2 Course PDF Bundle: Hip and Knee Joint Rehabilitation and Hip Fracture Literature Review

Sarah R.Stillings, MA, PT, MPT, CHT

Sarah R. (Sally) Stillings is a PT and Certified Hand Therapist in Texas. She received her physical therapy degree from the University of North Carolina at Chapel Hill. Prior to becoming a therapist, Sally taught university-level writing courses and was assistant editor of The Journal of Craniomandibular Practice. In her extensive career as a PT, she has held a variety of clinical, teaching, administrative, and business roles, including general PT practitioner, upper extremity specialist, clinic manager, hand therapy clinic coordinator, continuing education (CE) instructor, and CE course administrator. She has also served as Executive Director of the Kellermann Foundation, a U.S. nonprofit organization supporting healthcare and community development in Uganda, East Africa. Her work now focuses on creating evidence-based CE materials for rehab professionals. Sally is a lifelong runner who celebrates all those who cover the ground.

1412 Hip Fracture Rehabilitation: Literature Review—Course  Objectives 

After successfully completing this continuing education course, the learner should be able to: 1. Differentiate among the main surgical treatments of choice for femoral neck fractures  based on their Garden classifications. 

2. Identify the pros and cons of cemented vs. noncemented prostheses for femoral neck  fractures. 
3. Recognize the various mechanisms of preventing venous thromboembolism (VTE) after  hip or knee arthroplasty based on the pharmaceutical agent that is used, and recall the  authors’ recommendations regarding VTE chemical prophylaxis. 
4. Identify the study design, objectives, strengths, and limitations of the included studies. 5. Indicate the post-hip-fractures outcomes found in the studies, including: a. Complications in patients on Coumadin based on INR value groups 
5. Factors in whether patients are discharged home or to skilled nursing care c. Differences among inpatient, outpatient, and home-based rehab 
6. Association between probable sarcopenia and outcomes 
7. Recall the main conclusions of each article presented. 
8. Indicate ways in which the information presented in these articles may contribute to  functional, occupation-focused practice. 
9. Identify how application of the information presented may:  
10. Guide assessment and intervention choices 
11. Help meet patient-specific rehabilitation goals 
12. Improve patient outcomes

1412 Hip Fracture Rehabilitation: Literature Review—Table of  Contents 

Hour 1 

Course Instructions 3 About the Authors 

Course Description 

Course Objectives 6 

Introduction 9 Article 1: 10 Surgical treatment of femoral neck fractures: a brief review (15 pages) Hour 2 

Article 1 (continued) 

Hour 3 

Article 2: 11 Review of therapeutic options for the prevention of VTE in TJA (15 pages) Hour 4 

Article 2 (continued) 

Article 3: 12 Postop complications of hip fracture patients on chronic Coumadin (7 pages) Hour 5 

Article 4: 13 Factors determining home vs. rehab discharge following primary TJA (6 pages)

Article 5: 14 Outpatient and home-based treatment…for hip fracture rehab (10 pages) Hour 6 

Article 5 (continued) 

Article 6: 15 Knee extension strength measures indicating probable sarcopenia (13 pages) Hour 7 

Article 6 (continued) 

Examination 17 Evaluation 23

473 Hip and Knee: Advancements in Joint Replacement

Course Objectives

After successfully completing this course, the learner should be able to:

1. Identify relevant anatomical features of the hip and knee regions and the pathophysiology of osteoarthritis and rheumatoid arthritis
2. Recall the prevalence of osteoarthritis in the U.S.
3. Recall the history of hip and knee joint arthroplasties
4. Identify recent advancements in the construction and use of joint replacement components
5. Differentiate the main standard and minimally invasive surgical approaches used for hip and knee total joint arthroplasties, including computer-assisted surgery, and recall their advantages and disadvantages
6. Define elements of the healing sequence and identify possible complications after joint replacement
7. Recall traditional post-operative hip restrictions and precautions specific to various surgical approaches
8. Identify and apply in case studies conventional and rapid-recovery therapy interventions for patients with these joint replacements at various stages of recovery
9. Recall appropriate therapeutic interventions to specific case studies
10. Recall comprehensive treatment approaches to help patients who are status post hip and knee replacement in order to regain function

