JA Flashcards
Content: conventional TSA (2)
- Cemented or un-cemented
- Indicated for OA and intact RC
Content: 3 advantages of THA
- Well studied
- Easier to perform
- Suitable for wider range of pt. pops
Defn: Geometric knee
Allows for correction of valgus/varus/flexion deformities
Q: What is the name of the scoring system for DVT and PE?
WELLS score
Q: What are the 3 disadvantages of ceramic on ceramic as a bearing surface for HA?
- Expensive
- Requires expert inseriton technique
- Possible joint noise
Q: What are the 3 disadvantages of cemented fixation for HA?
- Longer operative time
- More difficult to revise
- Potential for adverse reaction to cement
Content: 2 disadvantages of THA
- Higher risk of dislocation (~5%)
- More difficult to revise
Q: Bilateral TKA can be ____________ or ________ and involves _________ recovery, may require ____________ rehab.
concurrent, staged, longer, inpatient
Content: TSA Rehab Phase 2 (4)
- 4-6 wks
- AAROM/AROM
- PROM into full ER, flexion < 140 (not OP)
- Initiate AROM esp into flexion
Q: When did TSA begin?
Early 1950s
Q: When did hip arthroplasty begin?
In the 1820s
Q: Who typically receives THR?
Younger, more active pts.
Q: What is the disadvantage of metal on polyethylene as a bearing surface for HA?
Polyethylene debris may lead to aseptic loosening
Defn: Anametric knee
Separate right and left femoral components with decreasing radii or rotation
Content: Contraindications for JA (5)
- Infection
- Severe or uncontrolled HTN
- Progressive neurological disease
- Dementia (may be considered relative contraindicaiton)
- Latent renal or respiratory insufficiency (may be considered relative contraindicaiton)
Q: TKA complication of infection - ~______% risk in 1st 2 years, cumulative risk of _____% over 10 years, _________ site or _____ peri-prosthetic, ~____% assocaited with MRSA.
1.8, 2.47, surgical, deep, 20
Content: Early Post-Op THA Intervention (Acute & Sub-Acute) (7)
- Ice and positioning
- Education - PRECAUTIONS
- Strengthening (AAROM, AROM, isometrics, SAQ, LAQ, ankle pumps)
- Mobility (bed, transfers, tait, stairs, car transfer)
- Edema management
- Equipment recommendations
- DC planning/recommendations
Q: What is the difference between a total and hemi hip arthroplasty?
Total = femoral head and acetabulum replaced
Hemi = femoral head only replaced
T/F: With THA you should progress to CC and functional activities as soon as possible.
True
T/F: Adherence to bilateral posterior hip precautions is difficult.
True
Q: What does R for TKR stand for?
Resurfacing
Content: Unicompartmental Arthroplasy is ideally indicated for… (6)
- Fexion > 90,
- Full extension
- < 15 varus/valgus deformity
- Mobile patella
- Intact tibial plateau/femoral condyles
- Satisfactory ligamentous stability
Content: Late THA Intervention (chronic) (5)
- Emphasize functional activities
- Strengthen hip flexors, extensors, and abductors
- Include resistance training if possible
- Wean from AD if appropriate
- Limit high impact actiivty or activities with rotational forces
Q: Who is unicompartmental arthroplasty used on?
Often older, lower demand pts.; increasingly used in younger pops.
T/F: THR results in a decreased risk for femoral neck fracture.
False; increased
Q: Prosthetic fialure rate of < ___% per year, _______% survive 10 yr, ____% survive 20 yr.
1, 90-95, 85
T/F: Bilateral TKA is less common than bilateral THA/THR.
False, more
Q: What are the 3 advantages of metal on polyethylene as a bearing surface for HA?
- Cost effective
- Evidence supports use
- Predictable lifespan
T/F: Pts may assume they have posterior precautions based on their own “research” or the experiences of friends and family.
True
Q: Regarding THA outcomes; ~____% of function is recovered within 8 months, ____% report satisfactory outcomes at 10 years; as many as ____% return to athletic activites within 3 yrs.
80, 90, 60
T/F: The effects of CPM on knee ROM are justifiable.
