Electrotherapy + TJA

To reduce pain and disability, restore motion, increase function, and improve overall quality of life.

Osteoarthritis, rheumatoid arthritis (RA), dysplasia, trauma, tumor, avascular necrosis.

Patients with non-severe symptoms, psychological distress, obesity (BMI >40), and younger patients.

Loosening/lysis, fracture, dislocation, infection, deep vein thrombosis (DVT), pain, erosion, malposition, progression of disease, instability, incorrect sizing, prosthesis breakage.

Loosening causing pain, deep infection, dislocation.

Weight-bearing as tolerated (WBAT).

Severe pain and reduced quality of life with no further benefit from conservative treatment.

Loosening, infection, patellofemoral pain, other pain, instability, arthrofibrosis, joint stiffness, fracture, malalignment, deep vein thrombosis (DVT), patellar tendon rupture.

Loosening or infection.

Weight-bearing as tolerated (WBAT).

Safe mobility, discharge planning, education, strengthening, range of motion (ROM).

Younger age, pre-op range of motion (ROM), previous knee surgery, current smoker, high post-op pain, poor compliance with physiotherapy.

The purpose of the PAC includes gathering pre-operative information, ensuring pre-operative medical optimization, educating patients about post-operative requirements, planning for discharge (destination, length of stay, required services and equipment), identifying and problem-solving discharge barriers, providing pre-operative education, engaging the multidisciplinary team if necessary, setting expectations for the post-operative phase, ascertaining goals for discharge, encouraging and organizing prehabilitation, and providing resources for risk assessment and planning.

The Risk Assessment and Planning Tool (RAPT) is used to assess and plan for prehabilitation by providing education and exercises to minimize risk and maximize recovery, ultimately improving outcomes post total hip replacement (THR) and total knee replacement (TKR) and potentially leading to a shorter length of stay (LOS).

The components include subjective assessment (social history, previous medical history, current status), objective assessment (vitals, DVT assessment, chest assessment if indicated, lower limb neuro assessment, assessment of attachments), specific objective assessments for THR (hip range of motion and mobility) and TKR (knee range of motion and mobility), and assessment of overall mobility including bed mobility, transfers, gait, and stairs if required.

The typical post-operative physio treatment plan includes early mobilization on the day of surgery, followed by progressive chest care (if indicated), ice application, range of motion and strength exercises, bed exercises, closed and functional exercises, mobilization with a gait aid, progression of joint range of motion and strength, mobility distance, gait aid progression, stairs if required, promotion of independence, prescription of a standing and functional exercise program, discharge planning, and referrals for continued physiotherapy post-discharge.

Considerations include the implications of bed-based assessment findings, post-operative precautions, pre-operative muscle and mobility status, issues with the unaffected limb, the level of assistance likely to be required, the most appropriate gait aid, utilization of bed mechanics and other equipment to assist transfers, swelling management, analgesia optimization, avoidance of complications, completion of home exercise programs, weight-bearing status and any post-operative restrictions or precautions, a graded walking program, and preferred resting positions.

The goals for discharge planning include ensuring that the patient can safely manage with support, has an adequate follow-up physio plan, and has required services and aids to support earlier discharge home. The patient may not necessarily need to be independent with transfers, ambulation, and stairs with a gait aid prior to discharge, or achieve a specific degree of knee flexion (TKR) prior to discharge, but they should be at a level where they can safely manage with support and have appropriate follow-up care and services.

Components of the exercise prescription for TKR include knee range of motion exercises (active, passive, active-assisted, functional, manual techniques), positioning exercises, knee strength exercises (quadriceps, calf), and stretches for ankle and hamstring.

Components of the exercise prescription for THR include hip flexion exercises, hip range of motion exercises, hip strength exercises, and potentially other specific exercises tailored to the individual patient's needs and recovery.

Prehabilitation aims to minimize risk and maximize recovery, ultimately improving outcomes post-THR and TKR and potentially leading to a shorter length of stay. It involves providing education and exercises to prepare the patient for surgery and optimize their physical condition prior to the procedure.

The post-operative physio treatment plan aims to promote early mobilization, prevent complications, progress joint range of motion and strength, improve mobility and functional independence, educate the patient on self-management, and facilitate a safe and timely discharge with appropriate follow-up care. It plays a crucial role in optimizing the patient's recovery and rehabilitation following TJA.

Key components of the subjective assessment include the patient's social history (living situation, support, home environment), relevant previous medical history (orthopedic, cardiovascular, respiratory, neurological), and current status (pain, dizziness, nausea, cognitive state). These factors help the physiotherapist understand the patient's context and potential challenges in their recovery.

Assessing and planning for prehabilitation is important because it helps minimize risk, maximize recovery, improve post-operative outcomes, and potentially shorten the length of stay for patients undergoing TJA. Prehabilitation sets the foundation for a successful post-operative rehabilitation and contributes to overall patient well-being and functional outcomes.

It is important to inform the patient about the risk of burn to ensure their safety during the ultrasound procedure. Patients should also be informed about what sensations they should expect to feel and what they should not feel during the procedure. Additionally, emphasizing the importance of communication ensures that any discomfort or unusual sensations are immediately addressed.

The key questions that should be asked to the patient before proceeding with ultrasound treatment are: 1. Do they understand the information provided? 2. Do they have any questions or concerns? 3. Do they give their informed consent for the treatment to proceed?

The purpose of performing the hot and cold test is to ensure the suitability for the ultrasound treatment to go ahead. This test helps in determining the patient's responsiveness to hot and cold stimuli, which is important for the effectiveness and safety of the ultrasound treatment.

An appropriate technique for continuous ultrasound should involve demonstrating the correct application of the ultrasound device, including the proper movement of the soundhead, the use of gel, and ensuring that the soundhead is perpendicular to the treatment area.

The different methods of applying ice for swelling and pain management include ice packs, ice massage, contrast therapy, ice submersion, and ice towel (often used for heat stroke). The recommended dosage is 20 minutes on and off.

The methods of applying heat for pain management include commercial heat packs kept in hydrocollator @ 70 degrees, microwave hot packs (must be 2cm between the hot pack and patient’s skin), and Hotteeze packs (adhere to clothing). The recommended dosage is 20 minutes on and off.

The different application methods for ultrasound treatment include topical (using gel) and subaqueous. The recommended dosages are 5 minutes for acute conditions and 10 minutes for chronic conditions. It is important to note that the soundhead must always be moving and must be perpendicular to the treatment area.

The steps involved in reading X-rays include checking the patient’s name and the date the film was taken, ensuring the correct placement of the film in the x-ray box, and looking at the markers for left (L) and right (R). The key consideration for alignment (A) relates to the relationship of the bones to one another, while bone integrity (B) involves assessing the structure and condition of the bones.