Table of Contents Page #

HOUR 1

Course Instructions 2
About the Author / Course Description 3
Course Objectives 4
Table of Contents 5
Introduction 8
Chapter 1: Applied Anatomy and Pathophysiology 9
The Hip
Functions
Bony Anatomy 10
Ligaments 12
Muscles 13
Nerves and Blood Supply 15
The Knee 17
Functions
Bony Anatomy
Ligaments and Tendons 19
Muscles 21
Blood Supply and Nerves 22

HOUR 2

Pathophysiology 23
Prevalence of Arthritis 24
Osteoarthritis 26
Grading Systems 29
Rheumatoid Arthritis 31
Chapter 2: Hip Arthroplasty Surgical Options 33
Types of Hip Arthroplasty 34
History of Hip Replacements 35
Current Prosthesis Types 37
Metal-on-Polyethylene 38
Metal-on-Metal 39
Ceramic-on-Ceramic 40
Ceramic-on-Polyethylene 41
Ceramic-on-Metal 42

HOUR 3

Fixation Techniques
Cemented Prostheses
Cementless Prostheses 43
Hybrid Prostheses 44
Component Designs
Acetabular Components 45

Femoral Components 46
Surgical Approaches to the Hip 47
Posterior Approach 48
Direct Lateral Approach 51
Direct Anterior Approach 53
Anterolateral Approach 56

HOUR 4

Minimally Invasive Surgery
Computer-Assisted Surgery 60

Chapter 3: Knee Arthroplasty Surgical Options 63
History of Knee Replacements 64
Types of Knee Arthroplasty 65
Total Knee Arthroplasty
Unicompartmental Knee Arthroplasty 66
Patellofemoral Arthroplasty
Current Prostheses Types 67
Materials
Fixation
Design
Posterior-Stabilized Prosthesis 68
Cruciate-Retaining Prosthesis 69
Bicruciate-Retaining Prosthesis 71
Tibial Fixed-Bearing Component
Tibial Mobile-Bearing Component 72
Unicompartmental Prosthesis 73
Patellar Component
Gender-Specific Implants 75

HOUR 5

Revision Prostheses

Primary Surgical Approaches to the Knee 76
Medial Parapatellar Approach 78
Subvastus Approach 80
Midvastus Approach 82
Trivector Approach 83
Other Surgical Approaches to the Knee 84
Lateral Approach 85
V-Y Turndown 86
Quadriceps Snip
Tibial Tubercle Osteotomy 87
Minimally Invasive Surgery 89
Bilateral TKAs 90
Computer-Assisted Surgery 91

HOUR 6

Chapter 4: Postoperative Healing and Complications 92

Healing after THA or TKA
Tissue Repair 93
Recovery Schedule 95
Post-Operative Prognosis 98
Complications 100
Infection
Periprosthetic Fracture 103
Peripheral Nerve Injury 105
Implant Dislocation 107
DVT/PE 109

HOUR 7

Other Complications 113
Osteolysis 114
Heterotopic Ossification

Muscle Injury

Limb Length Discrepancy 115
Chronic Pain

Component Longevity 116
Return to Athletics 117
Chapter 5: Rehabilitation after THA 122
Preoperative Intervention 123
“Prehabilitation”
Preoperative Patient Education

Traditional Post-THA Rehabilitation 125
Restrictions and Weight-Bearing Status
Phases of Traditional Rehabilitation 128

HOUR 8

Rapid Recovery Approaches 133
Phases of Rapid Recovery Rehabilitation 137
Addressing Postsurgical Soft Tissue Impairments 139
Muscle Contractures 140
Muscle Weakness 141
Chapter 6: Rehabilitation after TKA 144
Preoperative Intervention
Traditional Post-TKA Rehabilitation 145
Phases of Traditional Rehabilitation

HOUR 9

Rapid Recovery Approaches 149
Phases of Rapid Recovery Rehabilitation
Best Practices for Rehab after TJA 151
Addressing Postsurgical Impairments 153
Knee Stiffness
Difficulty Kneeling 154
Muscle Imbalances 155

Conclusion 157
Case Studies 158

HOUR 10

Appendix A: Patient Education Links 162
Appendix B: Rehabilitation Protocols 164
References 166
Examination and Evaluation 182-195

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Educational Level: Intermediate

Target Audience: PT, PTA, OT, OTA

Course Completion Requirements: Passing an online exam with 70% or greater will be required to earn continuing education credit

• Hip Fracture Rehabilitation: Literature Review is approved for 0.7 CEUS. 7 contact hours

• Hip and Knee: Advancements in Joint Replacement is approved for 1.0 CEUS. 10 contact hours

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