Training the Joint Replacement Client · Joint Replacement Statistics Find Current Stats at CJRR or CIHI Degenerative osteoarthritis cause for replacement (81% hip/93% knee) 2010

Training the Joint Replacement Client

© LeapFit Training Professionals 2016 Page 1

What is a Joint Replacement?

What is a joint?

Osteoarthritis and the role cartilage plays

The prosthesis (Metal,Plastic,Ceramic)

Prosthesis attached directly either as a cemented or uncemented replacement

A hip replacement can by a hybrid which means it is a combination of cemented and uncemented

The uncemented replacement is secured by a ‘press fit’ prosthesis that has a porous coated surface allowing bone to grow through

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What Causes Joint Damage?

1. Osteoarthritis (OA)- the progressive weakening and degeneration of the articular cartilage around a joint causing pain, inflammation, stiffness, bone deformity, and lack of mobility

Risk Factors Contributing to OA (mechanical factors, repetitive stress, and being overweight)

2. Traumatic Arthritis – caused by injury such as bone

fracture, improper cartilage alignment, ligament injuries..

3. Rheumatoid Arthritis – an inflammatory, autoimmune, systemic disease of the synovium which lines the joint cavity. The inflamed synovium leads to cartilage breakdown and joint destruction.

4. Osteonecrosis & Avascular Necrosis

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Osteoarthritis

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Symptoms leading to

Joint Replacement

Pain upon weight bearing

Sleep disturbances due to joint pain

Groin pain for individuals with OA of the hip

Activities of Daily Living (ADL) compromised

Loss of Range of Motion (ROM)

Feeling of Stiffness first thing in the morning and after prolonged periods of sitting/standing

Crepitus in the joint upon movement

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Joint Replacement Statistics

Find Current Stats at CJRR or CIHI

Degenerative osteoarthritis cause for replacement (81% hip/93% knee)

2010–2011, there were 50,733 knee replacements in Canada 15.0% increase from 2006–2007

In 2010–2011, there were 42,713 hip replacements as follows:

Total hip replacements: 31,666 (74.1%)

Partial hip replacements: 10,230 (24.0%)

Hip resurfacing procedures: 817 (1.9%)

Largest % increase per age group ’95-2002– Age 45-54 TKR female 168.8% / 45-54 male TKR 129.8%

– Age 45-54 THR female 49.7% / 45-54 male THR 47.3%

– Age 55-64 TKR female 79.9% / 55-64 male TKR 68.8%

– Age 85+ TKR female 110.7% / 85+ male TKR 123.1%

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Demographics

Hip Replacement

•Males younger at the time of hip replacement

•Male avg age 67.3 yrs / females avg age 72.5 yrs

•26.9% male hip replacement age 65 to 74 years

•Nearly 50% of all females were 75 yrs and older

Knee Replacement

•Average age for males 67.5 years old

•Average age for females 67.4 years old

•Avg Age Knee Replacement 65 to 74

(35.9% and 34.1% for males and females)

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Types of Joint ReplacementCemented vs. Uncemented

Cemented Heals faster

Weight bear sooner

May loosen faster

50% require revision within 10-20 years

Older patient, poor bone quality, patient who needs to move quicker post surgery

Uncemented lasts longer due to

bone growth through prosthesis (photo)

Takes longer to heal

Cannot weight bear as quickly as cemented

Younger, active patient

Healthy bone

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Cemented vs Uncemented

- The cement is not a true glue; it is a filler

- It hardens within 10 minutes

- The surgeon decides if cement will be used for all or parts of the prosthetic

- Uncemented prosthesis has a porous coating on the implant for bone to grow through

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Cemented Hip Implant

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Total Knee Replacement

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Hip Replacement Surgery

• The Surgical Procedure

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Types of Total Hip

Replacement

Hybrid Hip Replacement (femoral shaft cemented / acetabular implant uncemented)

Cemented / Uncemented

Minimally Invasive Hip Replacement– Less invasive 2-4 inch incision

– 1 mini incision or 2-2inch incisions

– Dependent on arthritic stage, bone density, body size, normal hip anatomy, weigh less than 200lb and no previous surgery

Anterior Hip Incision (USA)

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Hip Incision

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Hip Replacement Checklist (pg 47)

√ Restrictions from Surgeon / Physioand for how long?

√ Surgical Incision Type (if known), Healing

√ Weight Bearing Status (FWB, PWB)√ Leg Length Discrepancy√ Flexibility (Hip Flexors, Hamstrings,

Quadriceps)√ Strength / Functional Assessments√ Gait / Posture / Balance / Pain

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Contraindications &

Precautions Hip Replacement

Hip **Medial Incision (most common)Time Frame 3 Months!

