Total joint arthroplasty is the most common surgical procedure performed in the U.S. and will continue to climb rapidly. However, as surgical advances and prosthetic implants improve rapidly, the therapeutic process and protocols used with this population have remained stagnant. In an attempt to improve outcomes while reducing length of stay and therapy visits, clinicians have over utilized rigid protocols while neglecting proprioception and function yielding a reduction in long term outcomes. Today’s clinician must possess a stronger understanding of the techniques used by surgeons, the prosthetics commonly (and uncommonly) used, and evidence-based treatment strategies determined not just by their referring surgeon but by current research.

This course investigates the latest surgical and minimally invasive techniques used and the benefits and risks associated with these techniques. Taking hundreds of nationally established joint protocols, presenter Trent Brown summarizes the most effective and functionally relevant treatment strategies and protocols. Numerous labs will occur to ensure application of material and immediate carry-over to the clinical setting. Mr. Brown will also discuss documentation techniques and examples to strongly justify the need for skilled services with this population in hospital, in-patient, acute, home health, and outpatient settings.

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Course Dates & Locations

Educational Credit

A certificate of attendance for 15 Contact Hours will be awarded to each participant. All Therapy Network Seminars are pre‐approved for CEUs in the state where the course is conducted when required for PT, OT, ATs & Assistants.

Therapy Network, Inc. (BOC AP#: P2563) is approved by the Board of Certification, Inc. to provide continuing education to Certified Athletic Trainers. Our seminars are eligible for a maximum of 15 Category A hours/CEUs. ATs should claim only those hours actually spent in the educational program.

AOTA Approved Provider of Continuing Education # 3073 Category 1 Domain of OT. The assignment of AOTA CEUs does not imply endorsements of specific course content, products, or clinical procedures by AOTA

Audience

This is an intermediate level course intended for PTs, PTAs, OTs, OTAs and ATs

NOTE: Nothing in this course is to enable or permit the learner to apply techniques outside of the scope of practice in their individual state and discipline.

Objectives

  • Identify the diagnostic, demographic, and lifestyle explanations related to an increase in joint arthroplasty and the increased need for therapy services following arthroplasty
  • Identify and apply current evidence behind tissue healing science and how it affects the total joint client
  • Identify the evidence justifying therapy following total joint arthroplasty and the long and short-term benefits of therapy
  • Identify the difference between standard and reverse total arthroplasty components and techniques and how it impacts rehabilitation
  • Demonstrate evidence based hip therapeutic strategies used for recovery of the most commonly used hip surgical techniques
  • Identify the difference between the various surgical components and techniques used for knee arthroplasty and the impact of treatment
  • Demonstrate the best treatment strategies for patients seen in any therapeutic setting following practice of techniques in lab

Schedule

  • Day 1

    8:00 Registration and Continental Breakfast
    8:30 Common Themes and Research behind Shoulder, Hip and Knee Arthroplasty (TSA, THA, TKA)
    Demographics
    Age, gender, lifestyle, and socioeconomic status

    Inclusion criteria for TJA (based on AMA) and who should
    avoid TJA
    Common diagnosis, pain levels, and reduced functional
    levels

    Neurological and psychological consequences from delaying
    total joint arthroplasty
    Depression, sleep disturbances, confusion, and memory
    loss

    Healing stages
    Inflammatory, proliferative, remodeling (over icing?)
    Bone, cartilage, muscle, tendon, and nervous tissue

    Review of joint movement and osteokinematics
    Rolling, gliding, scapulohumeral rhythm, and spinning
    10:30 BREAK
    10:45 Gait (Functional Mobility) and Arthroplasty
    The Determinants of Gait vs. Phases

    -Minimizing COM Displacement pre-post arthroplasty

    -Curtate-Prolate-COM Cycloid theories

    -What the phases of gait neglect and how to address
    following arthroplasty

    -Why clients don’t fall performing “gait”

    -How Shoulder, Hip, and Knee arthroplasty all impact
    gait (pre and post-surgery)
    11:30 Total Shoulder Arthroplasty
    History leading to current procedures and prosthetics
    -Functional verses textbook ROM for “normal” function

