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TOTAL JOINT REPLACEMENT Joint replacement is indicated for irreversibly damaged joints with loss of function and unremitting pain (e.g., degenerative and rheumatoid arthritis [RA]), selected fractures (e.g., hip/femoral neck), joint instability, and congenital hip disorders. The surgery can be performed on any joint except the spine. Hip and knee replacements are the most common procedures. The prosthesis may be metallic or polyethylene (or a combination) implanted with a methylmethacrylate cement, or it may be a porous, coated implant that encourages bony ingrowth. CARE SETTING Inpatient acute surgical unit and subacute or rehabilitation unit. RELATED CONCERNS Fractures Psychosocial aspects of care Rheumatoid arthritis Sepsis/septicemia Surgical intervention Thrombophlebitis: deep vein thrombosis Patient Assessment Database ACTIVITY/REST May report: History of occupation/participation in sports activities that wears on particular joint Difficulty walking; stiffness in joints (worse in the morning or after period of inactivity) Fatigue, generalized and muscle weakness Inability to participate in occupational/recreational activities at desired level Interruption of sleep, delayed falling asleep/awakened by pain; does not feel well rested May exhibit: Decreased ROM and muscle strength/tone HYGIENE May report: Difficulty performing ADLs Use of special equipment/mobility devices Need for assistance with some/all activities NEUROSENSORY May exhibit: Soft tissue swelling, nodules Muscle spasm, stiffness, deformity Impaired ROM of affected joints PAIN/DISCOMFORT May report: Pain (dull, aching, persistent) in affected joint(s), worsened by movement SAFETY May report: Traumatic injury/fractures affecting the joint Congenital deformities History of inflammatory, debilitating arthritis (RA or osteoarthritis); aseptic necrosis of the joint head May exhibit: Distorted joints Joint/tissue swelling, decreased ROM, changes in gait TEACHING/LEARNING May report: Current medication use, e.g., anti-inflammatory, analgesics/narcotics, steroids, hormone replacement therapy (HRT), bone resorption inhibitor (e.g., Fosamax), calcium supplements
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Discharge plan DRG projected mean length of inpatient stay: 3–5 days (depending on joint replaced) considerations: May need assistance with transportation, self-care activities, homemaker/maintenance tasks, possible placement in rehab/extended-care facility for continued rehabilitation/assistance Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES X-rays: May reveal destruction of articular cartilage, bony demineralization, fractures, soft-tissue swelling; narrowing of joint space, joint subluxations or deformity. Bone scan, CT/MRI:
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