age related joint changes & TKA - exam 3

Question 1

what two areas in the knee are more likely to get age-related joint changes at?

Answer 1

medial femoral condyle
patella articular surface

Question 2

greatest prevalence of ARJC is in the ______ level but similar prevalence seen in ______ and ______ populations

Answer 2

elite
non-elite and non athletic

Question 3

Risk factors of ARJC:

Answer 3

older age
previous joint injury, esp meniscus
increasing BMI
occupational activity (deep squats or stairs)
quad weakness

Question 4

onset of ARJC:

Answer 4

gradual and unknown worse with WB

Question 5

severity of ARJC is associated with:

Answer 5

bone edema with subarticular bone attrition
synovitis

Question 6

severity of ARJC is NOT associated with:

Answer 6

osteophytes or reduction in joint space on imaging

Question 7

symptoms of ARJC:

Answer 7

P! relieved with non-WB
stiffness < 30 minutes after prolonged positions
limited and painful motion esp with ext (CPP)
may become nociplastic p!

Question 8

signs of ARJC:
- observation
- ROM
- combined motions
- stress tests

Answer 8

1. Antalgic/asymmetrical gait
   Possibly genu varum
2. limited with firm end feels depending on acuity
   P! esp w CPP of ext
   capsular pattern of restriction flx > ext
3. consistent block
4. distraction: relief of P!
   compression: likely P!

Question 9

signs of ARJC:
- accessory motion
- special tests:
- M. activity/MMT
- palpation

Answer 9

• hypomobile
• possible (+) meniscus tests
• impaired walking distance and gait velocity with 6 MWT and TUG
• inhibited quads and hip abductors
• joint line tenderness

Question 10

knee MRI:
____ % of asymptomatic people had a cartilage lesion
____ % of asymptomatic people had osteophytes/spurring

Answer 10

17
27

Question 11

PT Rx: ARJC
- POLICED:

Answer 11

STM may help
- massage improved P! and function but less than JMs
- better than usual care when individualized with JM
Modalities:
- E-stim & electromagnetic devices may help
- US - short term P! relief
- acupuncture may help
- dry needling - unclear

Question 12

PT Rx: ARJC
orthotics/braces:
- not recommended:
- helpful:

____ _____ to minimize/avoid limping

Answer 12

lateral heel wedges
unloader knee brace

assistive device

Question 13

how should JM be utilized for ARJC?

Answer 13

as needed AND with exercises

Question 14

PT Rx: ARJC
MET:
- long term benefits: (2)
- targeted mm: (2)

Answer 14

increase in anti-inflammatory markers and chondroprotective properties (exercise is anti-inflammatory)
NMES - mod support

long term benefits:
- P! and function
- better when individualized

targeted mm:
- quads
- hip exercises

Question 15

what type of activities can help ARJC?

Answer 15

aerobic
aquatic
coordination and balance

Question 16

______ management and patient ______ are also recommended for patients with ARJC

Answer 16

weight
education

Question 17

which shows better outcomes for patients with ARJC:
PT appts spread out over a year OR
many PT appts in a short amount of time

Answer 17

PT appts spread out over a year

Question 18

in the year before someone gets TKA, what are > 50% of non-inpatient costs associated with? what does this mean to us?

Answer 18

injections
PT
orthotics
prescriptions

often overutilization of ineffective interventions and less efficient use of visits

Question 19

MD RX: ARJC:
- NSAIDS
- tylenol
- narcotics
- injections
- platelet rich plasma

Answer 19

• strong support. more effective than tylenol (anti inflammatory effects)
• strong support
• adverse effects, NOT effective
• cortisone: inconclusive
  hyaluronic acid (synvisc - mimics synovial fluid): strong evidence against
• may help

Question 20

what does the research show about arthroscophy or “cleaning” for ARJC?

Answer 20

strong recommendation against
no benefits for P!, function, or quality of life

Question 21

what is the prognosis of TKA followed by PT vs PT alone at 12 months?

Answer 21

when TKA is needed, it is best but with greater potential of adverse events
timing of TKA influences outcomes i.e., don’t wait too long as other bodily areas and functions may suffer (mental health)

Question 22

what are arthroplasty or joint replacement options for ARJC?

Answer 22

partial knee arthroplasty
TKA
- for very asymmetrical changes on one side of the jt vs the other
- more common
- mini-procedure available
- increasing

Question 23

what would you focus on in prehab for TKA?

Answer 23

AD training
planning for recovery
expectation management

Question 24

does the research show better quality of life and increased strength and function if you do prehab before TKA?

Answer 24

yes

Question 25

TKA procedure:
Incise?
Collaterals?
ACL?
FORCEPS?
dislocate?
Add?
Close?
Full?

Answer 25

incise capsule
collaterals remain possibly PCL
ACL always removed
forceps adjacent structures
dislocate knee
add prosthetic
close capsule
full range under anesthesia

Question 26

unique PT Rx with TKA:
- early rehab (within 24 hours)

Answer 26

decreases avg. hospital stay and number of sessions
greater progress with ROM/strength
faster autonomy and normal gait and balance with TKA

Question 27

unique PT Rx with TKA:
- early and intense rehab:

Answer 27

higher intensity
spread visits out for longer duration
single limb training
higher level of functional exercises
better quads activity

Question 28

what are ROM goals for TKA?

Answer 28

full ext (1-2 weeks)
110 deg flx (6 weeks)
120 deg flx (overall)