8.24 TKA, Misc Flashcards
unicompartmental TKA: yay or nay?
- not much reason to just salvage one side
- most recent evidence doesn’t support as much
TKA: most surgeons use this technology to ensure the best fit
- real-time fluoroscopy
- computer topography
Why would the entire top of the tibia not be removed for a TKA?
if they’re saving the cruciate ligaments
Function of a plastic spacer in a TKA
- helps with stability
- some stability is lost with removal of the ligaments
TKA procedure
- entire top removed (may or may not save cruciates)
- almost always take off back of patella
- plastic spacer put in
TKA bandage: what to consider
- long strip
- must think about strikethrough
When can infections happen after surgery?
can happen quickly after surgery or years after
Why can infections happen years after?
- always some inflammatory responses going on around the prosthesis
- systemic infections tend to go to the surgical site
What would show up on the objective eval that would be cause for concern?
- fever
- warmth/redness that’s more than normal
- streaking
- increased girth
- increased drainage
- increased pain
- weak/tired
What do they do for an infection in a total joint?
- long-term IV antibiotics to try to try to salvage the joint and prosthetic
- Irrigation and debridement: open up and rinse out
If a bad enough infection and osteomyelitis has set in, what happens?
- prosthetic has to be removed
- fill the void with antibiotic beads
What are antibiotic beads?
- way to deliver concentrated antibiotics
- leach out into the joint and blood supply to hopefully get rid of the infection
How long will a pt have antibiotic beads in the void?
can be like this for months - until the infection clears
Can the pt walk with antibiotic beads?
may be WBAT or not
What happens if the infection is so bad that there’s not enough bone to put another prosthesis back?
may require amputation
What will happen if you as a PT don’t get ROM back after a total joing?
The pt may have to have a manipulation under anesthesia
What are some of the surgical complications following total joint replacement?
- infection
- deficits in ROM
- fat emboli
- stroke
- severed/pinched nerve
- nicking of an artery
- ileus
TKA and strokes
Often get TKA and a stroke that affects the opposite side
Normal sensory loss
over the incision site is normal
Severed or pinched nerve: sign
- new loss of sensation/motor distally
- may be attributed to swelling in the area
Why might a pinched or severed nerve not be caught early?
may be attributed to nerve block
s/s of a nicked artery
- complaints that don’t seem the same as any other TKA (i.e. strange sensations or pain in foot or calf)
- cold, gray, white - skin doesn’t look the same
CHECK PEDAL PULSE!
Catching a nicked artery
- nursing or PT should be checking up on this
- usually not caught quickly enough - can’t salvage the leg
What is an ileus?
peristalsis is halted in the gut
Who is at risk for an ileus?
- any surgical pt that doesn’t get mobilized quickly enough
- have been given meds to slow everything down so surgery can be done
s/s of an ileus
- distention
- no bowel sounds
- cranky pants
- “coffee ground” emesis
reverse peristalsis
vomiting
treatment for an ileus
- NG tube to suck everything out
- mobilize them
- slowly build them back to their normal diet
Why would a laxative not be helpful for a pt with an ileus?
- they aren’t full of stuff
- food is just not getting processed into their intestines
- laxatives only blow out the end (colon)
