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
what are some therapeutic exercises to do after a TKA?
upper extremity strengthening
CPM
knee AROM (particularly flexion) for TKR
quad sets
straight leg raising for TKR
heel slides
ankle pumps
deep breathing and coughing
what are some post operative goals for after a TKA?
independence in transfers
independence in ambulation
- non-cemented hip and knee replacements may require a walker to maintain NWB status for up to 6 weeks
- cemented replacements may allow for earlier partial weightbearing
- independence on stairs may be challenged by NWB status
90-100º of knee flexion ROM for TKR
how long does a TKR last?
approx 25 years on average
what are the indications for a PKA?
DJD in one compartment
max 10º varus or 5º valgus from mechanical axis
flexion contractures < 10º
intact ACL
absence of PFPS
BMI < 32
what are goals after a PKA in weeks 1-4?
control postoperative swelling
minimize pain
ROM 0-90º
3/5 to 4/5 strength of quadriceps
ambulate with or without assistive device
establish home exercise program
what are goals after a PKA in weeks 4-8?
reduce swelling
ROM 0-110º or greater
full weight bearing
4/5 to 5/5 strength
unrestricted ADL function
improved balance, neuromuscular control, and functional mobility
adherence to home exercise program
what are goals after a PKA beyond 8 weeks?
develop maintenance program and educate patient on importance of adherence including methods of joint protection
community ambulation
improve cardiopulmonary endurance/ aerobic fitness
what are interventions after a PKA in weeks 1-4?
pain modulation modalities
compression wrap to control effusion
ankle pumps to minimize risk of DVT
AAROM and AROM
muscle setting quadriceps, hamstrings, and adductors
patellar mobilization (grades 1 and 2)
gait training
flexibility program hamstrings, calf, IT band
trunk/pelvis stabilization exercises
what are interventions after a PKA in weeks 4-8?
patellar mobilization
LE stretching program
closed-chain strengthening
limited range PRE
tibiofemoral joint mobilization, if appropriate and needed
proprioceptive training
stabilization and balance exercises
protected aerobic exercise- swimming, cycling, or walking
what are interventions after a PKA after 8 weeks?
continue to advance the previous phase as appropriate
progression of balance and advanced functional activities
implement exercise specific to identified deficits and expected functional tasks
what is the impact of quad weakness for TKA?
strength declines 60% of acutely after surgery
mizner et al found pts can return to pre-op quad strength (strength values can be anywhere from 20-60% of their age matched controls)
pre-op quad strength -> greatest predictor of post-op function
quad atrophy may last up to 10 months post-op
what are some soft tissue causes of knee stiffness after a PKA?
severity of pre-op arthritis
poor connective tissue morphology
lack of pt compliance with PT
poor physical health
inadequate post op pain management
what are some mechanical causes of knee stiffness after a PKA?
improper component size
improper positioning
malalignment or inadequate soft tissue tensioning
PCL management during surgery
T/F: pts with stiff knee prior to surgery tend to c/o knee stiffness post op
true may be due to soft tissue restriction. maximizing pre-op ROM is important
what are some complications of TKA?
wound healing issues
DVT <5%
PE < 3%
pneumonia
myocardial infarction
nerve or vascular issues
joint instability
UTI
nausea/vomittin
bleeding in joint
infection
anesthesia risks- heart, lung, kidney damage
which activities are highly recommended after a TKA?
stationary cycling
swimming. water aerobics
walking
golf
ballroom or square dancing
table tennis
what activities are recommended if participated prior to TKA?
road cycling
speed/power walking
low-impact aerobics
cross-country skiing
table tennis
doubles tennis
rowing, canoeing
bowling
which activities are not recommended after a TKA?
jogging, running
basketball
volleyball
singles tennis
baseball, softball
high-impact aerobics
stair-climbing machine
handball, racquetball, squash
football, soccer
gymnastics, tumbling
water skiing
