Functional Problems and Treatment Solutions After Total Hip and Knee Joint Arthroplasty by Anil Bhave, Michael Mont, Scott Tennis, Michele Nickey, Roland.

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Functional Problems and Treatment Solutions After Total Hip and Knee Joint Arthroplasty by Anil Bhave, Michael Mont, Scott Tennis, Michele Nickey, Roland Starr, and Gracia Etienne J Bone Joint Surg Am Volume 87(suppl 2):9-21 December 1, 2005 ©2005 by The Journal of Bone and Joint Surgery, Inc.

The percentages of the total number of functional problems (n = 76) after total hip arthroplasty(THA). The percentages of the total number of functional problems (n = 76) after total hip arthroplasty(THA). Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior standing radiograph showing an apparent limb-length difference caused by an abduction contracture. Anteroposterior standing radiograph showing an apparent limb-length difference caused by an abduction contracture. Note that the line drawn from the ischial tuberosity passes close to the lesser trochanter on both sides, indicating that there is no true difference caused by the implant. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

The percentages of the total number of functional problems (n = 68) after total knee arthroplasty (TKA). The percentages of the total number of functional problems (n = 68) after total knee arthroplasty (TKA). Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

A 25° knee flexion contracture seen five weeks following a primary total knee arthroplasty in a sixty-nine-year-old woman. A 25° knee flexion contracture seen five weeks following a primary total knee arthroplasty in a sixty-nine-year-old woman. The contracture was due to joint swelling, capsular contracture, and previously unrecognized tightness of the gastrocnemius. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Iliopsoas stretching with the patient stabilizing the lumbar spine and pelvis by maintaining a “back-flat” posture. Iliopsoas stretching with the patient stabilizing the lumbar spine and pelvis by maintaining a “back-flat” posture. This exercise is best done at the end of a table. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Image-intensifier-guided injection into the iliopsoas tendon just above the lesser trochanter. Image-intensifier-guided injection into the iliopsoas tendon just above the lesser trochanter. Intra-articular and extra-articular hip injections were used to provide pain relief and to decrease inflammation so that patients could tolerate stretching of the hip contracture and improve the range of motion. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Stretching of the tensor fasciae latae with the contralateral hip positioned in 90° of flexion. Stretching of the tensor fasciae latae with the contralateral hip positioned in 90° of flexion. The table stabilizes the pelvis, and the affected limb is stretched into extension and adduction. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Neuromuscular electrical stimulation to strengthen the gluteus medius. Neuromuscular electrical stimulation to strengthen the gluteus medius. The electrodes are placed posterior and posterosuperior to the greater trochanter, and the patient is instructed to abduct, extend, and externally rotate the hip while the stimulator is active. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

The customized knee device was used to increase the range of knee extension and to eliminate a knee flexion contracture. The customized knee device was used to increase the range of knee extension and to eliminate a knee flexion contracture. The patient lies supine with the knee extended. The brace is applied with tension produced by a Theraband in a figure-of-eight fashion to create a knee extension moment and a sustained end-range stretch of the posterior knee structures. Patients used the device three times a day for thirty minutes each time, before physical therapy. In some recalcitrant cases, the device was used for an extended period of time, for up to eight hours in total. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Closed-chain exercise for improving concentric and eccentric quadriceps strength. Closed-chain exercise for improving concentric and eccentric quadriceps strength. This exercise promotes full knee extension to train proper gait, helps to gain knee flexion, and provides proprioceptive input. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

The custom knee device that is used to improve knee flexion. The custom knee device that is used to improve knee flexion. The patient sits while a posterior force from the elastic tubing maintains maximal knee flexion for thirty minutes, two to three times per day. Note the use of a cylindrical tube to achieve a flexion force perpendicular to the tibia. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

The joint mobilization technique to improve knee flexion. The joint mobilization technique to improve knee flexion. Posterior glide of the tibia on the femur mobilizes the knee with the patient prone. This mobilization directly addresses tight structures and increases the range of knee flexion. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Rectus femoris stretch with inferior patellar mobilization. Rectus femoris stretch with inferior patellar mobilization. This technique promotes true elongation of the quadriceps without increasing joint contact forces of the patellofemoral joint. It also reduces pain during flexion mobilization. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Peroneal nerve release to decrease peroneal nerve symptoms so that the patient can gain functional knee extension. Peroneal nerve release to decrease peroneal nerve symptoms so that the patient can gain functional knee extension. Anil Bhave et al. J Bone Joint Surg Am 2005;87:9-21 ©2005 by The Journal of Bone and Joint Surgery, Inc.