False; too small to justify
Q: A bilateral THA is usually staged by at least ___ wk, but often > ___wks between surgeries.
1, 6
Q: During phase 3 of TSA Rehab overhead activity/forceful stretching > _____ flexion, ______ ER, and horizontal ADD beyond _________ should be avoided
140, 45, neutral
T/F: Oral pain medications rarely contribute to post-op nausea, dizziness, constipation, etc.
False: often
Q: What is malnutrition associated with in regards to JA? (4)
- Infection
- Delayed wound healing
- Increased LOS and rehab time
- Mortality
Q: What are the (PT) goals of rehabilitation for JA (3)
- Restore function
- Decrease pain
- Gain muscle control/strength
Content: Factors associated with increased risk of revision (5)
- Younger age
- Male gender
- Multiple comorbidities
- Avascular necrosis (vs. OA)
- Femoral head size (?)
T/F: Activities should be prescribed according to the standard 3 sets of 10.
False: according to physiological principles
Content: Risk factors for THA dislocation (8)
- Neuromuscular impairment
- Cognitive dysfunction
- Fracture
- Hx of srugery
- Posterior approach
- Small femoral head size
- Prosthetic alignment
- Surgeon experience
T/F: Bilateral THA is associated with no change in the risk for VTE.
False, increased risk
Q: Which approach allows for better functional compliance?
Anterior, the precautions are less likely to interfere with functional activity but the procedure is more difficult
Q: What is the lifespan of a joint replacement?
~15 years
Content: Reverse TSA (3)
- Normal ball and socket arrangement is switched
- Allows use of deltoid to lift arm (vs. RC)
- Indicated if RC is fully torn, cuff tear arthropathy is present or hx of failed replacement
Content: High Tibial Osteotomy (4)
- Surgical realignment of joint
- Delays TKA (gain ~9 yrs)
- Indicated for unicompartmental disease or agnular deformity
- Allows reasonable joint stability and an active lifestyle
Content: Relative contraindications for JA (3)
- Obesity
- Diabetes
- < 50 yo or > 90 yo
Content: Unicompartemntal Arthroplasty (4)
- Obseity is associated with high failure rates
- bone conserving procedure benefits younger pts.
- Post-op rehab < than TKA rehab
- 8-10 year surivial of hardward
Diagram: Study on THA vs. THR
Q: When did TKAs begin?
1860s
T/F: Epidural anesthiesia is not used for higher-risk pts.
False: may be used
Diagram: Treatment pyramid for OA. What do the red arrow indicate?
PT intervention indicated
Diagram: Standard THA vs. Mini-Incision
Content: Primary Indications for JA (6)
- Marked, disabiling pain
- Decreased fucntion
- Marked impairment in ROM
- Instability and/or deformity
- Recurrent dislocation
- Failure of prior interventions/surgeries
Content: Effect of pre-op education of JA process (3)
- Reduces pre-op anxiety and pain
- Reduces post-op pain medication use
- May reduce LOS
Content: Mini-Incision arthroplasty (4)
- Performed through 2 smaller incisions (2-6 vs. 8-10 inch)
- Possible short term advantages (less pain/bleeding/time to d/c)
- little long term evidence
- technically demanding
Content: TKA Rehabilitation (acute and subacute) (7)
- Ice and positioning
- ROM (DC goal of 0 extension, 90 flexion includes PROM)
- Strengthening (isometrics, ankle pumps, heel slides, SAQ, LAQ, SLR)
- Mobility (normalize gait, functional knee ROM)
- Education (WBing precautions, gait quality)
- Edema and pain management
- DC planning/recommendations
Content: Risk factors for infection following a TKA (4)
- Obesity
- Anemia
- Malnutrition
- Diabetes
Q: How many approaches are there for HA?
7 (Direct anterior, anteriolateral, direct lateral/transgluteal, lateral transtrochanteric, posterolateral, posterior mini, anterior mini)
T/F: In the past materials such as, ivory, glass, rubber, stainless steal, polyethylene, and acrylic, were used in hip arthroplasty.
