LE Orthopedics

Question 1

Challenges due to chronic orthopedic disability (address with OT):

Answer 1

• Disease of a body part
• Fear/Anxiety
• Change in body image
• Decreased functional ability
• Joint deformity
• Pain

Question 2

Hip Precautions – Posterolateral Approach

Answer 2

6 to 8 weeks:
• No hip flexion greater than 90˚
• No internal rotation
• No adduction (crossing legs or feet)

Question 3

Hip Precautions – Anterolateral Approach

Answer 3

6-8 weeks:
• No external rotation
• No adduction (crossing legs or feet)
• No extension
• Abduction may also be prohibited

Question 4

Biologic Fixation

Answer 4

Use of bony in-growth instead of cement to fix the prosthesis. Used in younger people; increases the strength of the fixation and decreases possibility of loosening. Identical precautions to cemented method, but may involve additional weightbearing restrictions.

Question 5

Unicompartmental Knee Arthroplasty (UKA)

Answer 5

Partial knee replacement. Indicated if there is medial or lateral compartmental damage between the femur/tibia. Often placed with minimally invasive technique, allowing greater knee flexion (up to 90˚) more quickly after surgery. Increased stability obtained immediately due to limited disruption to ligaments and joint structures.

Question 6

Total Knee Arthroplasty (TKA)

Answer 6

Total knee replacement. Indicated when two or more compartments of the knee are damaged. Various prosthetics based on medical condition/activities performed by client.
• FIXED WEIGHT-BEARING: allows only flexion/extension
• ROTATING PLATFORM/MOBILE WEIGHT-BEARING: allows slight rotation normally available in knee (for younger, more active people or women; more risk of mechanical failure)

Question 7

Precautions for Knee Replacement

Answer 7

• Start out-of-bed activities first day after surgery
• Ambulatory device may be used for greater stability
• May use knee immobilizer/brace to preserve alignment if joint is unstable
• Avoid excessive rotation for up to 12 weeks
• No restriction on flexion/extension; maintains mobility
• May use continuous passive motion (CPM) device to provide slow movement to improve ROM and reduce edema
• Avoid rotation of knee while weightbearing on it
• Avoid prolonged static positioning (standing/sitting) of knee
• Refrain from kneeling

Question 8

Bed Mobility post Knee Replacement

Answer 8

• No restrictions that dictate bed mobility procedures
• Supine position most recommended, with knee fully extended (encourages full extension required for ambulation)
• May put bolster under knee for pain control
• Pillow/wedge can be used when side-lying on non-op side