therapy is a huge part of the recovery process. Almost immediately following surgery, a
physical therapist will come in and do an evaluation on the patient and then either the PT or a
physical therapist assistant will help the patient start off with an exercise program. In the first few
weeks following surgery, the main goals for the patient are learning to walk with their walker or
crutches and gentle massage to the foot area. The patient can start a few exercises including keeping
the knee and hip joints strong and moving with strengthening and range of motion exercises. During
weeks two through six, other exercises are introduced including range of motion exercises for the
ankle. Calf and ankle stretches, towel crunches, and ankle range of motions with a babst board are
all beneficial and appropriate during this stage of treatment. After week six and x–rays are taken to
confirm the ankle has healed, strengthening and weight bearing exercises can slowly be introduced
to strengthen and reeducate the ankle back into a normal walking program and gait pattern.
Swelling, popping, and decreased strength can be expected for at least the first year following the

Total Knee Arthroplasty Essay
Total knee arthroplasty are also known as total knee replacement. It is used as one of the option to
relive the pain and to restore the function to an arthritic knee. Total knee arthroplasty or total knee
replacement is used when other methods such as weight loss, physical therapy, medical or injections
have failed to relive arthritis– associated knee pain. Knee replacement implant is remove of
damaged cartilage and bones from surface of knee joint and followed by implantation of an artificial
knee joint made with biomaterials. Femoral components and tibial component are made with metal
alloy. Between the Femoral component and tibal component there is a Polyethylene layer.
Inflammatory response is Phagocytes which is cells that are able to ... Show more content on
Helpwriting.net ...
Step3, Phagocytes engulf dead cells and cellular debris. Step4, Platelets move out of the capillaries
to seal the wounded area. The implantation of a biomaterial initiates the inflammatory response in a
sequence of events following the implantation from acute inflammation to chronic inflammation to
granulation tissue. Acute inflammation lasts a few hours to days. Histamine release and blood
vessels near the implantation site become dilated and leaky. Neutrophils and plasma protein
"escape" into tissue. Neutrophils are also called poymorphonuclear leucocyte (PMN). Area around
the injury becomes swollen and red due to the increase of blood flow. Major role of neutrophils is to
phagocytose (engulf and eat dead cells) microorganisms and foreign mateirals. Neutrophils are short
lived. Predominate during the first few days of inflammation. Chronic inflammation is the 2nd stage
of healing process. Presence of monocytes and lymphocytes. Monocytes differentiate into
macrophages to phagocytose particles and break it down into smaller fragments. If the device is
large, frustrated phagocytosis will occur where macrophages become larger by fusion and foreign
body giant cells will

Hip Arthroplasty Case Study
Patient: Mr. WL, 69y/o male retired mechanic; retired 8 years ago.
Medical diagnosis: V43.64– Total hip replacement (Rt.) with secondary diagnoses of essential HTN
(401.9), hypercholesterolemia (272), and depression.
Physical therapy order: Eval. & treat: Pt has been referred for physical therapy eval and TX post
total hip arthroplasty to improve strength, endurance, and balance in order to improve mobility and
facilitate return to PLoF. Skilled Pt services are also required to ensure patient's safety with assistive
devices, along with fall prevention, and environmental safety.
History: Patient reported of falling from the ladder (approximately 9ft. from the ground) on
06/27/2015, while painting the wall of his house. Pt. claims that he fell ... Show more content on
Helpwriting.net ...
Score > 5 indicates depression. BBS/Tinetti: Deferred. Will evaluate at a later time. Assistive and
adaptive devices: pt. used 2ww with for safety with WBAT. Pt could walk up to 40 ft. Pedal pulses:
normal, bilaterally.
Sensory: Normal touch, pin, and joint position sense in toes bilaterally.
Precautions: Low endurance– needs frequent rests, balance precautions include fall risk, hip
replacement precautions: do not allow the hip to bend more than 90 degrees in sitting, standing or
lying positions, Plan of care: Skilled therapy is necessary to overcome the strength and endurance
deficits, improve static and dynamic balance in order to improve gait/ transfers and to facilitate
return to PLoF. These include bed mobility training, transfer training, gait training on level and
stairs WBAT, therapeutic exercise for strengthening all extremities, with emphasis on R hip, and
patient instruction in post–op hip precautions and safety.
PT Goals:
STG to be achieved (time frame: 2 weeks)
1) Pt will be able to perform bed mobility with CGA (25%), functional transfers with min A, and
ambulation 100 ft. with 2 wheeled walker with CGA, in order to increase the level of

