OA and Surgical Repair of KaNee Flashcards
What surfaces are involved with OA?
the 3 compartments (medial, lateral and patellofemoral)
What are the subjective findings of OA?
- insidous onset of pain/stiffness
- pain with WB
- complaints of buckling, locking or giving away
- hard time climbing or descending stairs
What are the objective findings of OA?
- angular deformity thru knee
- effusion
- tenderness along joint lines
- loss of AROM in capsular pattern
What is the prognosis of OA?
a progressive condition
- can be controlled with external forces
- severe functional limits and pain at rest or at night = surgery needed !!!
What is stage 1 of OA?
min disruption
already 10% cartilage loss
What is stage 2 of OA
joint space is narrowing
cartilage is starting to break down
occurence of osteophytes
What is stage 3 of OA?
Mod joint space reduction
Gaps in the cartilage can exand till they reach bone
What is stage 4 of OA?
joint space madly reduced
60% of cartilage already lost
large osteophytes
What is the clinical diagnosis of knee OA?
- over 50 y/o
- stiffness over 30 min
- crepitus
- bony tenderness
- bony enlargement
- no palpable warmth
What is the sensitivity and specificity if there’s 3 or more clinical dx?
sensitivity - .95
specificity - .69
What are the lifestyle management of OA?
- weight loss
- exercise program
- ambulatory assist devices
- insoles
- unloaders
What is the exercise program for OA?
- PT referral
- quads strength
- ROM exercises
- low impact
What are the different unloaders for OA?
varus - bowlegged
valgus - knock kneed
What is the biomechanics of an unloader?
- energy storage and BW support during grav assisted knee flexion
- that energy returned to body during antigrav motion
What does literature say regarding the brace models for OA?
Reduced predicted knee joint loads (by 30-50%) across all structures
- at knee flexion angles > around 30 deg during DKB
What are the medical managemeent for OA?
- glucosamine/chondroitin
- acetaminophen
- NSAIDs
- Cox-2 inhibitors
- intraarticular injections (glucocorticoids and hyaluronans)
What is the classifications for unicompartmental knee replacement?
- arthritis in only 1 compartment of knee
- either young or old
- ligaments are intact
- no systemic disease
- weight over 200
- occupation
What is the kinematic advantages of unicompartmental surgery?
better because of the cruciate ligameents are retained
What is the ROM advantages of unicompartmenetal surgery?
Better ROM or ROM retention
What is the functional advantages of unicompartmenetal surgery?
better function especially with stairs
What is the overall advantages of unicompartmenetal surgery?
- decreased pain
- complications are less often and severe
- recovery is more rapid
- lower cost
What does anatomical surfaces TKA adjust?
- tibia
- femur
- patella
What is the process of TKA?
components are fixed to the bone with “cement”
Traditional approach has 20-30cm incision (zipper)
Why is the TKA minimally invasive?
- earlier mobilization
- less pain
- cost
- shorter hospital stays
- quicker rehab
- less blood loss
