8.24 TKA, Misc 2 Flashcards
What are the WB statuses?
- NWB
- TTW or TDWB
- PWB
- %WB
- WBAT
- FWB
NWB
NO weight
NWB
- bed mobility
- ambulation
- no weight with bed mobility
- roll-about is awesome for this to WB through the femur
TTW or TDWB
- toe touch
- touch down
What does TTW or TDWB mean?
- weight of the leg can touch (leg resting on the ground)
- can’t transfer any BW through the limb
How can you tell if TTW or TDWB is being done correctly?
- cracker packet or squeaker under the foot
- If it crushes, they’re putting too much weight on it
PWB - clarifying
- partial WB
- typically default to 50%, but clarify with the physician
WBAT
- put as much weight through as they can tolerate
- not going to hurt the surgical site
What is that stupid PWB status used by random doc?
protective WB
as much as they can with an assistive device present
Most TKA and THA pts have this WB status post-op
WBAT
What should be done if the pt is unable to maintain appropriate WB status?
YOU must move them back to a safer status
Why would a TKA or THA pt be on PWB status post-op?
- any additional trauma/microfractures during surgery
- i.e. oversized prosthetic used
What is a kyphoplasty?
- pump cement or balloon into the vertebral body to fill the space and/or reapproximate the surfaces
purpose of a kyphoplasty
done to increase the height or prevent additional compression
Why must a bone density scan be done prior to a kyphoplasty?
- Once cement is set, the vertebra is VERY hard
- Causes proximal vertebrae to fx as well if they aren’t strong enough
When does a tibial plateau fx typically happen?
- when the leg is extended
- greater force applied than normal
- often has a varus or valgus moment and compression
surgical fixation for a tibial fx
- put the piece back where it belongs so it can approximate with the femoral condyles
- screw in frontal plane to push the bone back up
Why would they not do a surgical fixation for a tibial plateau fx?
- If it’s not a bad fx
- May just leave it alone and hope the body pushes it back up to reapproximate
tibial plateau fx: WB status
NWB 8-12 weeks
Why must tibial plateau fx pts be immobilized in extension?
- pressure on the tibia when knee is bent
- condyles come in contact with tibial plateau
Gradual movement into flexion for tibial plateau fx
- starts in complete extension
- won’t be at 90˚ yet by the end of 8-12 weeks
tibial plateau fx: first few weeks
education, no therapy
tibial plateau fx: why is return of flexion so challenging?
- There’s a lot of tightness
- Very slow process from the PT side
Therapy for a tibial plateau fx: surgery vs. nonoperative
- same either way
- doesn’t allow WB or ROM earlier
What is done once therapy begins for tibial plateau fx?
- ROM
- strengthening
Where does a patellar tendon rupture occur?
distally
patellar tendon rupture: presentation
patella is sitting high on their leg
MOI: patellar tendon rupture
- typically occurs mid-fall
- everything fires to stop them from falling and it pops
- generally going downhill (weight and gravity already working against them)
What often happens with patellar tendon rupture?
bilateral ruptures
surgical treatment for patellar tendon rupture
tendon reattached to tuberosity by screws
immobilization for patellar tendon rupture
- won’t do a lot of ROM work
- in a knee immobilizer at 0˚ for at least 10-12 weeks
- tendon doesn’t heal quickly***
Can you ambulate a patient with a patellar tendon rupture?
yes - not a compression injury
PT mgmt after immobilization for a patellar tendon rupture
- long process to get them back to normal ROM
- have to make sure they don’t rerupture