Hip Arthroplasty Research Paper
Hip replacement surgery (Total hip arthroplasty (THA) or total hip replacement (THR)), has become
one of the most successful and cost–effective medical interventions since its introduction and
development in the 1960s by the British, Sir John Charnley, an orthopaedic surgeon.1 Sir John
Charnley established the fundamental principles of hip arthroplasty and his design concept of
prosthesis is still used in nowadays. THR is used mostly in patients with severe osteoarthritis (a
degenerative disease of the joint, which primarily affects the articular cartilage), reducing pain and
restoring the articulations to near normal function. Though, several other diagnoses resulting in the
eventual destruction of the hip articulation can also be reliably

Reverse Arthroplasty
One of Omaha's best orthopedic surgeons, Dr. Dolf R. Ichtertz, can be found at Nebraska Hand &
Shoulder Institute, P.C. Dr. Ichtertz has been performing shoulder surgeries since 1985. He is
especially adept at one of the newest and most effective types of rotator cuff surgery, reverse total
shoulder replacement.
Reverse total shoulder replacement arthroplasty (RTSA) is a type of shoulder surgery that
successfully relieves persistent pain that can occur following the rupture of the rotator cuff. RTSA is
an innovative solution to a common, debilitating shoulder problem. It was approved by the FDA in
the early 2000s. Without a rotator cuff people can experience loss of shoulder function, arthritic
decay, pain with use of the shoulder and even

The Clinical Plan For Post Knee Arthroplasty Rehabilitation
The clinical scenario presented by Sarah is very interesting and has got every chance a physical
therapist might face such similar situation in outpatient clinical practice. When a patient comes for
post knee arthroplasty rehabilitation, the physical therapist can often get too much focused on
therapy goals and overlook important clinical signs and symptoms that must be addressed and
referred in a timely manner. A weight gain of 20 pounds in 18 days was not a good indication of Mr.
Knee's general health status. Presence of localized edema is common to see in knee arthroplasty
patients. However, this patient has 2+ pitting edema even after taking Lasix 40 mg twice a day. The
evaluation did not specify more about of swelling, whether it has any increased or decreased
depends upon the time of the day. A weight gain of 2 pounds or more in 48 hours must be
considered as a red flag, which may be an indication of heart failure. Vital signs assessment
consistently demonstrated higher blood pressure and heart rate. The evaluation is not clearly
indicative of exercise induced asthma for patient. Weight gain, consistent higher levels of blood
pressure and heart rate along with exercise induced exertion can be signs of acute cardiac failure.
According to King, Kingery & Casey, 2012, heart failure is a common clinical syndrome
characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral
edema and pulmonary rales. In this case, the

Knee Arthroplasty Essay
Background: Previous studies demonstrated that an abrupt change in conformity occurs during
flexion of knee joint after total knee arthroplasty using the multi–radius femoral design implant. An
abrupt change in conformity was shown to lead to paradoxical anterior sliding and anteroposterior
movement. For this reason, a gradually reducing radius femoral design was introduced. Recent
studies showed that the gradually reducing radius design helped to attenuate paradoxical anterior
sliding and provide better contact area without point loading or edge loading.
Objectives: The purpose of this study was to evaluate the impact of MR versus GR knee design on
the kinematics and kinetics of the knee during level ground walking one year after total knee
arthroplasty. ... Show more content on Helpwriting.net ...
Exclusion criteria were more than fifteen degree of varus deformity, more than twenty degree of
flexion contracture and muscle weakness from neuromuscular disease including Parkinsonism or
cerebral lesion. The groups consisted of twelve patients (twenty knees) who had total knee
arthroplasty (TKA) with a representative MR designed implant (B Braun–Aesculap Vega® Knee
System) and thirteen patients (seventeen knees) who had TKA with a representative GR designed
implant (Depuy Attune® Knee System)
Gait analysis data were collected before the operation and one year after TKA using a three–
dimensional motion analysis system (Oxford Met¬rics Inc., Oxford, UK), which consisted of eight
VICON MX–T20 infra–red cameras and two force plates (AMTI, Water–town, MA, USA).
The kinematic and kinetic parameters of knee varus angle, first peak knee adduction moment,
sagittal plane knee excursion during mid–stance and extensor moment at first peak knee flexion
were evaluated during ground level walking, as well as the spatiotemporal gait outcomes of walking
speed, stride length, cadence, step length, the percentage of stance

