Basics Of Hip/Knee Replacement

Question 1

What is osteoarthritis? What is the incidence of hip OA?

Answer 1

Degenerative disease affected synovial joints that results in progressive loss of articular cartilage

88 per 100,000 per year

Question 2

What are the risk factors for hip OA?

Answer 2

Articular trauma 
High impact sports/work
Female>male
Increased age
Genetics

Question 3

What is the incidence of knee OA? What are the symptoms?

Answer 3

240/100,000 per year

Pain with activity, rest, nocturnal
Activity induced swelling
Knee stiffness
Mechanical: instability, locking, catching sensation

Question 4

What is the non operative treatment for knee OA?

Answer 4

NSAIDs (first line of tax)
Weight loss
PT
Corticosteroid injections

Question 5

What are the indications for an arthroplasty?

Answer 5

Pain relief caused by arthritis 
Trauma (hip fx) 
Tumor 
Younger pts. With multiple jts. Involved 
Patellofemoral arthritis 
Progressive deformity

Question 6

What are the hip precautions for a posterolateral approach?

Answer 6

Avoid (6-12 weeks)

1. Flexion past 90 degrees
2. Internal rotation
3. Adduction

Question 7

What are the hip precautions for an anterolateral approach? (And direct approach)

Answer 7

Avoid:

1. Extension
2. External Rotation
3. Adduction
4. Bridging (direct)

Question 8

In an acute hospital setting, what is the pain management protocol consist of?

Answer 8

Pre op: NSAIDs and opioids

Post op: multimodal oral drug therapy (GOLD STANDARD)
Toradol and Tylenol

Question 9

In an acute hospital setting, what do PT goals consist of?

Answer 9

Gait training, transfers, bed mobility, independent ADLs

Question 10

In an acute hospital setting, what do the discharge home criteria consist of?

Answer 10

Independent ADLs, transfers, and gait with AD

Appropriate home assistance

Question 11

When can patients return to work, play and driving post arthroplasty?

Answer 11

Sport: low impact exercises

Driving: 4 weeks, once off narcotics

Work: within a month if no manual labor involved

Question 12

How often is physical therapy recommended post arthroplasty? What is the focus for knee replacements?

Answer 12

2-3x a week for at least 2 weeks

Knee: focus on closed chain exercise
AVOID RUNNING: decreases longevity of implant

Question 13

What is the risk of developing a DVT? (W/ and w/o prophylaxis (prevention))?

Answer 13

33-46% risk of asymptomatic DVT without prevention

0.3-3% risk with prevention

Question 14

What is Virchow’s Triad?

Answer 14

1. Venous stasis
2. Hypercoaguable state
3. Endothelial injury

Question 15

What are the level I and level II AAOS Guidelines for non-arthroplasty?

Answer 15

Level I: low impact aerobic exercise
NO needle lavage, arthroscopy, glucosamine/chondroitin

Level II: activity mod and education, quad strengthening, corticosteroids, acetaminophen, NSAIDs