    Procedures/components
    -Glenoid component, humeral component
    -Hemiarthroplasty, cemented vs. cementless, constrained
    vs. non-constrained)

    Reverse TSA
    Why reverse TSA?
    Minimally invasive R TSA including subscapularis sparing


    12:00 LUNCH (ON YOUR OWN)
    1:00 General therapeutic guidelines (3 or 4 phase approach)
    -Goals, Precautions, Advancement Criteria (function vs.
    a timeline)
    1:30 LAB: TSA Treatment

    Phase 1:
    -The proper pendulum
    -Isometrics and elbow mechanics

    Phase 2:
    -4 approaches to GPG mobilization technique
    -Non-WB scapular depression
    -Natural arm swing and gait (standing/seated swingers)

    3:00 BREAK
    3:15 Phase 3 and 4

    Functional carry-over

    TSA failure rates, functional outcomes, and ROM

    Appropriate “Functional” Standardized Assessments
    4:00 Total Hip Arthroplasty
    History leading to current procedures and prosthetics

    Normal versus functional ROM

    Procedures/components
    -Femoral component (cemented versus cementless)
    -Acetabular component (plastic, metal, or ceramic)
    -Anterolateral, posterolateral, direct lateral, anterior, and
    superpath approaches

    Advantages and disadvantages to each approach
    5:30 Adjourn
  • Day 2

    8:00 LAB: General therapeutic guidelines
    Treatment

    Phase 1 – 4 (Goals, Precautions, Advancement Criteria
    (function vs. timeline)

    Supine lateral stability (bed mobility)

    Trochanter Tension
    -Glut Med emphasis (what works? Evidence-based)
    -Hip Hitch – Standing Sliders
    -Pelvic Teeter Totter

    10:00 BREAK
    10:15 LAB:
    -Hip Flexor lengthening

    -Lateral pelvic tilt in sitting leading to frontal plane
    control (bed mobility)

    -Seated Rotation

    -Lateral weight shift - pelvic tilt emphasis (single leg
    stance with resistance)

    -Static Chops
    Clinical Evidence behind THA and appropriate activities
    12:00 LUNCH (ON YOUR OWN)
    1:00 Total Knee Arthroplasty
    History leading to current procedures and prosthetics
    - “Normal” range versus functional range

    Procedures/components
    -Femoral component (cemented versus cementless)
    -Tibial component (metal platform with plastic surface for
    ROM and absorption)
    -Patellar component (metal or plastic)
    -Cruciate retaining, posterior stabilized design, fixed
    bearing, mobile bearing, and gender specific,
    unicompartmental option
    -Incisions (parapatellar, midvastus, subvastus/quad
    sparing)
    -Computer Aided Orthopedic Surgery (CAOS) why isn’t
    being utilized?

    1:45 LAB: General therapeutic guidelines
    Treatment

    -Phase 1 – 4 (Goals, Precautions, Advancement Criteria
    (function vs. timeline)
    -Quad sit-up (NDT approach) (WB and functional
    emphasis)
    -4 directional Patellar Joint Mob
    -AP/PA Tibiofemoral Joint Mob
    2:30 BREAK
    2:45 LAB
    Gold standard of the stationary bicycle

    Knee Flexion 8* at Midstance

    Gastroclock and Soleuostretch

    Dynamic PNF Mobile Chops
    4:15 Clinical Evidence behind TKA
    4:30 Documentation
    Documentation ideas “outside the box” for the total joint
    client
    -Long-term care, acute, HH, outpatient, and transitional
    clients

    -Case study implementing research and treatment ideas
    5:00 Course Evaluation and Adjourn

Cancellation Policy

Registration fee less a $75 administrative charge is refundable if cancellation received 14 days prior to program date. No refunds will be given after that time. Therapy Network, Inc. reserves the right to cancel a seminar and will refund in full the registration fee only. TNI is NOT responsible for registrants nonrefundable airfare, accommodations or fees.