eMedicine Specialties > Physical Medicine and Rehabilitation > Rehabilitation Protocols

Total Joint Replacement Rehabilitation: Multimedia

Author: Abraham T Rasul Jr, MD, Medical Director for Rehabilitation, Specialty Hospital of Washington; Medical Director for Rehabilitation, St Thomas More Medical Complex; Founder, Arizona Golf Medicine Institute
Coauthor(s): Jeffrey Wright, PT, ATC, Director, Department of Rehabilitative Services, Providence Hospital; Director, Department of Sports Medicine, National Hospital for Orthopaedics and Rehabilitation; Certified Strength and Conditioning Specialist
Contributor Information and Disclosures

Updated: Jun 23, 2009

Multimedia

Image from a patient who had a normal total hip a...Media file 1: Image from a patient who had a normal total hip arthroplasty. This coronal computed tomography reformatted image shows the femoral (ceramic head [right yellow arrow], metal stem, cementless, cable) and acetabular (ceramic cup [top yellow arrow], metal backing, cementless) components.
Image from a patient who had a normal total hip a...

Image from a patient who had a normal total hip arthroplasty. This coronal computed tomography reformatted image shows the femoral (ceramic head [right yellow arrow], metal stem, cementless, cable) and acetabular (ceramic cup [top yellow arrow], metal backing, cementless) components.

Image from a patient who had a normal bipolar hem...Media file 2: Image from a patient who had a normal bipolar hemiarthroplasty. This anteroposterior radiograph shows the femoral (metal head and stem, cemented) and acetabular components (polyethylene cup, metal backing).
Image from a patient who had a normal bipolar hem...

Image from a patient who had a normal bipolar hemiarthroplasty. This anteroposterior radiograph shows the femoral (metal head and stem, cemented) and acetabular components (polyethylene cup, metal backing).

A total knee replacement prosthesis before implan...Media file 3: A total knee replacement prosthesis before implantation.
A total knee replacement prosthesis before implan...

A total knee replacement prosthesis before implantation.

Definitive components of total knee arthroplasty,...Media file 4: Definitive components of total knee arthroplasty, in situ.
Definitive components of total knee arthroplasty,...

Definitive components of total knee arthroplasty, in situ.

Radiograph demonstrating a medial unicompartmenta...Media file 5: Radiograph demonstrating a medial unicompartmental replacement. Note the relative preservation of the lateral joint compartment.
Radiograph demonstrating a medial unicompartmenta...

Radiograph demonstrating a medial unicompartmental replacement. Note the relative preservation of the lateral joint compartment.

Radiograph of an uncemented, hydroxyapatite-coate...Media file 6: Radiograph of an uncemented, hydroxyapatite-coated total knee replacement. No gaps are present in the bone-prosthesis junction, indicating incorporation of the bone onto the prosthesis.
Radiograph of an uncemented, hydroxyapatite-coate...

Radiograph of an uncemented, hydroxyapatite-coated total knee replacement. No gaps are present in the bone-prosthesis junction, indicating incorporation of the bone onto the prosthesis.

Image from a patient who had a cementless total h...Media file 7: Image from a patient who had a cementless total hip arthroplasty with a subsequent loose femoral component. This anteroposterior radiograph shows a >2 mm lucency (arrow) around the femoral stem due to an abnormal distal toggling motion. Note the presence of sclerosis at the femoral stem tip, which is termed pedestal formation.
Image from a patient who had a cementless total h...

Image from a patient who had a cementless total hip arthroplasty with a subsequent loose femoral component. This anteroposterior radiograph shows a >2 mm lucency (arrow) around the femoral stem due to an abnormal distal toggling motion. Note the presence of sclerosis at the femoral stem tip, which is termed pedestal formation.

More on Total Joint Replacement Rehabilitation

References
Further Reading

References

  1. Racial disparities in total knee replacement among Medicare enrollees--United States, 2000-2006. MMWR Morb Mortal Wkly Rep. Feb 20 2009;58(6):133-8. [Medline][Full Text].

  2. Meunier A, Aspenberg P, Good L. Celecoxib does not appear to affect prosthesis fixation in total knee replacement. Acta Orthop. Feb 2009;80(1):46-50. [Medline][Full Text].

  3. Clagett GP, Anderson FA Jr, Levine MN, et al. Prevention of venous thromboembolism. Chest. Oct 1992;102(4 Suppl):391S-407S. [Medline].

  4. Colwell CW Jr, Spiro TE, Trowbridge AA, et al. Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement. A clinical trial comparing efficacy and safety. Enoxaparin Clinical Trial Group. J Bone Joint Surg Am. Jan 1994;76(1):3-14. [Medline].

