Total Joint Rehabilitation: Matching Intervention to Knee & Hip Impairment – Chad M. Thompson

• 3D motion analysis of gait
• Evaluate interventions in real time
• Customized prosthetic components
• Using the evidence to address strength loss and functional range
• Avoid revisions & component removal
• The future of bio growth tissue

Join Chad M. Thompson, PT, DPT, OCS, CEAS, to elevate your treatment of total joint patients into the here and now. Recent advances in total joint techniques and components, along with the advances in pre-care, anesthesia, pain control, and pharmacological regimens, are allowing for clients to now consider treatment options through surgical centers and out-patient surgery sites. The high-tech development of 3D custom joint fabrication, in conjunction with 3D motion analysis of gait, both pre- and post-operatively, allow the patient to receive the most state-of-the-art care available. Total joint patients now have the option of customized prosthetic components, which fit more precisely with less tissue trauma.

You will learn how to evaluate real-time evidence to determine whether current interventions are contributing to the most successful outcomes for the client. Based upon this evidence, we will discuss how to select targeted exercises that will achieve cost effective, functional goals. During this inspiring day, you will have an opportunity to see how 3D gait and motion analysis can match your client’s needs for a truly customized program. Discussion of the most recent literature findings will be incorporated as well, explaining such things as how convalescence is understood to be a year-long process, due to bone to metal interfaces demonstrating higher tensile stresses than bone to bone. Let us bring the future of total joint rehabilitation forward… as you discover the exciting new opportunities within your role, update your prescription methodology and determine ways to anticipate the evolving needs of your total joint client.

OUTLINE

Options Prior to Total Joint Replacement

• Bio-logics
• Supplements to manage OA
• Hyaluronic injections
• Selective cox II
• Physical therapy

When Is It Time for an Elective Total Joint Procedure?

• Total Joint Assessment Scales
• Physical Exam Criteria
  • Pain: Visual analog scale, Wong Borg facial scale
  • Range of motion loss: What are functional ranges? What is functional gait?
  • Quality of life measure/outcomes: LEFS, TUG
• Client’s Goals
  • The Bucket List
  • Leisure Time
  • Work Expectations
  • Enjoying the Later Years

Hospital Course

• PreHaB
• Critical pathways
• Typical stay
• Length
• Pain control: Oral meds, PCA, nerve blocks
• Rehab goals
  • Gait distance
  • Exercise protocol
  • Discharge planning
  • Anticipating needs at home
• Rehab Outcomes
  • Gait distances
  • Knee stability
  • Click six
  • Iowa scale

Complicated Hospitalizations

• Risks
  • Fracture
  • Blood clot
  • Component failure
  • Infection
  • Blood loss
  • Death
• Expectations for a Complicated Course
  • Blood transfusions
  • Revision
  • Treating Infections: Component removal, IV antibiotics, oral meds
  • Back on track

The Focus of Post Hospital Care

• Assessment of motion analysis
• Evaluative findings
• Customized exercise prescription
• Gait assistive device selection

Rehabilitation Goals

• Scar care
• Benefits of scar care soft tissue mobilization
• Cost of poor scar care
  • Fibrosis
  • Patellar adhesion
  • Range of motion loss
  • Manipulation
• Functional range restoration
  • Normal ranges
  • Cost of range restriction
  • 3D assessment
  • Cost of NOT Restoring Range of Motion: Knee and hip
• Strength loss
  • 3D Comparison of Functional Cost to Strength Loss
  • Best Practice Exercises WHY?
    • Squat
    • Lunge
    • Lateral Stepping
    • Stretch: Active and passive insufficiency

Cost analysis

• Average hospital length
  • Saving a hospital day
  • Risk reduction: Infection, blood clot, nosocomial infections
• Rehab cost
  • Hospital total cost
  • Outpatient cost
  • Home health
  • Bridge program
• Joint life
  • Revision rates: Knee and hip
  • Revision difficulties: Knee and hip
• The future of bio growth tissue
  • Cartilage re-growth
  • Bone re-growth
  • Can we ever prevent DJD? RA?

OBJECTIVES

1. Evaluate conservative management of degenerative joints to discern when these options are the best for the client.
2. Analyze total joint replacement prescription for outcome achievement.
3. Anticipate strategies to optimally manage complications.
4. Contrast the current trends for comprehensive rehab programs.
5. Determine how 3D gait and motion analysis can become a powerful tool in the development of functional rehab programming.
6. Compare the effects of residual deficits well beyond the initial healing phase.
7. Establish goals for complete rehabilitation.
8. Review cost analysis and purposed saving as they pertain to customized joint replacements.