Total Knee Arthroplasty Case Study
Background
UPMC has over 500 rehabilitation professionals at 50 Centers for Rehab Services across western
Pennsylvania. These facilities offer physical therapy, speech therapy, and occupational therapy, and
each CRS has different specialized therapy programs to provide care for any individual's
rehabilitation needs.
At the CRS McCandless location, the specialized programs include balance therapy, hand therapy,
lymphedema management, neurorehabilitation, sports rehab, women's health, and men's health
programs.
The mission of Centers for Rehab Services is to help improve health, independence, and quality of
life. As an intern, I was able to learn UPMC's mission and approaches for physical therapy and
apply these values and methods toward helping their patients.
Internship Duties
Prepare ice, hot packs, Game Ready, and E–Stim equipment
Assist patients through exercises for therapy sessions
Assist front office with filing, paperwork, and patient charges
Clean facility and equipment
Stock linens and towels
Available for miscellaneous duties needed by PTs, PTAs, and rehabilitation aides
Total Knee Arthroplasty ... Show more content on Helpwriting.net ...
A patient would get a TKA to relieve symptoms of extreme pain, discomfort, and stiffness that may
be caused by arthritis, a destructive disease, or trauma. The prosthesis includes a metal shell that
replaces the distal end of the femur and a plastic piece with a metal stem that replaces the proximal
end of the tibia. Physical therapy is an essential part to getting the joint to optimal strength, range of
motion, and function. Patients go through a series of exercises that work the new knee joint as well
as the hip, ankle, and all of the associated leg

Arthroplasty Case Study Essay
The patient had a distal open reduction internal fixation on her left and right wrist. She explained to
me that she sustained the injury from a fall. According to her, " both of her wrists broke from that
fall"; which I don't buy. The patient admitted that she has a history of falls, but what I think is that
she was getting abused by someone close to her. There's no logical reason why she should have
sustained so many injuries from frequent falls, without a severe medical condition to support them at
a young, but what do I know? She has complication on the left side of her head; because of the
many falls, she endured in the past. It seems like she falls decreased when her husband passed, not
to be cruel or anything. Arthroplasty was also

Hip Arthroplasty Case Studies
DOI: 12/2/2011. The patient is a 48–year old male service/installer technician who sustained a
work–related injury to his bilateral knees, left shoulder, upper/lower back and neck. Per OMNI,
patient underwent a left hip arthroscopy with a major synovectomy, debridement of the
anterosuperior labrum, chondroplasty of the femoral head on the anterosuperior aspect, as well as a
femoroplasty on 11/4/2014. Per office notes dated 09/02/2015, the patient continued to have, not
only pain, but also a clicking sensation with superior and anterior aspect of the left hip consistent
with internal rotation of causing him mechanical symptoms in a pathology of the labral tear. The
patient was found to have labral tear with changes within the joint as well. ... Show more content on
Helpwriting.net ...
The patient has reduced adduction of 20 degrees compared to right hip. In addition, the patient has a
positive click when the hip is flexed and adducted with reproduction of significant pain to the left
hip. In addition, the patient has a positive anterior posterior glide test as well as a lateral glide test as
well. At this point, examination of the left hip is consistent with having a recurrent left labral tear.
Another MRI is needed to evaluate the further labrum if he has a further labral tear, if he needs to be
re–attached, or if he needs a decompression on the acetabular site or the femoral site whether the
patient may also have a femoral acetabulum impingement as well. MD opined that MR arthrography
will determine further management of the left hip. Per IME dated 07/15/2015 by Dr Varriale,
physical therapy should be continued twice a week for four weeks for the left hip. One further
orthopedic visit within four weeks with the claimant's treating doctor is warranted. There is no need
for transportation, household help or future diagnostic

Nursing Assessment And Comprehensive Post Operative...
Hip fractures are one of the most common causes of extended hospital stay among the elderly, and
approximately one third of patients undergoing hip arthroplasty surgery will die within the first year
(Gregersen et al., 2012). The specialised nature of the orthopaedic ward is a complex environment
for not only nurses, but for all health care professionals. It is the role of the registered nurse within
the orthopaedic ward to provide holistic assessment and comprehensive post–operative planning to
facilitate client centred care for an elderly patient undergoing a total hip arthroplasty (Walker, 2012).
The purpose of this essay is to identify and prioritise appropriate nursing assessments and care
provided for an elderly man (Mr. Simons) transferred to the Orthopaedic ward from the Emergency
Department via operating theatres. The discussion will initially consider the environment of the
orthopaedic ward and the role that the nurse must assume to provide high quality care. Focusing
briefly on the ageing population and the impact that hospitalisation has on the elderly, the essay will
then rationalise and prioritise current nursing assessments considering the primary and secondary
assessment strategy and consideration of major body systems. Moreover, the discussion will detail
and rationalise the appropriate management of patient safety, comfort and communication with
substantiated planning of care by the registered nurse in the first eight hours of stay. The post–
operative care

