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PTRS 746 Exam 1 > Joint Arthroplasty and Post-Surgical Rehabilitation > Flashcards

Joint Arthroplasty and Post-Surgical Rehabilitation Flashcards

1
Q

Q: ____ million Americans are living with TKA, ____ million American are living with THA.

A

4.7, 2.5

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2
Q

Q: What is the lifespan of a joint replacement?

A

~15 years

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3
Q

Q: What does R for TKR stand for?

A

Resurfacing

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4
Q

Diagram: Treatment pyramid for OA. What do the red arrow indicate?

A

PT intervention indicated

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5
Q

Q: What are the (PT) goals of rehabilitation for JA (3)

A
  1. Restore function
  2. Decrease pain
  3. Gain muscle control/strength
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6
Q

Content: Primary Causes of JA (5)

A
  1. OA
  2. RA
  3. Traumatic arthritis
  4. Avascular necrosis
  5. Fracture repair
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7
Q

Content: Primary Indications for JA (6)

A
  1. Marked, disabiling pain
  2. Decreased fucntion
  3. Marked impairment in ROM
  4. Instability and/or deformity
  5. Recurrent dislocation
  6. Failure of prior interventions/surgeries
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8
Q

Content: Contraindications for JA (5)

A
  1. Infection
  2. Severe or uncontrolled HTN
  3. Progressive neurological disease
  4. Dementia (may be considered relative contraindicaiton)
  5. Latent renal or respiratory insufficiency (may be considered relative contraindicaiton)
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9
Q

Content: Relative contraindications for JA (3)

A
  1. Obesity
  2. Diabetes
  3. < 50 yo or > 90 yo
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10
Q

T/F: Epidural anesthiesia is not used for higher-risk pts.

A

False: may be used

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11
Q

Content: Complications of JA (16 - just recognize)

A
  1. DVT and PE
  2. Infection (acute and long term)
  3. Arthrofibrosis
  4. CRPS
  5. Component loosening/failur
  6. Allergic reaction
  7. Pneumonia
  8. Hematoma
  9. Surgical fracture
  10. Mal-alignment of prosthesis
  11. Fracture of prosthesis
  12. Limb length discrepany
  13. Dislocatoin
  14. Neural injury
  15. Thermal damage/laceration
  16. Heterotrophic ossification (HO)
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12
Q

Q: When did hip arthroplasty begin?

A

In the 1820s

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13
Q

T/F: In the past materials such as, ivory, glass, rubber, stainless steal, polyethylene, and acrylic, were used in hip arthroplasty.

A

True

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14
Q

Q: What are the 3 advantages of metal on polyethylene as a bearing surface for HA?

A
  1. Cost effective
  2. Evidence supports use
  3. Predictable lifespan
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15
Q

Q: What is the disadvantage of metal on polyethylene as a bearing surface for HA?

A

Polyethylene debris may lead to aseptic loosening

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16
Q

Q: What are the 2 advantages of metal on metal as a bearing surface for HA?

A
  1. Low friction/wear
  2. Lower dislocation risk
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17
Q

Q: What are the 2 disadvantages of metal on metal as a bearing surface for HA?

A
  1. Possible carcinogenic effect of metal ions
  2. Metallosis
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18
Q

Q: What are the 2 advantages of ceramic on ceramic as a bearing surface for HA?

A
  1. Low friction/wear
  2. Inert material
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19
Q

Q: What are the 3 disadvantages of ceramic on ceramic as a bearing surface for HA?

A
  1. Expensive
  2. Requires expert inseriton technique
  3. Possible joint noise
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20
Q

Q: What are the 2 advantages of uncemented fixation for HA?

A
  1. Lower risk of CV and VTE events
  2. Bone conserving
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21
Q

Q: What are the 2 disadvantages of uncemented fixation for HA?

A
  1. Increased risk of peri-prosthetic fracture
  2. Lack of good long term outcome data
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22
Q

Q: What are the 2 advantages of cemented fixation for HA?

A
  1. More stable initially
  2. Better short and mid term outcomes
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23
Q

Q: What are the 3 disadvantages of cemented fixation for HA?

A
  1. Longer operative time
  2. More difficult to revise
  3. Potential for adverse reaction to cement
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24
Q

Q: How many approaches are there for HA?

