Steffany Moonaz, PhD, RYT-500

 Damage to surrounding tissues  Consider lifespan of surgical technique  Don’t take surgery too lightly  Consider all management strategies ◦ Weight loss ◦ Strengthen surrounding tissues ◦ Pain management

 Is QOL compromised?  Is posture compromised?  Relationship between fitness and recovery  “Bone-on-bone”  Pain is a subjective, individual experience

 Set timeline with doc  Work around/with pain  Consider fitness for best recovery  Encourage education about options  Ask doc about recovery process

 Get written permission to speak with doc  Get written report of movement limitations  Focus on other aspects of yoga practice ◦ Breathing ◦ Mindful movement ◦ Relaxation ◦ Meditation  Hope and Planning  Support network

 Get clear about type of procedure  Know the movement limitations of each  They are an expert on how the joint works  Less about pain than ROM, function

 Non-constrained ◦ Most common ◦ Relies on ligaments, muscles ◦ Work on stability  Semi-constrained ◦ More stable ◦ Some/all ligaments removed  Constrained or hinged ◦ Severely damaged knees ◦ Elderly ◦ Revision procedures ◦ Doesn’t last as long  Unicondylar ◦ Only one half replaced ◦ Some surgeons still opt for full replacement

 Quadriceps setting (contraction)  Terminal knee extension (rolled towel under knees)  Heels slides (toward glutes, slight stretch)  Straight leg raising (opposite bent)  Pillow squeezes (adductors)

 Cemented ◦ Age 60+ ◦ Gold standard ◦ Substance between bone and artificial component  Non-cemented ◦ Bone grows into metal ◦ Young, active candidates (loosen components) ◦ Scar tissue acts as cement  Hybrid fixation ◦ No cement on socket, cement on femur  Surface Replacement ◦ Neck of femur is preserved

 For 6-8 weeks: ◦ Avoid bending the hip beyond 90 degrees. (Consider sitting surfaces. Raise hips.) ◦ Avoid bending over from the hip. ◦ Avoid crossing the surgical leg over the non- surgical leg. ◦ Keep the legs three to six inches apart. ◦ Avoid turning the operated leg inward (pigeon- toed)

 Standard ◦ One or both components replaced ◦ May be smoothed or capped with metal, plastic ◦ Cemented or uncemented  Reverse ◦ Newer procedure ◦ Not all surgeons will perform it ◦ Ball becomes socket and vice-versa ◦ Allows more ROM (above shoulder height)

 No use of muscles for 6 weeks (pulleys, sling, support during sleep)  3 months of gradual muscle use, stretching, rehab  More intense muscle use after 3 months  2 years of antibiotics before medical procedures, dental work  Intended for ADLs, not repetitive motion

 Why do you need to know about these procedures?  What is your role in each stage (before, recovery, long term)?  Can/should you communicate with medical providers? How?  What is the edge of your scope of work?