Hip Arthroplasty: A Case Study
Article Summary 1 Conservative treatment is the first approach in relieving pain and dysfunction
caused by osteoarthritis, but when this treatment approach fails to relieve the symptoms a surgical
approach might be necessary. Total Hip Arthroplasty is a surgical approach used to alleviate pain
and help improve physical functioning in people suffering from osteoarthritis. This article reviewed
several publications on the recovery of physical functioning after a Total Hip Arthroplasty. The
purpose was to examine the level of recovery with regard to three aspects of functioning: perceived
physical functioning, functional capacity to perform activities, and actual daily activity in the home
situation. For this study, data was obtained from two databases, MEDLINE and EMBASE. For a
study to be selected for this article it had to have a before–after design and the patients included had
to have primary THA for osteoarthritis. Two reviewers ... Show more content on Helpwriting.net ...
The results of the study showed that for perceived physical functioning patients recovered from less
than 50% preoperatively to about 80% of that of controls 6–8 months post–surgery. On functional
capacity, patients recovered from 70% preoperatively to 80% of that of controls 6–8 months post–
surgery. For daily activity, patients recovered from 80% preoperatively to 84% of that of controls at
6 months post–surgery. This article is beneficial in informing patients about recovery of physical
functioning after a Total Hip Arthroplasty. In comparing the 3 aspects of physical functioning, it
showed the different degrees of recovery after surgery. Physical functioning showed a significant
recovery, functional capacity showed a moderate recovery, and daily activity showed a minimal
recovery. All three of the physical functioning aspects recovered to about 80% of that of controls at
6–8 months post–Total Hip

Total Hip Arthroplasty
Despite contrary belief, hip replacement is not necessarily negative. Many Americans believe that in
order to have a hip replacement, your condition must be terrible. A survey conducted in 2012 said
that almost 1/3 of respondents to the hip replacement survey felt they would have benefited from
having their surgery done earlier. This procedure has and continues to change the lives' of many
people in our world. Hip replacement, or arthroplasty, is a surgical procedure in which the diseased
parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are
called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving
the function of the hip joint, and relieving pain. According to the Centers for Disease Control and
Prevention, 332,000 total hip replacements are performed in the United States each year. "Hip
Replacement." Questions and Answers about. N.p., n.d. Web. 21 Oct. 2013. What were once
considered high–tech, joint replacements are now a common operation. Surgeons replace more than
a million hips and knees each year in the U.S. Studies show joint replacements can significantly
relieve pain and increase mobility in about 90% of people who get them. Feature, R. Morgan,
Griffin WebMD. "Should You Have Knee or Hip Replacement Surgery?" WebMD. WebMD, 30
Dec. 0089. Web. 21 Oct. 2013. What symptoms should tell a person that it is time for a hip
replacement? The first and most important sign is pain and

Arthroplasty Case Studies
DOI: 7/14/2011. Patient is a 68–year–old female business development specialist who sustained an
injury when she went around a file and struck the corner of the file cabinet with her knee. Per
OMNI, she is post left knee arthroscopy and chondroplasty on 10/6/11. She had left total knee
replacement on 10/8/2014.
Per the PT note dated 11/19/14, the patient has attended 5/12 sessions.
Based on the medical report dated 12/15/16, the patient complains of pain in the left knee, described
as achy, dull, radiating, pressure and deep. Severity of pain is 8–9/10.
Pain is better with lying flat and not moving legs, and worse with bending, walking standing, sitting
climbing stairs and applying pressure on left knee.
Associated symptoms include feeling depressed, difficulty concentrating, ... Show more content on
Helpwriting.net ...
She was given a prescription for Pamelor 10 mg 1–2 tablets at bedtime to address insomnia and
chronic pain, #60.
Treatment plan includes cognitive behavioral therapy evaluation eight sessions, physical therapy for
the left knee, neurologic consultation for neurologic complaints and medication monitoring program
with urine drug screen.
Patient has been previously denied with 12 Physical Therapy Sessions for the Left Knee on 02/03/15
(Review 206852).
Requested verification from the provider's office on the number of visits to date; however, no
callback/report was received prior to the submission of this request to PA.
Please note that the provider did not specify the number of PT visits requested. If this will be
certified, please determine the number of approved PT visits.
Attached is the QME report dated 03/18/14 and addendum dated

