Total shoulder arthroplasty.

Surgeons perform total shoulder arthroplasty (TSA) procedures to reduce patients' intractable arthritic pain and to repair humeral head fractures. Total shoulder arthroplasty has undergone remarkable advances--not only in prosthetic improvements and refinements--but in patient outcomes. Advantages to TSA procedures include decreased pain and patients' increased ability to perform activities of daily living.

Tools for building a successful orthopaedic pathway.

In this arena of ever-changing health care, critical pathways have been identified as a tool to analyze cost as well as improve patient care and resource utilization. The Orthopaedic Department of Allegheny General Hospital was one of the first departments to begin the process of developing critical pathways with DRG #209, Total Joint Replacements. This article explains how the multidisciplinary team members used the Continuous Quality Improvement process through the use of various questionnaires, tools, and tracking documents in identifying ways to improve customer services.

Metacarpophalangeal joint implant arthroplasty.

Rheumatoid arthritis (RA) usually requires lifelong treatment and sometimes surgery. Metacarpophalangeal joint (MCPJ) implant arthroplasty is one surgical treatment for patients with severe RA malformation of the finger joints. Although not a cure, MCPJ implant arthroplasty can enhance patients' quality of life by improving their performance of independent activities of daily living. The silicone implant acts as a spacer until tendons and connective tissues are able to control the joint's functions. Comprehensive preoperative and postoperative patient teaching and aggressive physical therapy are needed to achieve optimal outcomes in patients who undergo this surgical procedure.

Development and impact of a hospital-based perioperative patient education program in a joint replacement center.

This article describes the development and impact of a hospital-based education program for patients undergoing knee or hip replacement surgery. The program consists of three components: a preoperative 1-hour education session conducted by a case manager providing information on what to expect from the procedure; a discussion by previous patients addressing unnecessary fears; and elective membership after discharge in a hospital-based support group providing patients with information on how to live with arthritis and with new joints. The impact of the program on patient outcomes was investigated through a 5-year retrospective study. Data were collected from patients to assess their perceptions of the program and of the outcome of their surgery. Results of the study indicated favorable impact on both patient care outcomes.

Total elbow replacement.

Elbow joint replacement is performed primarily in patients with severe elbow pain and elbow joint destruction caused by rheumatoid arthritis. The capitellocondylar implant is the prototype of the nonconstrained elbow resurfacing implant. Successful total elbow joint replacement can result in pain relief and improve rotation and flexion of the arm. Outpatient and inpatient nursing intervention in coordination with occupational therapy promotes optimum function.

Perioperative concerns of the older adult undergoing total joint replacement.

Total joint replacement can be an important intervention in dealing with the chronic joint pain and immobility experienced by many elderly people. Elderly patients, however, do have concerns that are unique to them; therefore, preoperative preparation and continual assessment are imperative nursing interventions and are necessary to put elderly patients in the best position for successful recovery.

Patient perceptions of pain and disability after joint arthroplasty.

Patients having elective total hip or knee arthroplasty are routinely assessed for flexibility, muscle strength, and gait both preoperatively and postoperatively, but there appears to be limited information available on patients' self-reported pain levels. This study used two self-report measures of health status and a pain scale to measure patients' perceptions of disability and pain immediately prior to surgery and at 6 weeks and 6 months after total hip or knee arthroplasty.

Total ankle arthroplasty. A procedural review.

Total ankle arthroplasty is a demanding surgical procedure, but the advantages of maintaining motion in the tibiotalar joint in the patient with systemic arthritis are known. Although the technology of ankle implant arthroplasty is still evolving, current results in properly selected patients approach the results of other leg implants.