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PTA Ortho: Exam 1 > Knee Unit-TKA > Flashcards

Knee Unit-TKA Flashcards

Joint surgery

1
Q

What is the primary reasons for knee replacements?

A
  • Eliminate severe pain

- Restore ADL function in patients to OA and RA

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2
Q

What are contraindications for a TKA?

A
  • Active sepsis
  • Prior knee infection
  • Absent quadriceps function
  • Significant genu recurvatum
  • Severe obesity
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3
Q

What are the most common materials for a TKA?

A

cobalt chromium or titanium

Can withstand 1,000lbs of pressure

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4
Q

Stabilization of a TKA?

A

-with or without cement
>If uncemented may have delayed wtb
&raquo_space;Typically toe touch for up to 6 weeks

-Can have unicompartmental TKA

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5
Q

What is a hybrid TKA?

A

they have uncemented femoral and patella components and cemented tibial components

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6
Q

TKA complications?

A
  • DVT
  • Pulmonary embolus (PE)
  • Infection
  • Patellofemoral problems
  • Vascular damage
  • Fracture surrounding the prosthesis
  • Nerve damage
  • Loosening of the prosthesis
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7
Q

Precautions post op for TKA (immediate)

A
  • Weight bearing status determined by physician

- May wear knee immobilizer post op

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8
Q

Precautions for several months post surgery

TKA

A
  • Avoid excessive stress to the knee
  • Avoid squatting
  • Avoid quick pivoting
  • Don’t use pillows under knee in bed
  • Avoid low sitting
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9
Q

What does rehabilitation involve?

A
  • Education
  • Reconditioning
  • *Restoring ROM
  • Gait training

PTA needs to be aware of different types of TKA’s and any special precautions

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10
Q

Treatment settings

A

-Will begin the afternoon of surgery or the next morning
-Usually will be seen BID(2x/day) during the week and QD (1x/day) on weekends
-Usually have short acute care stays
>Discharged to home with home health, to skilled nursing facilities or acute rehab to complete rehabilitation

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11
Q

What is the time frame for a TKA

A

6-12 weeks

return to activity depends on recovery and MD clearance

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12
Q

Outcome for TKA

A

-highly successful surgery that should significantly reduce pain and increase function
-minor limitations in ROM post rehab
-TKA can loosen up over time and require revision
>life expectancy of prosthesis 15-20 years

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13
Q

What happened in 1960 in TKA world?

A

First TKA’s; hinged implants

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14
Q

What happened in 1970 in TKA world?

A

condylar implants: allowed rotation but only came in two sizes and solid pieces

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15
Q

What happened in 1990 in TKA world?

A

implants became easier to place and better instrument design. TKA”s became widely accepted. Subvastus and Midvastus technique

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16
Q

What happened in 1998 in TKA world?

A

Mini-incision TKA

17
Q

What happened in 2002 in TKA world?

A

Minimally Invasive Solutions (MIS) quadriceps sparing TKA

18
Q

What is a classic TKA

A

large cut ( more than 5 finger widths )made into quadriceps muscle

19
Q

What is a mini TKA?

A

relatively small cut ( 1-4 finger widths) made into the quadriceps

20
Q

What is an MIS TKA?

A

“Minimal Invasive Solution” Quad Sparing – quadriceps muscle is spared

21
Q

Does the size of the incision define the procedure?

A

No, it does NOT

22
Q

Other Factors Used To Define Minimally Invasive

A

-Some do define by the length of the incision

-Patella displacement
>Retraction versus eversion

-Knee joint location

23
Q

The Mini TKA Advantages

Comparing to MIS Quad Sparing

A
  • Approach similar to traditional
  • Allows full visualization of distal femur
  • Uses existing instruments with only a few changes
  • Requires little additional training
  • Can address more severe pathology
24
Q

The Mini TKA Disadvantages

Comparing to MIS Quad Sparing

A
  • More traumatic than MIS-QS
  • Deters aggressive rehab
  • Additional training/experience needed to address wide range of pathologies
  • Quadriceps cut
25
Q

MIS Quad Sparing TKA Advantages

Comparing to the Mini TKA

A
  • Less traumatic to tissue
  • More rapid recovery
  • New instrumentation can easily transition between types of TKA surgeries
  • With training and experience can address large range of pathologies
26
Q

MIS Quad Sparing TKA Disdvantages

Comparing to the Mini TKA

A
  • More challenging approach than traditional
  • Limited femur visualization
  • Requires new instruments and some freehand cutting
  • Requires extensive skill
  • Cannot address severe pathology
27
Q

What are the goals of MIS-QS?

A
  • Minimize surgical trauma
  • Minimize blood loss
  • Maximize analgesia before, during and after operation
  • Rigid implant fixation

-All of these factors should facilitate early and aggressive rehab

28
Q

Expected Outcomes by Technique- Open TKA

A

Exposure: 20-30 cm
Quad incision
Patella everted

Rehab: Mobilization
PROM- PT

LOS: 3-5 days

Other: Blood loss
Morbidity risk
Length rehab

29
Q

Expected Outcomes by Technique- Mini

A

Exposure: 12-14 cm
2 cm quad split
Avoid patella tension

Rehab: Mobilization
PROM- PT
Flex 90 by day 3

LOS: Less than 3 days

Other: Less blood loss
Earlier SLR
Earlier amb

30
Q

Expected Outcomes by Technique- MIS QS

A

Exposure: 8-12 cm
Quad spared
No patella eversion

Rehab: Early mobilization
Flex 90 on surgery day

LOS: 1-2 days

Other:
Minimal blood loss
Earlier flexion
Amb on surgery day

31
Q

Indications for MIS- QS

A

-Mild/moderate OA
-No large bone defects
-No severe instability or contracture issues
>Flexion contracture less than 10 degrees
-No severe bony misalignments
-ROM of greater than 90 degrees
-Fixed varus less than 10 degrees or valgus less than 15 degrees

32
Q

Contraindications for MIS QS

A
  • Large fixed deformity
  • Obesity
  • Inflammatory arthritis
  • Multiple open knee surgeries
  • Arthrofibrosis
  • Heavily muscled
  • Large bones, patellae or muscles
  • Multiple comorbidities
  • Deficient/scarred skin
  • Severe DM or steroid use
  • Minimal retained hardware
  • Extreme sizes or unusual mismatch of sizes
  • Patella baja
33
Q

Who should get a MIS-QS?

A 
-Young, active, motivated patients
   >Patient needs to be able to do an independent rehab program
-Older patients
   >May benefit from less trauma
-Males
   >Less than 250 lbs
-Females
  >Less than 225 lbs

PTA Ortho: Exam 1 (16 decks)

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