Arthroplasty
Currently, one of the main achievements in the field of arthroplasty is total joint replacement, where
the entire load–bearing joint (mainly in the knee, hip or shoulder) is replaced surgically by ceramic,
metal or polymeric artificial materials. Bone replacement, fracture fixation, dental implants, dental
restorations, bone plates and orthodontic wires are some of the medical devices that provide
structural and mechanical support. A pioneer of hip replacement surgery, Sir John Charlene–a
British orthopedic surgeon– first begun to experiment with Ultra–high–molecular–weight
polyethylene (UHMWPE) in 1962. However, UHMWPE did not begin to be widely used until the
1970's. As a means of improving the product, scientists decided to experiment with UHMWPE by
incorporating it with carbon fiber in order to, what they believed, would straighten the product. As it
would turn out, this would be a completely failed attempt. Again ... Show more content on
Helpwriting.net ...
Such regulatory requirements are necessary and appropriate. A rigorous but responsive and
responsible regulatory process helps to ensure that new medical technologies represent the state of
the art, have the real potential to do well as demonstrated in scientifically grounded studies and
reach patients promptly. Despite the enormous contribution medical devices have made to the public
health, there is a fear of the possibility of liability exposure in the event of device malfunction or
failure. Its influence is growing and is having a chilling effect on innovation. It also damages global
competitiveness and increases health care costs directly and indirectly. Ironically, the shadow of
product liability may actually be keeping better performing products from the market rather than
being a force for

Total Right Hip Arthroplasty Observation
TOTAL RIGHT HIP ARTHROPLASTY OBSERVATION 2
Total Right Hip Arthroplasty Observation
On April 11, 2014, I had the privilege of direct observation of a patient's orthopedic surgery, from
the pre–operative to post–operative setting. The patient with the initials N.R, which we will call
Mrs. R, arrived to the hospital just prior to 6:30a.m. As the name implies, Mrs. R was a female
patient, 76 years old with an admitting diagnosis of right hip osteoarthritis. Due to arthritis in her
hip, Mrs. R's ability to perform daily activities and participate in hobbies such as dancing has been
extremely compromised over the last 2 years. The overall goal of Mrs. R's surgery ... Show more
She will need to be taught the basic mechanics of using the walker especially on stairs, since she has
3 stairs to get into her house and a couple within her house. For safety purposes the therapists will
need to teach Mrs. R how to navigate both up and down these steps. Second, Mrs. R might need a
bench to sit on while taking a shower (once allowed) or be taught how to get in and out of a tub
shower with this same bench inside for her to sit on. Navigating over the side of the tub might be
challenging for Mrs. R especially if she has no assistance, since most of her family lives in Georgia.
Most importantly Mrs. R will have to accomplish all of this without flexing her new hip more than
90 degrees causing a dislocation which is a potential complication after a hip surgery (Lewis,
Dirksen, Heitkemper, Bucher, & Camera, 2011, p

Joint Arthroplasty
The value of total joint arthroplasty is well established. Doctors, nurses, and patients know that the
procedures are common and effective, and that successful surgeries have great benefits. Successful
operations are known to relieve pain and to improve the quality of life for patients and families.
Should one of the surgeries result in infection, however, the consequences can be harsh, including
serious illness, additional surgeries, or even deadly complications.
Bones generally resist disease. Therefore, osteomyelitis, the medical term for bone infection, usually
occurs when a source outside of the body's bone structure introduces bacteria. Surgery commonly is
a source because invasive procedures create pathways that let bacteria into bones. ... Show more
The researchers' goal was to achieve successful wound healing by identifying good practices before
and during surgery. The study relied on evidence–based analysis to isolate the most successful
practices. They saw that when wound healing was successful, an infection–free recovery from joint
surgery was most likely. The authors argued that, because the chance of complications comes with
the surgeries, medical practitioners must know the best practices for reducing the risk of infection
after surgery (Jones, Russell, and Huo, 2015).
It also is vitally important that nurses identify warning signs before, during, and after surgery. With
that in mind, the authors of the study offered guidance. Preoperative assessment should include
obesity, nutrition, control of diabetes, immunosuppression, tobacco use, anemia, and the presence of
bacteria. Standard postoperative care should focus on preventing blood clots, monitoring wounds for
poor healing, and treating any infection risk promptly (Jones et al.,