External/internal rotation Flexion hip past 90 Forward trunk flexion Adduction past midline One leg balance Sitting or Standing for long periods How would you modify stretches for

THR?

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Hip Contraindications

Anterior Incision **Rare done in U.S.

For an Anterior Incision Hip….

Avoid:

Prone Extension

No toes out Charlie Chaplin

Focus:

• They will have a weak hip flexor

• Start with seated marching at 90 degrees hip flexion

• Hip Flexion Supine with Core Engaged

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Program Design for Pre & Post-

Op Hip Replacement

Exercise: 1. One shoe off 2. Walk with shortened stride

1. What muscles are weakened when weight bearing has been restricted?

2. Which exercises will help strengthen these muscles?

3. How should pre and post-op exercise selection be differentiated?

4. What other muscles need to be strengthened to support the hip?

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Hip Pre-Op Exercise

Guidelines

1. Flexibility - stretch Hip Flexors

2. Strength – Gluteus Medius, Minimus, and Maximus and maintain strength in functional ADL

3. Cardiovascular

4. Core

5. Non Weight Bearing (pain guide)

6. Gait education

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Hip Post-Op Exercise Guidelines

How will post-op exercises vary from Pre-Op?

How will strength and flexibility exercises change?

What new options available in cardio?

Focus on Function ADL, car, hobbies

Gait Emphasis and Education

Importance of Core, Balance, Agility

The 3 Month Rule of Thumb!!

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Hip Dislocation

Incidence of Dislocation may be as high as 10%

Anterior Surgical Approach and MI decrease risk of dislocation

Risk of Dislocation doubles and triples over primary surgery rate

More than ½ occur in first 4-6 weeks

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Hip Dislocation Factors

1. Surgical Approach

2. Prosthetic Component Size & Orientation

3. Weakness or Imbalance of Muscles

4. Multiple Revision Surgeries

5. Inadherence to ROM restrictions

6. Individual factors (age, female,…)

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Hip Dislocation

Lateral Restrictions: 90 degrees hip flexion, adduction past midline, internal rotation

Anterior Restrictions: avoidance hip extension and external rotation

Restrictions for 6 weeks uncomplicated

Restrictions for 12 weeks complicated

Late Dislocation not uncommon

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Exercise Progressionsand Signs & Symptoms of

Advancing too soon Increased swelling

Increased pain

Increased or abnormal fatigue

Change in performance/technique

Muscle soreness level /duration 48hr+

New source of discomfort/pain

Inability to maintain current reps/sets

The 1 Day a Week Wonders

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POINTS OF INTEREST

Illiotibial band Tightness

The Importance of Core in THR

The Stretching Intensity Debate

Scar Tissue page 78

(development, importance of early mobilization, alternative treatments)

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Getting up and down off

the floor

How should we instruct a THR or Hip Resurfacing client to get down on the floor?

How would our instructions change for a TKR or PKR client to get down on the floor?

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Cardiovascular Program

Design Hip & Knee

1. What lifestyle changes have affected these individuals pre and post-op?

2. How does this impact our programming of the F.I.T.T. principle for their cardiovascular conditioning?

3. Which aerobic machines are best for knee or hip replacement and why?

Pole Walking

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Compounding Health Issues &

Heart Rate Training Zones

Use the beginner / inactive target heart rate calculations whether using Karvonen formula or 220-age

Beta Blockers and RPE

Combination measurement of HR reading, RPE, and the talk test

Emphasize Warm-up and Cool-Down

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Pre Course Consultation

Consultation check list Appendix Q & R

Medical Clearance

Health Screening Questions Specific to Joint Replacement

The importance of personal Goals to program design and client satisfaction

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Building a Successful

Joint Replacement Class

Program

Excellence

Instructors

Facility

Client Perks

Marketing

Organized System

Community Links

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Creating a Positive

Atmosphere for Healing

Role of the InstructorListeners, Interviewing Skills, CaringSkills of Working in a Class Setting

Client Perks / Social

Going the Distance

Self Care and Boundaries for Instructors

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Scope of Practice

Define Scope of Practice

Boundaries

Educating the Public

When should you refer?

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Physiotherapists

The Fitness Professional’s Link to the Medical Community

Networking

Communication

Partnership

Physio Referral / Information Release Forms

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Thank You!

Changing Lives!

You Make a Difference!

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Documents

Training the Joint Replacement Client · Joint Replacement Statistics Find Current Stats at CJRR or CIHI Degenerative osteoarthritis cause for replacement (81% hip/93% knee) 2010