A

7 (Direct anterior, anteriolateral, direct lateral/transgluteal, lateral transtrochanteric, posterolateral, posterior mini, anterior mini)

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25
Content: Mini-Incision arthroplasty (4)
1. Performed through 2 smaller incisions (2-6 vs. 8-10 inch) 2. Possible short term advantages (less pain/bleeding/time to d/c) 3. little long term evidence 4. technically demanding
26
Diagram: Standard THA vs. Mini-Incision
27
Q: What is the difference between a total and hemi hip arthroplasty?
Total = femoral head and acetabulum replaced Hemi = femoral head only replaced
28
Q: Who typically receives THR?
Younger, more active pts.
29
T/F: THR results in a decreased risk for femoral neck fracture.
False; increased
30
Content: 3 advantages of THR
1. Lower dislocation risk (\<1%) 2. Bone conserving 3. Lower wear/friction
31
Content: 2 disadvantages of THR
1. Technically difficult 2. Little long term data
32
Content: 3 advantages of THA
1. Well studied 2. Easier to perform 3. Suitable for wider range of pt. pops
33
Content: 2 disadvantages of THA
1. Higher risk of dislocation (~5%) 2. More difficult to revise
34
Diagram: Study on THA vs. THR
35
Content: 3 precautions for the posterior lateral THA
1. Avoid adduction past nuetral 2. Avoid hip flexion \> 90 3. Avoid hip IR
36
Content: 3 precautions for the anterior lateral THA
1. Avoid abduction 2. Avoid hip extension 3. Avoid hip ER
37
T/F: Pts may assume they have posterior precautions based on their own "research" or the experiences of friends and family.
True
38
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
39
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
40
Q: What are the functional concerns with posterior precautions?
Getting into/out of chairs/car
41
Content: Risk factors for THA dislocation (8)
1. Neuromuscular impairment 2. Cognitive dysfunction 3. Fracture 4. Hx of srugery 5. Posterior approach 6. Small femoral head size 7. Prosthetic alignment 8. Surgeon experience
42
Content: Recurrent THA dislocation (4)
1. Spica brace may be required 2. May also require WB restrictions/movement precautions 3. Education, ADL, home evaluation 4. Communication with pt., family, medical team
43
Q: Prosthetic fialure rate of \< \_\_\_% per year, \_\_\_\_\_\_\_% survive 10 yr, \_\_\_\_% survive 20 yr.
1, 90-95, 85
44
Content: Factors associated with increased risk of revision (5)
1. Younger age 2. Male gender 3. Multiple comorbidities 4. Avascular necrosis (vs. OA) 5. Femoral head size (?)
45
Content: Early Post-Op THA Intervention (Acute & Sub-Acute) (7)
1. Ice and positioning 2. Education - PRECAUTIONS 3. Strengthening (AAROM, AROM, isometrics, SAQ, LAQ, ankle pumps) 4. Mobility (bed, transfers, tait, stairs, car transfer) 5. Edema management 6. Equipment recommendations 7. DC planning/recommendations
46
T/F: With THA you should progress to CC and functional activities as soon as possible.
True
47
Content: Late THA Intervention (chronic) (5)
1. Emphasize functional activities 2. Strengthen hip flexors, extensors, and abductors 3. Include resistance training if possible 4. Wean from AD if appropriate 5. Limit high impact actiivty or activities with rotational forces
48
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
49
Q: When did TKAs begin?
1860s
50
Defn: Geometric knee
Allows for correction of valgus/varus/flexion deformities
51
Defn: Anametric knee
Separate right and left femoral components with decreasing radii or rotation
52
Content: High Tibial Osteotomy (4)
1. Surgical realignment of joint 2. Delays TKA (gain ~9 yrs) 3. Indicated for unicompartmental disease or agnular deformity 4. Allows reasonable joint stability and an active lifestyle
53
Content: Unicompartemntal Arthroplasty (4)
1. Obseity is associated with high failure rates 2. bone conserving procedure benefits younger pts. 3. Post-op rehab \< than TKA rehab 4. 8-10 year surivial of hardward
54
Q: Who is unicompartmental arthroplasty used on?
Often older, lower demand pts.; increasingly used in younger pops.
55
