knee surgery

Question 1

Indications for Knee arthroplasty

Answer 1

RA, OA, osteonecrosis
that lead to significant functional limitations

Question 2

Risk Factors for TKA ( 3)

Answer 2

overweight, sports-related injury, genetics

Question 3

partial knee replacement/Unicompartmental: (medial or lateral)
advantages ( 4)

Answer 3

fewer surgical risks, less blood loss, faster recovery, less overall pain

Question 4

4 selection criteria for unicompartmental TKA

Answer 4

1. noninflammatory OA ( RA = contraindication)
2. minimal varus or valgus
3. Intact ACL
4. flexion contracture ( < 15*)

Question 5

• Cobalt-chrome alloy femoral component
• Polyethelene spacer (“tray”)
• Titanium tibial component
  are used in these types of TKAs

Answer 5

Bicompartmental: (medial and lateral)
Unicompartmental: (medial or lateral)

Question 6

Tricompartmental involves

Answer 6

All articular surfaces of femur, tibia, and patella

Question 7

Do NOT perform anterior - posterior tibiofemoral joint mobs if patient had this procedure

Answer 7

PCL sacrificing

Question 8

What is the greatest challenge with Revision Arthoscopy ?

Answer 8

bone loss and integrity
Augmentation & allografts can be used to support components

Question 9

What is the Gold standard for TKA?

Answer 9

Medial parapatellar ( paramedian)

Question 10

2 advantages for medial parapatellar (paramedian) approach

Answer 10

1. Great exposure for surgeon
2. Optimal for alignment

Question 11

Medial parapatellar ( paramedian) 1 disvantage

Answer 11

1. Compromises quad muscle-tendon (greater post-op quad weakness)

Question 12

Advantages for Subvastus approach

Answer 12

1. spares quad tendon
2. better post op flexion
3. less post op pain
4. higher patient satisfaction
5. better patellar tracking
6. faster ADL recovery

Question 13

Disadvantage for Subvastus approach

Answer 13

1. harder / more technical for surgeon

Question 14

Advantage for Midvastus approach

Answer 14

1. Minimizes quad trauma

Question 15

Disadvantage for Midvastus approach

Answer 15

1. disrupts VMO
   No evidence to suggest any better outcomes than paramedian

Question 16

2 Advantages for lateral approach

Answer 16

1. See the structures that may need to be released (IT band, LCL, popliteus)
2. Allows for correction of malalignment

Question 17

Advantages for lateral proced

Answer 17

Advantages:
Great exposure to structures that may need to be released (IT band, LCL, popliteus) for surgeon
Allows for correction of malalignment

Question 17

2 Disadvantages for lateral approach

Answer 17

1. less medial visualization
2. more technically complicated

Question 18

2 advantages of Minimally Invasive (quad sparing) approach

Answer 18

1. Avoids quad trauma
2. Avoids patellar disruption

Question 19

Disadvantages of Minimally Invasive ( quad sparing) approach

Answer 19

lot of issues because it’s complicated
Implant malpositioning
Delayed wound healing
Periprosthetic fractures
Patellar fractures
Infection
Peroneal nerve palsy

Question 20

What is the greatest risk first post-operative week?

Answer 20

DVT
** use wells criterion

Question 21

What is Hoomans signs?
how does it compare in research efficacy compared to wells criterion?

Answer 21

Hoomans = forced DF manuever causes pain in calf
Wells criteria&raquo_space;> homans

Question 22

Detection of infection

Answer 22

Warmth & redness of skin,
wound drainage (>4 days post-op),
odor from wound, fever, malaise, hardening of incision, severe pain

Question 23

Key consideration with management of arthrofibrosis?

Answer 23

Identify earlier rather than later

Question 24

Hip ROM motions to check during knee exam?

Answer 24

Hip flex, ext, abd; knee flex, ext; ankle motions
** check Hip ER/ IR later

Question 25

Self reported outcome measures

Answer 25

1. LEFS
2. WOMAC
3. PSFS

Question 26

Performance Outcome Measure

Answer 26

1. TUG
2. 30 second chair sit-stand test
3. Functional Gait Assessment (FGA)
4. Berg Balance Scale

Question 27

3 outcome predictors

Answer 27

1. pre- op. ROM
2. pre- op quad strength
3. BMI