True
Q: What are the 2 advantages of ceramic on ceramic as a bearing surface for HA?
- Low friction/wear
- Inert material
Q: What are the 2 advantages of cemented fixation for HA?
- More stable initially
- Better short and mid term outcomes
Content: TSA Rehab Phase 3 (4)
- 8-12+ wks
- AROM into flexion and ER
- Strengthen shoulder girdle
- Avoid overhead activity and forceful stretching
Q: Incidence of dislocation with THA is ~_______% for primary procedures and may increase to as much as ____% with revision; _____% of dislocations occur within ___wks of surgery
0.3-10, 28, 60-70, 6
Q: Who is an ideal pt. for a TKA? (2)
- > 60 yo
- < 180 lbs
Q: What are the 2 advantages of metal on metal as a bearing surface for HA?
- Low friction/wear
- Lower dislocation risk
Q: What components are involved in a TSA?
Humeral and (optional) glenoid component
Q: What are the 2 disadvantages of uncemented fixation for HA?
- Increased risk of peri-prosthetic fracture
- Lack of good long term outcome data
Content: Recurrent THA dislocation (4)
- Spica brace may be required
- May also require WB restrictions/movement precautions
- Education, ADL, home evaluation
- Communication with pt., family, medical team
Q: What are the functional concerns with posterior precautions?
Getting into/out of chairs/car
Content: 3 precautions for the anterior lateral THA
- Avoid abduction
- Avoid hip extension
- Avoid hip ER
T/F: A bilateral TKA should be bilateral WBAT.
True
Q: What are the 2 disadvantages of metal on metal as a bearing surface for HA?
- Possible carcinogenic effect of metal ions
- Metallosis
Content: Risk factors for VTE following TKA (6)
- BMI > 25
- COPD
- Atrial fibrillation
- Anema
- Depression
- History of DVT
Content: 3 precautions for the posterior lateral THA
- Avoid adduction past nuetral
- Avoid hip flexion > 90
- Avoid hip IR
Content: TSA Rehab Phase 1 (4)
- 2-4 wks
- PROM/AAROM
- Immobilization
- No AROM
Content: Primary Causes of JA (5)
- OA
- RA
- Traumatic arthritis
- Avascular necrosis
- Fracture repair
Q: What are the 2 advantages of uncemented fixation for HA?
- Lower risk of CV and VTE events
- Bone conserving
Content: Complications of JA (16 - just recognize)
- DVT and PE
- Infection (acute and long term)
- Arthrofibrosis
- CRPS
- Component loosening/failur
- Allergic reaction
- Pneumonia
- Hematoma
- Surgical fracture
- Mal-alignment of prosthesis
- Fracture of prosthesis
- Limb length discrepany
- Dislocatoin
- Neural injury
- Thermal damage/laceration
- Heterotrophic ossification (HO)
Q: TKA complication of venous thromboembolism (VTE) - with prophylaxis up to ____% will developt DVT and up to ____% will developt PE
5,
Q: During phase 1 of TSA rehab, no flexion > ______, ER > ______ or ABD > ______.
120, 30, 45
Content: 3 advantages of THR
- Lower dislocation risk (
- Bone conserving
- Lower wear/friction
Content: TKA Late Intervention (chronic) (4)
- Emphasize functional activity
- Increase ROM
- strengthening
- limit high impact
Q: On the WELLS scale a score of > ___ means a high pretest probability of DVT and a score of > ___ means a high pretest probability of a PE.
3, 6
Q: Does fast tracking work?
Current evidence suggest yes:
- more rapid return to function
- reduced opiode consumption
- shorter LOS
- reduced risk of blood transfusion
- reduced mortality
Content: Areas of priority for fast-tracking recovery (4)
- Pre-op education
- Nutritional supplementation
- Pain management
- Early mobilization
Q: TKA complication of venous thromboembolism (VTE) - without prophylaxis up to ____% will developt DVT and up to ____% will developt PE
60, 20
Q: ____ million Americans are living with TKA, ____ million American are living with THA.
4.7, 2.5
Content: 2 disadvantages of THR
- Technically difficult
- Little long term data