Recurrent Infection
Response/Recommendation: There are no studies focusing on the strategies to minimize the risk of
recurrent infection of a previously infected joint during reconstructive procedures. However, based
on the available literature on surgical site infection (SSI) and prosthetic joint infection (PJI)
prevention, the strategies below can be recommended:
Exclude local and systemic signs of infection and apply the Musculoskeletal Infection Society
(MSIS) criteria for PJI diagnosis. If necessary, a pre–operative joint aspiration can evaluate synovial
white cell (WBC) count and percentage polymorphonuclear leukocytes (PMN)
Apply all the strategies previously proposed to reduce the risk of SSI or PJI
If an anterior cruciate ligament reconstruction ... Show more content on Helpwriting.net ...
In patients with previous methicillin–resistant staphylococcus aureus (MRSA) infection, adding
vancomycin or teicoplanin should be considered.18,19
Skin preparation: using soap (antimicrobial or non– antimicrobial) or an antiseptic agent on at least
the night before the operative day should be considered.2,18
Particle–free operating environment: although there are no definitive studies on the efficacy of
laminar air flow in non–arthroplasty surgery, the number of theatre personnel should be minimized
to reduce the risk of recurrent infection.18
Respect the soft tissue: meticulous surgical technique and wound closure, and reducing surgical time
helps minimize the risk of recurrent infection.18,20 Furthermore, copious irrigation is considered an
effective strategy to reduce the number of pathogens in the surgical wound

Essay On Arthroplasty
Introduction: Total knee arthroplasty (TKA) is an effective technique to treat end–stage
osteoarthritis of the knee. One important goal of the procedure is to restore a physiological knee
kinematics. However, fluoroscopy studies have shown abnormal knee kinematics after TKA which
may lead to suboptimal clinical outcomes. Posterior slope of the tibial component may significantly
impact the knee kinematics. There is currently no consensus about the most appropriate slope.
Objectives: The goal of the present study was to analyze the impact of different prosthetic slopes on
the kinematics of a PCL–preserving TKA. The tested hypothesis was that the knee kinematics will
be different for all tested tibial slopes.
Methods: A PCL–retaining TKA (Optetrak CR, Exactech, Gainesville, FL) was performed by a
board–certified orthopedic surgeon on six fresh frozen cadaver with healthy knees and intact PCL.
The TKA was implanted using a computer–assisted surgical navigation system (ExactechGPS®,
Blue–Ortho, Grenoble, FR). The implanted tibial baseplate was specially designed to allow
modifying the posterior slope without repeatedly removing/assembling the tibial insert with varying
posterior slopes, avoiding potential damages to the soft–tissue envelope. ... Show more content on
Helpwriting.net ...
Respective 3D positioning of femur and tibia implants was recorded by the navigation system.
Femoro–tibial angle, antero–posterior translation and internal–external rotation were plotted
according to the knee flexion

Arthroplasty Essay
Efficacy and Safety in Total Knee Arthroplasty In our review, the focus is on benefits of liposome
bupivacaine on management of post–operative pain after TKA procedure. Bramlett et al.
(NCT00485693) Phase 2, randomized, double–blind, dose–ranging study evaluated the efficacy,
safety and pharmacokinetics of four dose levels of Depo–Foam bupivacaine compared with 150 mg
of bupivacaine HCl/epinephrine, in TKA (N=138). Patients with age limit from 18–75 years who
were undergoing TKA are allowed to participate in the study. Patients who were pregnant or nursing
, using long–acting opioid medication within past 3 days or any opioid medication within 24 hours
were excluded from the study. Patients enrolled in the study were divided into three groups on the
basis of different dosages of Depofoam bupivacaine. In ... Show more content on Helpwriting.net ...
In group 2, patients received DepoFoam bupivacaine 133 mg, 266 mg, 399 mg. Patients in group 3
received DepoFoam bupivacaine 532 mg. The goal of this study was to evaluate the effects of
different doses of liposomal bupivacaine on cumulative pain score by using AUC of numeric rating
scale at rest (NRS–R) where (0=no pain and 10= extreme pain) and at activity (NRS–A)after
maximal flexion at the joint through Days 2, 3, 4 and 5 after surgery. Safety parameters were also
evaluated by AEs, vital signs, wound healing status, scarring, and electrocardiogram results. Results
of the study showed mean AUC of NRS–A scores were lower in the DepoFoam bupivacaine at 266–
mg, 399–mg, and 532–mg groups compared with bupivacaine HCl through Days 2, 3 and 5,
(p>0.05) though the differences is not statistical significant. Mean scores of AUC of NRS–R were
also lower for the three highest dose levels

