Amputation+Joint replacements

Amputation is the removal of a body part by surgical procedure or trauma, performed to control pain, disease, improve function, or enhance quality of life.

1. Medical (e.g., diabetes, peripheral vascular disease, cancer, gangrene, infection, obesity) – usually lower extremity, 74% of cases. 2. Trauma (e.g., crushing injury, burns, frostbite) – often upper extremity, 23% of cases. 3. Congenital anomalies (birth defects) – can be upper or lower extremities, 3% of cases.

Poor circulation, particularly peripheral vascular disease due to diabetes mellitus, is the major cause of amputation in the US.

Over 80% of lower extremity amputations are due to vascular disease.

Body image disturbances, acute pain, risk for dysfunctional grief, risk for depression, impaired physical mobility, and loss of independence.

The patient will avoid looking at the amputated area.

Above Knee Amputation (AKA) and Below Knee Amputation (BKA).

A cone-shaped stump is ideal for prosthesis fitting; improper shape can prevent successful prosthesis use.

Infection, pain (including phantom limb pain), edema, wound healing issues, and skin breakdown.

Phantom limb pain is pain felt in the missing limb, experienced by 60-70% of new amputees.

Wearing the prosthesis can help reduce phantom limb pain.

Residual limb pain is pain in the remaining limb, caused by poor prosthetic fit, bruising, neuroma, chafing, poor circulation, or nerve damage.

Teaching patients to rub, tap, or strike the stump helps desensitize it.

Achieve a conical shape, maximum shrinkage, absence of tenderness, freely movable scar, firm skin, and normal muscle strength and range.

A strong and dedicated mindset is crucial for successful prosthesis use; body image disturbance can hinder success even with a well-shaped stump.

The figure-8 wrapping technique is recommended, and clips should be avoided.

Placing pillows under the stump can cause knee contractures, preventing proper prosthesis fitting.

Patients should lie on their stomach (prone position) to keep the knee straight.

Client motivation, self-care skills, family support, absence of hip/knee contractures, and no interfering medical problems.

Daily assessment for skin breakdown using a mirror; any minor cuts must heal before prosthesis use.

Strengthening exercises, prone positioning, complication prevention, ADL adaptations, prosthetic fitting/use education, pain management, and emotional support.

Walkers, canes, and crutches.

Proper nutrition supports wound healing and overall recovery.

The team includes orthopaedists, surgeons, prosthetists, physiatrists, nurses, therapists, social workers, psychologists, and others to provide comprehensive care.

To decrease pain and increase or restore function.

Osteotomy (cutting/realigning bone) and arthroplasty (removing/replacing an unhealthy joint).

Severe osteoarthritis (OA).

Anti-inflammatory medications, weight management, physical therapy, assistive devices, activity modification, acupuncture, and massage.

Joint edema, pain, and stiffness relieved by rest; X-rays show joint space narrowing and osteophytes.

RA is an autoimmune inflammatory disease causing joint swelling and deformation, while OA is a chronic, progressive joint disease mainly due to wear and tear.

Avascular necrosis is bone tissue death due to loss of blood supply, caused by trauma, intraluminal obliteration, increased marrow pressure, or cytotoxicity.

It influences weight-bearing status and rehabilitation precautions post-operatively.

X-rays and MRIs.

Anterior lateral approach is preferred over posterior.

Failure to follow precautions can result in refracture or dislocation of the prosthesis.

Always use a pillow between the knees to prevent adduction and promote abduction.

Give pain meds, take vital signs, measure leg lengths, and assist with joint reduction if needed.

Loosening/dislocation, infection (e.g., UTIs), blood clots, and pain.

To decrease the risk of thrombus (blood clot) formation.

Sit with legs 3-6 inches apart, keep 2 pillows between legs when lying/turning, inform professionals of prosthesis.

Don't cross legs/ankles, don't bend past 90 degrees at the waist, don't bear full weight on the operative side until cleared.

Diagrams showing not to bend hip >90°, not to cross legs, and not to twist the operated leg inward.

Redness, swelling, increased pain, drainage, and fever.

Assess for scatter rugs and recommend living on the first floor for 3-6 months to prevent falls.

Patients are on anticoagulants, which have implications for travel and risk of blood clots.

Living on the first floor for 3-6 months to avoid stairs and reduce fall risk.