Paul M. Levy – The Total Joint Replacement Patient: Supporting a Successful Journey

Outline

Pre-operative Work-up

• The pre-operative work-up is a vitally important part of the operative process. Not all patients with arthritis require surgery. Knowing the treatment options allows patients to make informed decisions about their care. Radiology examples will be included for case study discussion.

Diagnosis

• Osteoarthritis
• Bone Cancers
• Recurrent Infections
• Acute Injury, Falls, i.e.

Treatment Options

• Exercise / Physical Therapy
• Injections
• Operative Treatments

Pre-operative Planning

• Understanding the processes that need to take place prior to the surgery will help the patient better prepare for the surgery, allow for less patient anxiety and establish realistic goals and expectations.

• Pre-operative Testing
• Pre-operative Clearances
  • Medical
  • Cardiac
  • Pulmonary
  • Other/Individualized
• Obtaining Consent
• Pre-operative Education
  • One-to-one education
  • Online education
  • Pre-operative joint classes

Surgical Procedures

• Fixation
  • Treatment for fractures that do not require joint replacement
• Total Joint Replacement
  • Hip
  • Knee
  • Shoulder
  • Other Joints
    • The elbow, wrist, and ankle can also be replaced, but these surgeries are performed far less frequently. As well, there is currently a disk replacement surgery in study, but it is not yet FDA approved.
• Megaprosthetic Replacements
  • Replacement of both the joint and a portion of the surrounding bone
• Joint Revisions

Immediate Post-Operative Care

• Multi-modal Pain Management
  • Oral vs. IV
  • Nerve blocks
  • Ambulation
  • IV acetaminophen / NSAIDs
  • Intra-operative steroid injection
  • Age-related analgesia
  • Opioid tolerance
• Physical and Occupational Therapy
  • Positioning
  • Movement restrictions
  • Exercises
  • Assistive devices
• Wound Care / Infection Prevention
  • Dressings
  • Antibiotics
• VTE Prophylaxis
  • Mechanical
  • Pharmaceutical
• Joint Commission S.C.I.P. (Surgical Care Improvement Project) Protocols
• Surgical/Medical Complications

Post-acute Care and Follow-up

• Discharge Planning
  • Acute Rehab / Skilled Nursing / Home
  • Follow-up appointments
  • Home medications
• Readmission/complications