Revision Arthroplasties
Introduction: The number of revision arthroplasties performed each year is growing. Last year 9751
revision hip arthroplasties and 5783 revision knee arthroplasties were performed in England and
Wales. Between 2005 and 2010, the number of revision hip arthroplasties rose by 49.1%, and
revision knee arthroplasties by 92.1%. This number is predicted to rise by 31% and 332%
respectively by 20303. It is perhaps a concern that many surgeons and units perform small numbers
of revisions. The Getting It Right First Time (GIRFT) report suggested that about 80% of surgeons
carrying out revision knee surgery, and 60% of surgeons carrying out revision hip surgery, perform
fewer than 10 procedures per year. In the report a recommendation was made that specialist
networks be set up to support revision arthroplasty.
In March 2014, NHS England invited bids to run a pilot revision network. Nottingham Elective
Orthopaedic Service (NEOS), as part of Nottingham University Hospitals NHS Trust (NUH) was
successful and the East Midlands Specialist Orthopaedic Network (EMSON) was set up on a 'hub–
and–spoke' model, with NUH ... Show more content on Helpwriting.net ...
54% have been for revision knee arthroplasties. One patient had both a problematic hip and knee
replacement. In 43% of the cases there was a recommendation to change the management plan
following discussion in the meeting. In several cases, there has been a significant alteration to the
treatment plan; including changing the planned procedure from a single stage to a two stage
approach, cancelling planned revision surgery to aspirate the affected joint and obtain a
microbiological diagnosis prior to revision, and even changing the joint to be operated on.
Following discussion, seven cases (4%) have been transferred to NUH for revision surgery. Analysis
of the operative plan and the theatre inventories at each hospital revealed that in 59 cases (35%)
extra loan kit was likely to be

Hip Arthroplasty Case Study
A 60–year–old female with a history of left hip pain presents to her primary care physician for pre–
operative evaluation for total hip arthroplasty. She is scheduled to undergo a left total hip
arthroplasty. She has had a known systemic autoimmune disease for decades. She has a crippling
stiffness and deformity about both hands which prevents her from signing in at the reception desk.
Review of current medications includes: aspirin, omeprazole, and etanercept. In addition to ensuring
cardiac and pulmonary clearance for surgery, which of the following should be including in the pre–
operative work–up of this patient?
A. Antinuclear antibody (ANA) test
B. Blood cultures
C. Cervical spine X–rays
D. MRI of the neck
E. Tuberculosis testing
Answer ... Show more content on Helpwriting.net ...
This patient has rheumatoid arthritis (RA). The clues included in the question stem are arthritis of
multiple joints (including the hands) and the fact that she takes etanercept (inhibits TNF–alpha.) RA
has a number of unique risks for surgery. RA has a 60% greater risk of cardiovascular death that the
general population. They may have pulmonary fibrosis. In addition, rheumatoid arthritis can cause
atlantoaxial (C1–C2) subluxation and instability. The inflammatory and erosive processes of RA can
cause attenuation of stabilizing structures in the cervical spine, such as ligaments and the facet
capsules. Patients with RA undergoing surgery should receive cervical spine radiographs to evaluate
for instability to avoid possible paralysis during intubation and positioning in

