Title: Effect of physiotherapy to reduce the length of hospital stay in patients with total hip arthroplasty: a literature review Objective: The purpose of this thesis is to research and compare available studies investigating the effect of extra physiotherapy in reducing the length of stay for patients with total hip arthroplasty. In addition, to make a compilation of available sources about issue of the hip, total hip arthroplasty in terms of anatomy, kinesiology and biomechanics and length of hospital stay. Methods: This diploma thesis has descriptively-analytical character and is structured in the form of literary review. Results: Physiotherapy decreases length of stay in patients with total hip arthroplasty. Future research could address a specific group of subjects and the issue of cost-effectiveness in reducing the length of hospital stay by physiotherapy. Key words: Hip joint, total joint replacement, THA, physiotherapy, length of stay

Objective: The purpose of this study was to examine social cognitive constructs as predictors of preoperative exercise (PE) in a sample of individuals waiting for total joint replacement (TJR) surgery using the framework of Bandura’s Social Cognitive Theory (SCT). Methods: Participants (N = 78) were individuals waiting for TJR at the two major urban centres on Vancouver Island, Canada who completed measures of the SCT (barrier self-efficacy, outcome expectancy, self regulation, task efficacy & sociocultural factors of pain, physical function and neighbourhood walking environment) framed for (PE). Results: Independent t-tests suggested no differences between type of surgery (hip versus knee), gender or age for PE (p<.05). Over half of the sample was considered inactive (55%) using a definition of physical activity as accumulating at least 30 minutes of exercise at a moderate or vigorous intensity at least 3 days per week in bouts of 10 minutes or more. Bivariate correlations relating to PE were significant (p<.05) between self regulation (SR) (.25), task efficacy for exercise (TEE) (.27) and pain (-.28). Hierarchical regression analysis revealed that SR (β=.17) and TEE (β=.20) explained 10% of the variance in PE behaviour, but were not significant predictors of PE independently. The addition of pain to the regression analysis added 4% of the explained variance, and remained the only significant predictor (p<.05) of Pe behaviour. Conclusions: SCT showed modest capability in predicting PE in this sample, suggesting further testing of theoretical models is warranted in this area. These findings highlight the influence of pain on exercise before TJR surgery, and support the importance of considering individual factors such as pain when designing targeted interventions to increase activity in this population.

Biotribology, the study of lubrication, wear and friction within the body, has become a topic of high importance in recent times as we continue to encounter debilitating diseases and trauma that destroy function of the joints. A highly successful surgical procedure to replace the joint with an artificial equivalent alleviates dysfunction and pain. However, the wear of the bearing surfaces in prosthetic joints is a significant clinical problem and more patients are surviving longer than the life expectancy of the joint replacement. Revision surgery is associated with increased morbidity and mortality and has a far less successful outcome than primary joint replacement. As such, it is essential to ensure that everything possible is done to limit the rate of revision surgery. Past experience indicates that the survival rate of the implant will be influenced by many parameters, of primary importance, the material properties of the implant, the composition of the synovial fluid and the method of lubrication. In prosthetic joints, effective boundary lubrication is known to take place. The interaction of the boundary lubricant and the bearing material is of utmost importance. The identity of the vital active ingredient within synovial fluid (SF) to which we owe the near frictionless performance of our articulating joints has been the quest of researchers for many years. Once identified, tribo tests can determine what materials and more importantly what surfaces this fraction of SF can function most optimally with. Surface-Active Phospholipids (SAPL) have been implicated as the body’s natural load bearing lubricant. Studies in this thesis are the first to fully characterise the adsorbed SAPL detected on the surface of retrieved prostheses and the first to verify the presence of SAPL on knee prostheses. Rinsings from the bearing surfaces of both hip and knee prostheses removed from revision operations were analysed using High Performance Liquid Chromatography (HPLC) to determine the presence and profile of SAPL. Several common prosthetic materials along with a novel biomaterial were investigated to determine their tribological interaction with various SAPLs. A pin-on-flat tribometer was used to make comparative friction measurements between the various tribo-pairs. A novel material, Pyrolytic Carbon (PyC) was screened as a potential candidate as a load bearing prosthetic material. Friction measurements were also performed on explanted prostheses. SAPL was detected on all retrieved implant bearing surfaces. As a result of the study eight different species of phosphatidylcholines were identified. The relative concentrations of each species were also determined indicating that the unsaturated species are dominant. Initial tribo tests employed a saturated phosphatidylcholine (SPC) and the subsequent tests adopted the addition of the newly identified major constituents of SAPL, unsaturated phosphatidylcholine (USPC), as the test lubricant. All tribo tests showed a dramatic reduction in friction when synthetic SAPL was used as the lubricant under boundary lubrication conditions. Some tribopairs showed more of an affinity to SAPL than others. PyC performed superior to the other prosthetic materials. Friction measurements with explanted prostheses verified the presence and performance of SAPL. SAPL, in particular phosphatidylcholine, plays an essential role in the lubrication of prosthetic joints. Of particular interest was the ability of SAPLs to reduce friction and ultimately wear of the bearing materials. The identification and knowledge of the lubricating constituents of SF is invaluable for not only the future development of artificial joints but also in developing effective cures for several disease processes where lubrication may play a role. The tribological interaction of the various tribo-pairs and SAPL is extremely favourable in the context of reducing friction at the bearing interface. PyC is highly recommended as a future candidate material for use in load bearing prosthetic joints considering its impressive tribological performance.

This thesis deals with stress analysis strain proximal end of tibia with total joint replacements. The analysis is done on the basis of deformation characteristics of voltage, through the finite element method (FEM). We have developed two-dimensional models of the proximal end of tibia with tibial components total endoprosthesis (TEP), without loss and bone loss. Geometry model is created based on data obtained from computerized tomography, which were further processed in the program, Rhinoceros 3.0 and SolidWorks 2009th Computational solution was carried out by finite element method in Ansys Workbench 12.0. The model without loss of bone tissue was tested the hypothesis that the deformation is very small and there is no violation of the shank prosthesis. Due to loss of bone tissue is lost support to the tibial pulse in the proximal tibia and by a progressive increase in stress, which can lead to a breach of the shank total joint replacement. The analysis results show that, if the loss of bone tissue, so that the tibial part of the TEP will lose support, there is a crack stem total hip replacement due to stress.

No description available.

Background: Sophisticated guided surgery has not been implemented into total joint replacement-surgery (TJR) of the temporomandibular joint (TMJ) so far. Design and in-house manufacturing of a new advanced drilling guide with vector and length control for a typical TJR fossa component are described in this in vitro study, and its accuracy/utilization was evaluated and compared with those of intraoperative real-time navigation and already available standard drilling guides. Methods: Skull base segmentations of five CT-datasets from different patients were used to design drilling guides with vector and length control according to virtual surgical planning (VSP) for the TJR of the TMJ. Stereolithographic models of the skull bases were printed three times for each case. Three groups were formed to compare our newly designed advanced drilling guide with a standard drilling guide and drill-tracking by real-time navigation. The deviation of screw head position, screw length and vector in the lateral skull base have been evaluated (n = 72). Results: There was no difference in the screw head position between all three groups. The deviation of vector and length was significantly lower with the use of the advanced drilling guide compared with standard guide and navigation. However, no benefit in terms of accuracy on the lateral skull base by the use of real-time navigation could be observed. Conclusion: Since guided surgery is standard in implant dentistry and other CMF reconstructions, this new approach can be introduced into clinical practice soon, in order to increase accuracy and patient safety.

No description available.