Excision arthroplasty  Removing a certain bone that articulates with a certain area. Not as common A space it left behind with scar tissue laid down to help with the healing process  This is more common in the UE's  Such as humeroradial joint injuries, fracture of the radial head, and so on  This can be used on the LE's but is more for reconstruction Ex:) After multi-failed attempts of a THA   Complications after surgery  Joint instability  Leg length discrepancy  Constant muscular imbalance and weakness  Excision arthroplasty with implant  Similar to excision arthroplasty but the bone is replaced with a silicone flexible material.  Interposition arthroplasty  Mainly used to fix joint surfaces  Can be used on patients who do not qualify as a candidate for total joint replacements such as children  Most common is a CMC (carpometacarpal) joint of the thumb  Joint replacement arthroplasty  A total joint replacement basically  Used to relieve pain and improve function  Typical with severe OA patients    Basic material review of arthroplasty  Rigid  Metal mostly  Semirigid  Plastic mostly  Cemented  Cement mainly used for older patients or patients with a sedentary life style  Does eventually breakdown and cause pain  Noncemented  Use of biofixation such as ingrowth of bone to hold the prosthetic  Hybrid  One joint surface does not have cement and the another joint surface does  Contradindications  Mainly when patients are not a candidate for arthroplasty if this is seen report it if the patient is about to get surgery. Active infect of the joint  Chronic osteomyelitis (Inflammation of the bone due to an infection)  Substantial lost of bone  Significant paralysis of musclses surrounding the joint

Arthroscopic debridement and lavage   Removal of unstable or loosen bodies such as fragments of bones or cartilage. Post management after surgery  PROM / AAROM immediately after 24-48 hours of surgery  Quickly progress to AROM   Synovectomy  Removal of the synovial lining of the joint  Typical with RA patients who have constant inflammation of the joint  Conditions it can treat  Tenosynovitis (Inflammation of the tendon sheaths where muscles connect to)  Tensosynovectomy (Excessive synovium in the joint)    Post management after surgery  Slow process with exercise and ADL's  Depended on patient  Arthrodesis  Surgical fusion of two articulating joints  Typical in spine, wrist, thumb, and ankle  Used to relieve severe pain such as late stage of OA and can even be used on patients where a total replacement surgery failed  Kisner p.369, table 12-2 for positioning of joint post surgery  Post management  Post surgery they wear a cast over the joint for 6-12 weeks  No more ROM so ROM and strength must be maintained above/below the joint  WB status till proof of healing  ORIF  Some type of inter fixation device is used to stabilize the bone fragments during the healing process  As it heals a second surgery might be required to remove the fixation  Postmangement after surgery  Heavily dependent on so many factors  WB status is necessary while maintaining immobilization of the area  Osteotomy  Surgical cutting and realigment of bone  Common on the knee and hip  Used to reduce pain and deformity  Different types of procedures reffer to Kisner p.370 for more info  Postmanagement after surgery  If immobilized in a cast you can peform AROM above and below the joint to prevent stiffness and muscle weakness  WB status is typically 4-6 weeks  When WB status has improved and cast is removed you can perform AAROM and active exercise with light weights

https://www.youtube.com/watch?v=9pCbnvpyLvs

The ulna notch of the radius is a concave moving on a stable convex which is the head of the ulna.

All bones that are distal are concaves moving on a stable convex.

Patella is a moving convex and a stable concave which is the dip in the femur.

Fibula head is a moving concave on a stable convex which is the lateral condyle of the tibia.

0/5 No signs of contraction  1/5 Signs of muscle contraction but no joint movement 2-/5 GM, half of ROM  2/5 GM, Full ROM  2+/5 GM, Full ROM, Min resistance  GR, initiation of ROM  3-/5 GR, half of ROM  3/5 GR, Full ROM  3+/5 GR, Full ROM, Min resistance  4-/5 GR, Full ROM, Min-Mod resistance  4/5 GR, Full ROM, Mod resistance  4+/5 GR, Full ROM, Mod-Max resistance  5/5 GR, Full ROM, Max resistance

Active: When a muscle contracts at two joints at the same time.    Passive : When a muscle is lengthened over two joints at the same time.

Used to measure grip strength which is recorded in pounds or kilograms.

Measures static strength without movement.  Benefits are the ability to gather data on force, reaction time, muscle recruitment, and maximal exertion. The disadvantages are inability to translate into functional activities and contraindications to pt's with fx and significant hypertension.

Measures strength during a constant movement.  Benefits are the ability to measure muscle strength during different speeds.  The disadvantages is that this method is high cost and not functional.

Make test  Tests such as the dynamometer where pt's are asked to create force.  Break test MMT stuff