Content: Unicompartmental Arthroplasy is ideally indicated for... (6)
1. Fexion \> 90, 2. Full extension 3. \< 15 varus/valgus deformity 4. Mobile patella 5. Intact tibial plateau/femoral condyles 6. Satisfactory ligamentous stability
56
Q: Who is an ideal pt. for a TKA? (2)
1. \> 60 yo 2. \< 180 lbs
57
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
58
Content: Risk factors for infection following a TKA (4)
1. Obesity 2. Anemia 3. Malnutrition 4. Diabetes
59
Q: TKA complication of venous thromboembolism (VTE) - without prophylaxis up to \_\_\_\_% will developt DVT and up to \_\_\_\_% will developt PE
60, 20
60
Q: TKA complication of venous thromboembolism (VTE) - with prophylaxis up to \_\_\_\_% will developt DVT and up to \_\_\_\_% will developt PE
5, \<1
61
Content: Risk factors for VTE following TKA (6)
1. BMI \> 25 2. COPD 3. Atrial fibrillation 4. Anema 5. Depression 6. History of DVT
62
Q: What is the name of the scoring system for DVT and PE?
WELLS score
63
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
64
Content: TKA Rehabilitation (acute and subacute) (7)
1. Ice and positioning 2. ROM (DC goal of 0 extension, 90 flexion includes PROM) 3. Strengthening (isometrics, ankle pumps, heel slides, SAQ, LAQ, SLR) 4. Mobility (normalize gait, functional knee ROM) 5. Education (WBing precautions, gait quality) 6. Edema and pain management 7. DC planning/recommendations
65
T/F: The effects of CPM on knee ROM are justifiable.
False; too small to justify
66
Content: TKA Late Intervention (chronic) (4)
1. Emphasize functional activity 2. Increase ROM 3. strengthening 4. limit high impact
67
T/F: Bilateral TKA is less common than bilateral THA/THR.
False, more
68
T/F: A bilateral TKA should be bilateral WBAT.
True
69
Q: Bilateral TKA can be ____________ or ________ and involves _________ recovery, may require ____________ rehab.
concurrent, staged, longer, inpatient
70
Q: A bilateral THA is usually staged by at least ___ wk, but often \> \_\_\_wks between surgeries.
1, 6
71
T/F: Bilateral THA is associated with no change in the risk for VTE.
False, increased risk
72
T/F: Adherence to bilateral posterior hip precautions is difficult.
True
73
Q: When did TSA begin?
Early 1950s
74
Q: What components are involved in a TSA?
Humeral and (optional) glenoid component
75
Content: conventional TSA (2)
1. Cemented or un-cemented 2. Indicated for OA and intact RC
76
Content: Reverse TSA (3)
1. Normal ball and socket arrangement is switched 2. Allows use of deltoid to lift arm (vs. RC) 3. Indicated if RC is fully torn, cuff tear arthropathy is present or hx of failed replacement
77
Content: TSA Rehab Phase 1 (4)
1. 2-4 wks 2. PROM/AAROM 3. Immobilization 4. No AROM
78
Q: During phase 1 of TSA rehab, no flexion \> \_\_\_\_\_\_, ER \> ______ or ABD \> \_\_\_\_\_\_.
120, 30, 45
79
Content: TSA Rehab Phase 2 (4)
1. 4-6 wks 2. AAROM/AROM 3. PROM into full ER, flexion \< 140 (not OP) 4. Initiate AROM esp into flexion
80
Content: TSA Rehab Phase 3 (4)
1. 8-12+ wks 2. AROM into flexion and ER 3. Strengthen shoulder girdle 4. Avoid overhead activity and forceful stretching
81
Q: During phase 3 of TSA Rehab overhead activity/forceful stretching \> _____ flexion, ______ ER, and horizontal ADD beyond _________ should be avoided
140, 45, neutral
82
T/F: Oral pain medications rarely contribute to post-op nausea, dizziness, constipation, etc.
False: often
83
Content: Areas of priority for fast-tracking recovery (4)
1. Pre-op education 2. Nutritional supplementation 3. Pain management 4. Early mobilization
84
Content: Effect of pre-op education of JA process (3)
1. Reduces pre-op anxiety and pain 2. Reduces post-op pain medication use 3. May reduce LOS
85
Q: What is malnutrition associated with in regards to JA? (4)
1. Infection 2. Delayed wound healing 3. Increased LOS and rehab time 4. Mortality
86
T/F: Activities should be prescribed according to the standard 3 sets of 10.
False: according to physiological principles
87
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

PTRS 746 Exam 1 (9 decks)

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