age related joint changes & TKA - exam 3 Flashcards
what two areas in the knee are more likely to get age-related joint changes at?
medial femoral condyle
patella articular surface
greatest prevalence of ARJC is in the ______ level but similar prevalence seen in ______ and ______ populations
elite
non-elite and non athletic
Risk factors of ARJC:
older age
previous joint injury, esp meniscus
increasing BMI
occupational activity (deep squats or stairs)
quad weakness
onset of ARJC:
gradual and unknown worse with WB
severity of ARJC is associated with:
bone edema with subarticular bone attrition
synovitis
severity of ARJC is NOT associated with:
osteophytes or reduction in joint space on imaging
symptoms of ARJC:
P! relieved with non-WB
stiffness < 30 minutes after prolonged positions
limited and painful motion esp with ext (CPP)
may become nociplastic p!
signs of ARJC:
- observation
- ROM
- combined motions
- stress tests
- Antalgic/asymmetrical gait
Possibly genu varum - limited with firm end feels depending on acuity
P! esp w CPP of ext
capsular pattern of restriction flx > ext - consistent block
- distraction: relief of P!
compression: likely P!
signs of ARJC:
- accessory motion
- special tests:
- M. activity/MMT
- palpation
- hypomobile
- possible (+) meniscus tests
- impaired walking distance and gait velocity with 6 MWT and TUG
- inhibited quads and hip abductors
- joint line tenderness
knee MRI:
____ % of asymptomatic people had a cartilage lesion
____ % of asymptomatic people had osteophytes/spurring
17
27
PT Rx: ARJC
- POLICED:
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
PT Rx: ARJC
orthotics/braces:
- not recommended:
- helpful:
____ _____ to minimize/avoid limping
lateral heel wedges
unloader knee brace
assistive device
how should JM be utilized for ARJC?
as needed AND with exercises
PT Rx: ARJC
MET:
- long term benefits: (2)
- targeted mm: (2)
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
what type of activities can help ARJC?
aerobic
aquatic
coordination and balance
______ management and patient ______ are also recommended for patients with ARJC
weight
education
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
PT appts spread out over a year
in the year before someone gets TKA, what are > 50% of non-inpatient costs associated with? what does this mean to us?
injections
PT
orthotics
prescriptions
often overutilization of ineffective interventions and less efficient use of visits
MD RX: ARJC:
- NSAIDS
- tylenol
- narcotics
- injections
- platelet rich plasma
- 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
what does the research show about arthroscophy or “cleaning” for ARJC?
strong recommendation against
no benefits for P!, function, or quality of life
what is the prognosis of TKA followed by PT vs PT alone at 12 months?
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)
what are arthroplasty or joint replacement options for ARJC?
partial knee arthroplasty
TKA
- for very asymmetrical changes on one side of the jt vs the other
- more common
- mini-procedure available
- increasing
what would you focus on in prehab for TKA?
AD training
planning for recovery
expectation management
does the research show better quality of life and increased strength and function if you do prehab before TKA?
yes
TKA procedure:
Incise?
Collaterals?
ACL?
FORCEPS?
dislocate?
Add?
Close?
Full?
incise capsule
collaterals remain possibly PCL
ACL always removed
forceps adjacent structures
dislocate knee
add prosthetic
close capsule
full range under anesthesia
unique PT Rx with TKA:
- early rehab (within 24 hours)
decreases avg. hospital stay and number of sessions
greater progress with ROM/strength
faster autonomy and normal gait and balance with TKA
unique PT Rx with TKA:
- early and intense rehab:
higher intensity
spread visits out for longer duration
single limb training
higher level of functional exercises
better quads activity
what are ROM goals for TKA?
full ext (1-2 weeks)
110 deg flx (6 weeks)
120 deg flx (overall)
