Trent Brown – Joint Arthroplasty for Today’s Clinician: Greater Knowledge, Greater Evidence, Greater Outcomes

Outline

COMMON THEMES AND RESEARCH BEHIND SHOULDER, HIP, AND KNEE ARTHROPLASTY (TSA, THA, TKA)

• Demographics
• Inclusion criteria for TJA (based on AMA) and who should avoid TJA​
• Neurological and psychological consequences from delaying total joint arthroplasty​
• Healing stages
  • Inflammatory, proliferative, remodeling
  • Bone, cartilage, muscle, tendon, and nervous tissue
• Review of joint movement and osteokinematics​

TOTAL SHOULDER ARTHROPLASTY

• History leading to current procedures and prosthetics
• Functional verses textbook range of motion for normal function and ADLs
• Procedures/components
  • Glenoid component, humeral component
  • Hemiarthroplasty
  • Cemented versus cementless
  • Non-constrained versus constrained
  • Reverse TSA
    • Why reverse TSA?
    • Precautions of TSA versus standard TSA
• Research behind TSA regarding failure rates, functional outcomes, and ROM
• General therapeutic protocol
• 3 or 4 phase approach
• Treatment ideas/lab
  • Scapulohumeral rhythm
  • The proper pendulum
  • 4 approaches to the posterior glenohumeral glide (joint mobilization)
  • Non-weight bearing periscapular training

TOTAL HIP ARTHROPLASTY

• History leading to current procedures and prosthetics
• Procedures/components
  • Femoral component (cemented versus cementless)
  • Acetabular component (plastic, metal, or ceramic)
  • Anterolateral, posterolateral, direct lateral, anterior, and superpath approaches
• Research behind THA​
• General therapeutic protocol
• Treatment ideas/lab
  • 6 determinants of gait
  • Lateral pelvic tilt in supine leading to frontal plane control (LAB)
  • Lateral weight shift with pelvic tilt emphasis (single leg stance with resistance)
  • 4 way straight leg raise

TOTAL KNEE ARTHROPLASTY

• History leading to current procedures and prosthetics
• Procedures/components
  • Femoral component (cemented versus cementless)
  • Tibial component (metal platform with plastic surface for ROM and absorption)
  • Patellar component (metal or plastic)
  • Unicompartmental option
  • Cruciate retaining, posterior stabilized design, fixed bearing, mobile bearing, and gender specific
  • Incisions (parapatellar, midvastus, subvastus/quad sparing)
• Research behind TSA
• General therapeutic protocol
  • SLR and closed chain activity
  • Dynamic EOM and half-standing with weight bearing/functional emphasis
  • Gold standard of the stationary bicycle
  • 4 directional patellar joint mobilization
  • Treatment ideas

DOCUMENTATION

• Documentation ideas “outside the box” for the total joint client
• Case study implementing research and treatment ideas