knee surgery Flashcards
Indications for Knee arthroplasty
RA, OA, osteonecrosis
that lead to significant functional limitations
Risk Factors for TKA ( 3)
overweight, sports-related injury, genetics
partial knee replacement/Unicompartmental: (medial or lateral)
advantages ( 4)
fewer surgical risks, less blood loss, faster recovery, less overall pain
4 selection criteria for unicompartmental TKA
- noninflammatory OA ( RA = contraindication)
- minimal varus or valgus
- Intact ACL
- flexion contracture ( < 15*)
- Cobalt-chrome alloy femoral component
- Polyethelene spacer (“tray”)
- Titanium tibial component
are used in these types of TKAs
Bicompartmental: (medial and lateral)
Unicompartmental: (medial or lateral)
Tricompartmental involves
All articular surfaces of femur, tibia, and patella
Do NOT perform anterior - posterior tibiofemoral joint mobs if patient had this procedure
PCL sacrificing
What is the greatest challenge with Revision Arthoscopy ?
bone loss and integrity
Augmentation & allografts can be used to support components
What is the Gold standard for TKA?
Medial parapatellar ( paramedian)
2 advantages for medial parapatellar (paramedian) approach
- Great exposure for surgeon
- Optimal for alignment
Medial parapatellar ( paramedian) 1 disvantage
- Compromises quad muscle-tendon (greater post-op quad weakness)
Advantages for Subvastus approach
- spares quad tendon
- better post op flexion
- less post op pain
- higher patient satisfaction
- better patellar tracking
- faster ADL recovery
Disadvantage for Subvastus approach
- harder / more technical for surgeon
Advantage for Midvastus approach
- Minimizes quad trauma
Disadvantage for Midvastus approach
- disrupts VMO
No evidence to suggest any better outcomes than paramedian
2 Advantages for lateral approach
- See the structures that may need to be released (IT band, LCL, popliteus)
- Allows for correction of malalignment
Advantages for lateral proced
Advantages:
Great exposure to structures that may need to be released (IT band, LCL, popliteus) for surgeon
Allows for correction of malalignment
2 Disadvantages for lateral approach
- less medial visualization
- more technically complicated
2 advantages of Minimally Invasive (quad sparing) approach
- Avoids quad trauma
- Avoids patellar disruption
Disadvantages of Minimally Invasive ( quad sparing) approach
lot of issues because it’s complicated
Implant malpositioning
Delayed wound healing
Periprosthetic fractures
Patellar fractures
Infection
Peroneal nerve palsy
What is the greatest risk first post-operative week?
DVT
** use wells criterion
What is Hoomans signs?
how does it compare in research efficacy compared to wells criterion?
Hoomans = forced DF manuever causes pain in calf
Wells criteria»_space;> homans
Detection of infection
Warmth & redness of skin,
wound drainage (>4 days post-op),
odor from wound, fever, malaise, hardening of incision, severe pain
Key consideration with management of arthrofibrosis?
Identify earlier rather than later