  5. Johanson NA, Lachiewicz PF, Lieberman JR, et al. Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg. Mar 2009;17(3):183-96. [Medline].

  6. Berger RA, Jacobs JJ, Meneghini RM, et al. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res. Dec 2004;(429):239-47. [Medline].

  7. Andriacchi TP, Stanwyck TS, Galante JO. Knee biomechanics and total knee replacement. J Arthroplasty. 1986;1(3):211-9. [Medline].

  8. Bennett LA, Brearley SC, Hart JA, et al. A comparison of 2 continuous passive motion protocols after total knee arthroplasty: a controlled and randomized study. J Arthroplasty. Feb 2005;20(2):225-33. [Medline].

  9. Romness DW, Rand JA. The role of continuous passive motion following total knee arthroplasty. Clin Orthop. Jan 1988;(226):34-7. [Medline].

  10. Salter RB. The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop. May 1989;(242):12-25. [Medline].

  11. Ververeli PA, Sutton DC, Hearn SL, et al. Continuous passive motion after total knee arthroplasty. Analysis of cost and benefits. Clin Orthop. Dec 1995;(321):208-15. [Medline].

  12. Vince KG, Kelly MA, Beck J, et al. Continuous passive motion after total knee arthroplasty. J Arthroplasty. 1987;2(4):281-4. [Medline].

  13. Seon JK, Park SJ, Lee KB, et al. Range of motion in total knee arthroplasty: a prospective comparison of high-flexion and standard cruciate-retaining designs. J Bone Joint Surg Am. Mar 1 2009;91(3):672-9. [Medline].

  14. Andriacchi TP, Andersson GB, Fermier RW, et al. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. Jul 1980;62(5):749-57. [Medline].

  15. Schneider M, Kawahara I, Ballantyne G, et al. Predictive factors influencing fast track rehabilitation following primary total hip and knee arthroplasty. Arch Orthop Trauma Surg. Feb 7 2009;[Medline].

  16. Bernasek TL, Haidukewych GJ, Gustke KA, et al. Total hip arthroplasty requiring subtrochanteric osteotomy for developmental hip dysplasia 5- to 14-year results. J Arthroplasty. Sep 2007;22(6 Suppl 2):145-50. [Medline].

  17. Bhave A, Marker DR, Seyler TM, et al. Functional problems and treatment solutions after total hip arthroplasty. J Arthroplasty. Sep 2007;22(6 Suppl 2):116-24. [Medline].

  18. Bobyn JD, Miller JE. Features of biologically fixed devices. In: Morrey BF, ed. Joint Replacement Arthroplasty. New York, NY: Churchill Livingstone; 1991:61-80.

  19. Bonutti PM, Mont MA, McMahon M, et al. Minimally invasive total knee arthroplasty. J Bone Joint Surg Am. 2004;86-A Suppl 2:26-32. [Medline].

  20. Chimento GF, Pavone V, Sharrock N, et al. Minimally invasive total hip arthroplasty: a prospective randomized study. J Arthroplasty. Feb 2005;20(2):139-44. [Medline].

  21. DeFrances CJ, Podgornik MN. 2004 National Hospital Discharge Survey. Advance Data From Vital and Health Statistics. Hyattsville, Md: National Center for Health Statistics; May 4 2006. 14. [Full Text].

  22. Della Valle CJ, Sporer SM, Jacobs JJ, et al. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty. Sep 2007;22(6 Suppl 2):90-3. [Medline].

  23. Giachino A. Relationship between deep-vein thrombosis in the calf and fatal pulmonary embolism. Can J Surg. Mar 1988;31(2):129-30. [Medline].

  24. Hull RD, et al. A randomized trial of diagnosis strategies for symptomatic deep venous thrombosis. Thromb Haemost. 1983;50:160a.

  25. Jan MH, Hung JY, Lin JC, et al. Effects of a home program on strength, walking speed, and function after total hip replacement. Arch Phys Med Rehabil. Dec 2004;85(12):1943-51. [Medline].

  26. Janku GV, Paiement GD, Green HD. Prevention of venous thromboembolism in orthopaedics in the United States. Clin Orthop. Apr 1996;(325):313-21. [Medline].

  27. Laubenthal KN, Smidt GL, Kettelkamp DB. A quantitative analysis of knee motion during activities of daily living. Phys Ther. Jan 1972;52(1):34-43. [Medline].

  28. Mabry TM, Vessely MB, Schleck CD, et al. Revision total knee arthroplasty with modular cemented stems: long-term follow-up. J Arthroplasty. Sep 2007;22(6 Suppl 2):100-5. [Medline].

  29. Morrison JB. Function of the knee joint in various activities. Biomed Eng. Dec 1969;4(12):573-80. [Medline].

  30. Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med. Apr 1981;94(4 pt 1):439-44. [Medline].