The Patient Protection And Affordable Care Act
With the current implementation of the Patient Protection and Affordable Care Act (PPACA) and
Medicare's performance–based payment incentives, a streamlined model to help improve patient
outcomes and decrease healthcare costs must be developed for the perioperative setting (Berwick et
al 2012). Established in 2010 by the PPACA, Accountable Care Organizations (ACOs) hold multiple
providers accountable for achieving high quality of care and reducing the cost per capita when they
are directly involved in providing services for a designated patient population within an integrated
system (Kash et al 2014; Ferrari et al 2015). In order to comply with these ACO requirements, the
anesthesiologist must be involved in the coordination of the ... Show more content on
Helpwriting.net ...
Furthermore, the cost of the current practice accounts for a substantial portion of the inpatient
health–care expenses that can be reduced if cost–saving actions are put into place (Sathiyakumar et
al 2014; Okike et al 2014; Centers for Medicare and Medicaid Services 2013]. The PSH model
attempts to correct the current standard of care by focusing on three tenets: 1) improve clinical
outcomes through standardized best practices, 2) increase patient–centeredness and experience 3)
decrease the perioperative costs (Garson et al 2014; Prielipp et al 2015; Kain et al 2015; Kain et al
2014; Vetter et al 2013). There have been previous initiatives to improve perioperative care and
reduce costs, but most have focused on reducing the patient's length of stay (LOS) (Eskicioglu et al
2009). For example, Enhanced Recovery After Surgery (ERAS) programs utilize standardized
perioperative care in order to accelerate recovery and reduce complication rates (Eskicioglu et al
2009). Although the ERAS programs have shown increased cost–effectiveness and reduced
complications rates when compared to the traditional perioperative setting, there still is a need to
provide a better continuity of care across the perioperative timeline (Eskicioglu et al 2009; Leee et al
2014). The PSH has been

Physical Therapy For A Left Total Hip Arthroplasty Surgery
Introduction: Physical therapist working in various clinical setting should be familiar with the
patient 's medical condition including medications that they are actively taking to ensure that any
symptoms associated with the drug are appropriately and safely considered. Here is an example of
an acute care patient in the orthopedic ward anticipating for a left total hip arthroplasty surgery.
HPI: S.J. is a 67 y/o Caucasian male with a history of left hip pain for two years. He has difficulty
walking due to left hip pain and utilizes a cane, can walk five blocks, climbs stairs leading with the
right leg. He denies any surgeries on the left lower extremity. He sought physical therapy, but he
does not feel that it is improving his pain but does believe it is improving his strength. He is
scheduled for a left total hip arthroplasty due to the progression of severe osteoarthritis of the left
hip as confirmed by a pelvic x–ray and MRI of the lower extremity without contrast. S.J. has taken
various medications that are listed on the current medication section of this note.
PMH: Osteoarthritis, hyperlipidemia, hypothyroidism, sciatica and hypertension.
CURRENT MEDICATIONS:
Acetaminophen 325 mg tablet PO TID as needed for pain. Max Acetaminophen 4000 mg/day (2000
mg if has liver disease)
Atorvastatin Calcium 40 mg tablet PO QD for cholesterol
Chlorthalidone 25 mg tablet PO QD for blood pressure
Diclofenac Na 75 mg EC tablet PO BID after meals for pain or

Nursing Care Plan
Student Name: Dealon Rouse | Patient Initials: JB | Admission Diagnosis: Left Total Knee
Arthroplasty &Excision of Left Knee Mass Related to Gouty Arthritis | Date(s) of Care:
11/10/11– 11/12/11 | Age: 46 | | Date of Admission: 11/10/11 | Gender: Male | | Marital Status:
Married | Room #: 507 | Code Status: Full Code | Occupation: Electrician | Race: Hispanic | Isolation
Type: | Religion: Roman Catholic | | Allergies: No Known Allergies |
History of Present Illness: The patient is a 46–year–old male diagnosed with right and left knee
gouty arthritis. The patient in the past has undergone a right total knee arthroplasty. After more than
6 months of severe pain in the left knee, the growth of a mass ... Show more content on
Helpwriting.net ...
Even though they are most commonly found as hard nodules around the fingers, at the tips of the
elbows, in the ears, and around the big toe, tophi nodules can appear anywhere in the body. The
patient stated that he began experiencing painful swelling in his right knee over a decade ago. A
large mass grew around the knee and he underwent a total knee arthroplasty. Not long after the
arthroplasty of his right knee, he began experiencing similar symptoms in his left knee and right
elbow. | Diagnostic Procedures * Recurrent severe attacks of gout and the development of tophi can
cause permanent damage to the joints. Joint replacement surgery may be required to restore joint
function. * Surgery may be necessary to remove tophi that form in a person's joints as a result of
gout. These nodules can be uncomfortable and unsightly, and in rare instances cause dangerous
infections. The patient has now undergone total knee arthropalsty in both knees and plans to
schedule surgery to remove the tophi that have formed in his right elbow within a years' time. |
Treatment (Patients may be instructed to do one or more of the following) * Rest the affected
joint(s). * Take NSAIDS, Colchicine, and/or Corticosteroids * Drugs called xanthine oxidase
inhibitors decrease production of uric acid by the body. | Reference using APA format *Note

Mechanically Aligned Arthroplasty Results

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