knee surgery (only until test 1) Flashcards
what surgeries can be performed on the knee?
articular cartilage defect repair (microfracture, OATS, ACI)
knee arthroplasty
meniscal repair
meniscectomy (excision)
ligamentous reconstruction (ACL, PCL)
patellofemoral procedures
what is the conservative treatment for OCD?
activity limitation, crutches, restricted ROM
what is the surgical treatment for OCD?
arthroscopic drilling
pinning or screw fixation
fragment excision
osteochondral autograft/allograft transplantations (OATS)
autologous chrondrocyte implantation (ACI)
who should partake in osteoarthritis articular cartilage repair?
young active adults
defects >1-2 cm and < 4 cm
what are indications for osteoarthritis articular cartilage repair?
symptomatic knee
focal lesion of TF or PF joint
where are the site of repair for osteoarthritis articular cartilage repair?
WB region of medial/lateral femoral condyle
trochlear groove
articular facet of patella
what are the medical pre-operative evaluation for a TKA?
joints above and below are evaluated
review of medications (wardarin- blood thinner, and anti-inflammatory medications may be adjusted or discontinued)
blood tests of liver and kidney function, urine tests
chest x-ray and EKG
what are the PT pre-operative instructions for a TKA?
expectations regarding the postoperative period and level of function
instruction in ambulation with assistive devices
instructions in transfers
therapeutic exercises (deep breathing and coughing, heel slides, ankle pumps, AROM, continuous passive motion device)
what are indications for a TKR?
may be considered when the tibiofemoral joint has been damaged by progressive and severe OA, trauma, or destructive disease
marked deformity- valgus females, varus males
severe pain
joint swelling
feeling of knee “giving way”
severe loss of motion
loss of function
what is a cemented TKA?
allows for immediate WBAT
implant is cemented into the bone
high rate of biomechanical loosening at bone-cement interface (highest risk in young, active patients)
what is a uncemented TKA?
WB restricted immediate post-op
rely on rapid bone growth into porous prosthesis
high rate of loosening at the tibial interface
what is a “hybrid” TKA?
uncemented femoral component
cemented tibial component
describe the operative procedure for a TKA
the distal end of the femur is removed and replaced with a metallic shell
the proximal tibia is removed and replaced with a channeled plastic component with a metal stem
depending on the condition of the patella, a plastic “button” may be added under the retropatellar surface
what happens in the immediate post-op period after a TKA?
1.5-3 hours
vital organs are monitored in recovery room
foley catheter is inserted into the urethra
PT 48 hours after surgery
pain, discomfort, and stiffness are to be expected, but gradually diminish
knee immobilizers are used to stabilize the knee
consistent monitoring of the wound is required
what does physical therapy look like after TKA?
examination
chart review, inspection of incision, upper quarter function
hip or knee: AROM, PROM, resisted tests, neurological (dermatomes, myotomes)
function (transfers, raised toilet seat)
ambulation with walker if NWB, with quad cane if PWB