  31. National Institutes of Health. Total Hip Replacement. NIH Consensus Statement 1994 September 12-14. Bethesda, Md: National Institutes of Health; 1994. [Full Text].

  32. Oishi CS, Grady-Benson JC, Otis SM, et al. The clinical course of distal deep venous thrombosis after total hip and total knee arthroplasty, as determined with duplex ultrasonography. J Bone Joint Surg Am. Nov 1994;76(11):1658-63. [Medline].

  33. Ostrosky KM, VanSwearingen JM, Burdett RG, et al. A comparison of gait characteristics in young and old subjects. Phys Ther. Jul 1994;74(7):637-44; discussion 644-6. [Medline].

  34. Otis JC, Fabian DF, Insall JF. Evaluation of the VA Rancho gait analyzer using total knee arthroplasty patients preoperatively and postoperatively. Trans Orthop Res Soc. 1979;4(76).

  35. Paul JJ. Force actions transmitted in the knee of normal subjects and by prosthetic joint replacement. Inst Mech Eng. 1974;126-31.

  36. [Best Evidence] Peak EL, Parvizi J, Ciminiello M, et al. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. J Bone Joint Surg Am. Feb 2005;87(2):247-53. [Medline].

  37. Pearse EO, Klass B, Bendall SP, et al. Stanmore total knee replacement versus internal fixation for supracondylar fractures of the distal femur in elderly patients. Injury. Jan 2005;36(1):163-8. [Medline].

  38. Peters CL, McPherson E, Jackson JD, et al. Reduction in early dislocation rate with large-diameter femoral heads in primary total hip arthroplasty. J Arthroplasty. Sep 2007;22(6 Suppl 2):140-4. [Medline].

  39. Rasul AT. Individualized hip precautions for patients at risk for dislocation after total hip replacement. (Presented at the Annual AAPM&R meeting October 1996). Arch Phys Med Rehabil. 1996;77(9).

  40. Rasul AT Jr, Fischer DA. Primary repair of quadriceps tendon ruptures. Results of treatment. Clin Orthop. Apr 1993;(289):205-7. [Medline].

  41. Rasul AT Jr, Tsukayama D, Gustilo RB. Effect of time of onset and depth of infection on the outcome of total knee arthroplasty infections. Clin Orthop. Dec 1991;(273):98-104. [Medline].

  42. Rasul AT, Bunning R. Dislocation after total hip replacement during inpatient rehabilitation. The effect of medical comorbidities and cognitive status. Dislocators compared to a control group matched according to age and sex (unpublished). National Rehabilitation Hospital, Washington, DC. 1997.

  43. Resnick B, Orwig D, Wehren L, et al. Health-related quality of life: is it a good indicator of function post THR?. Rehabil Nurs. Mar-Apr 2005;30(2):46-54, 67. [Medline].

  44. Rose J, Gamble JG. Gait analysis. In: Human Walking. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1994:139-64.

  45. Skinner HB, French HG, Dlabel TA, et al. Correlation of gait analysis and clinical evaluation of polycentric total knee arthroplasty. J Orthop Res. 1983;6(5):576-9.

  46. [Best Evidence] Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil. May 2009;90(5):745-55. [Medline].

Keywords

total joint arthroplasty, knee replacement, hip replacement, arthroplasty, joint replacement, total knee replacement, total hip replacement, knee arthroplasty, hip arthroplasty, total hip arthroplasty, total knee arthroplasty, knee replacement recovery, hip replacement recovery, cemented joint replacement, cemented joint arthroplasty, ingrowth joint replacement, ingrowth joint arthroplasty, cementless joint replacement, cementless joint arthropathy, primary joint replacement, primary joint arthroplasty

Contributor Information and Disclosures

Author

Abraham T Rasul Jr, MD, Medical Director for Rehabilitation, Specialty Hospital of Washington; Medical Director for Rehabilitation, St Thomas More Medical Complex; Founder, Arizona Golf Medicine Institute
Abraham T Rasul Jr, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey Wright, PT, ATC, Director, Department of Rehabilitative Services, Providence Hospital; Director, Department of Sports Medicine, National Hospital for Orthopaedics and Rehabilitation; Certified Strength and Conditioning Specialist
Jeffrey Wright, PT, ATC is a member of the following medical societies: American Physical Therapy Association and National Strength and Conditioning Association
Disclosure: Nothing to disclose.

Medical Editor

Curtis W Slipman, MD, Director, University of Pennsylvania Spine Center; Associate Professor, Department of Physical Medicine and Rehabilitation, University of Pennsylvania Medical Center
Curtis W Slipman, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, International Association for the Study of Pain, and North American Spine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.