Terry Rzepkowski – An Intensive Training Lab on Total Joint Replacements

Outline

Determinants for Joint Replacement

• Muscle imbalance
• Acute injuries
• Chronic conditions
• Systemic conditions

Pre-operative Selection Determinants

• Postural deformity
• Diagnostic imaging
• Function and pain level
• Conservative therapies
• Physical co-morbidities
• Relative bone density
• Post-op considerations: Acute rehab? Skilled nursing? Home? Which is the right choice in terms of accessibility, assistance, activity restrictions, and length of time?

Surgical Procedures with Video Presentations

• Total shoulder arthroplasty (TSA)
• Reverse TSA
• Total elbow arthroplasty
• Total hip arthroplasty (THA), conventional posterior and lateral approaches
• Anterior THA and THA revision
• Total knee replacement (TKA), conventional and subvastus
• Total ankle replacement
• The future of joint replacement:
  • Video radio graph assisted total elbow arthroplasty
  • Computerized and robotic assisted hip, knee and ankle replacement

Acute Post-op Recovery Interventions

• Pain management, opioid tolerance and opioid induced constipation (OIC)
• Wound care/Infection prevention demonstration of PICO dressing
• VTE prophylaxis
  • Hands on demonstration
    • Point-of-care PT/INR
    • The latest recommendations on TED hose
    • Cold recirculator units and cold compression devices

Treatment Sessions for the Acute through the Subacute Recovery Phase

• Physical/Occupational therapy
• Movement restrictions
• Demonstration of proper positioning
• Hands on practice
  • UE: Donning and doffing of UE immobilizers
    • Shoulder, distal UE exercises, and active proximal scapular exercise, cervical stretching techniques
  • Hip: Immediate post-op exercises and progressions for the conventional/anterior approach hips, including transfer considerations
  • Knee: Immediate post-op exercises and progressions for the conventional/subvastus approach, forms of stretching

Out-patient and Beyond: Strategies for Optimal Function and Joint Longevity

• Hands on activities
  • Shoulder: Manual techniques to build proximal scapular stabilization, progression to rotator cuff strengthening
  • Hip: Progression of core pelvic strengthening, proximal trunk stability, proprioceptive, balance, coordination activities, return of normal gait mechanics
  • Knee: Progression of flexibility exercises, patellar mobilization, importance of proper footwear, proprioceptive, balance, coordination activities, return of normal gait mechanics