Joint Replacements

Question 1

Examination Areas

Answer 1

Cardiovascular and pulmonary function
Musculoskeletal assessment
Incision line ( infection or dehiscence)
Pressure ulcers at the heels, sacrum, and ischium
LE peripheral edema 
Contractures
Strength testing 
Sensory testing 
Muscle stretch reflexes 
Proximal and distal pulses 
Functional assessment (bed mobility, transfers, and ability to ambulate using an appropriate assistive device)

Question 2

ICF Model

Answer 2

Impairments: weakness in the affected extremity, limited range of motion, reduced endurance, and impaired balance.
Activity limitations: difficulty performing activities of daily living such as bathing, dressing, grooming, transfers from different surfaces, and ambulation on different terrains and stairs
Participation restriction: inability to drive, return to work, and high-level recreational activities such as jogging and bicycle riding

Question 3

Physiotherapy

Answer 3

Physical therapists work with the patient on
A) improving the range of motion of the lower extremities within restriction parameters and
B) strength training of key muscle groups such as the hip flexors, abductors, and extensors; knee flexors and extensors; ankle dorsi and plantar flexors.
C) Modalities such as cold therapy can be used to reduce pain.
D) Functional activities such as bed mobility, transfers, and ambulation on different terrains and stairs are also performed.

Question 4

Occupational Therapy

Answer 4

Occupational therapists educate the patients on performing specific
A) activities of daily living such as bathing, dressing, and toileting within the restrictions of their range of motion.
B) In addition, they work with the patient on strengthening key muscle groups of the upper extremities and trunk that are essential for performing these types of activities and
C) also provide the patient with appropriate assistive devices to assist them in these activities.

Question 5

VTE

Answer 5

One study showed thrombosis in 16% of THA patients and 31% after TKA.

Question 6

Fact

Answer 6

Studies have shown that up to 83% of total hip and knee arthroplasty patients are nontherapeutic on postoperative day 4

Question 7

Hip Precautions

Answer 7

To prevent dislocations, hip precautions are prescribed: (a) no hip adduction across the midline, (b) no hip flexion greater than 90°.
Placing an abduction pillow between the patient’s legs can be of benefit.
If a dislocation occurs, the patient may be fitted for a brace to maintain the correct position.

Question 8

Falls post THR

Answer 8

A) if the patient uses his or her walker or cane appropriately and waits until he or she has assistance. B) Weight bear restrictions,
C) Postural hypotension from lying in bed for a long period of time.
D) Environmental modifications such as lowering the patient’s bed and ensuring that the brakes are on, eliminating clutter around the bedside, and educating the patient to use a call bell are all important to minimize risk of falls.
E) Educating the patient on reoccurrence of falls if they do happen is just as important as preventing falls in the first place.

Question 9

Foot Drop Post Surgery

Answer 9

A) Possible etiologies include injury to the sciatic or common peroneal nerve.
B) The incidence of footdrop is fairly low with Weber et al. reporting a 0.07% incidence in 2,012 hip arthroplasties .
C) Occasionally footdrop may occur secondary to acquired spinal stenosis after joint arthroplasty.
D) Sometimes this can occur up to 9 months after surgery.

Question 10

Rehabilitation of MSK

Answer 10

The basic phases of rehabilitation include (a) pain control and reduction of inflammation, (b) restoration of normal shoulder motion, (c) improved strength, (d) improved proprioception, and (e) return to task or sport-specific activities.

Question 11

Pain Control

Answer 11

Pain control and reduction of inflammation may be obtained by a combination of relative rest, icing, electrical stimulation, and acetaminophen or a nonsteroidal anti-inflammatory medication.

Question 12

“Brief, Huddle, Debrief.”

Answer 12

A) The Brief component involves a short session prior to the start of any treatment to discuss team formation, assign essential roles, establish expectations, and anticipate outcomes.
B) The Huddle portion is an ad hoc planning to reestablish situation awareness, reinforce plans already in place, and assess the need to adjust the plan.
C) Debrief is an informal information exchange session designed to improve team performance and effectiveness

Question 13

Triple Skills

Answer 13

A) Cost efficiency in ordering tests, especially radiological studies, is a skill that can be difficult but one that every physiatrist should attempt to master.
B) Preventive medicine also has been shown to be extremely important in reducing costs and improving the health of populations.
C) Physiatrists dealing with patients with upper extremity musculoskeletal disorders will notice that many injuries, especially in their elderly population, occur due to falls. A plan to prevent falls in geriatric patients can decrease the high costs associated with the treatment of upper extremity injuries secondary to falls.