Ortho Part 2 Flashcards
what two things indicate a joint arthroplasty?
functional mobility loss and degenerative arthritis
what percentage is associated with PWB
20-50%
what is the ROM of the knee
130-140 - 0 - 10
what knee ROM is needed to ascend stairs?
0 - 83
what knee ROM is needed to descend stairs
0 - 90
what knee ROM is needed for normal gait
0 - 67
what knee ROM is need to tie shoes?
0 - 106
which TKA approach leads to post op quad inhibition?
medial parapatellar approach
what are two major surgical complications specific to TKA (hint: infection is not one of them in this case)
intercondylar fracture and peroneal nerve injury (foot drop)
what are expected outcomes for discharge to home following a TKA
- HEP independence
- safety in household mobility
- knowledgeable about precautions
- 0 - 90 flexion
when is a posterior extension splint used for a TKA patient? when is it DC?
when OOB and during WB activities until quad control is reestablished
what are the holy trinity of post op precautions following TKA?
- avoid agressive flexion ROM
- avoid SLR in SL
- avoid pillow under the knee
why do you avoid aggressive flexion ROM post op TKA?
excessive tension can open incision site
why do you avoid SLR in SL post op TKA?
varus/valgus stress to operated knee
where do you recommend a pillow under an elevated TKA extremity to minimize knee flexion contracture?
under the calf
what two activities for TKA patients reduce the risk of CVP complications post op?
incentive spirometry and ankle pumps
relative to 100% pre op, how would you rate 1 month post op quad strength (despite PT 24 hours after surgery)
60% 1 month post op
what provides the greatest benefit to strength and function 48 hours post op TKA?
NMES to quads 2x/day 48 hours post op
when can you start stretching following TKA?
immediately, but be wary of incision site closure
how much hip flexion is needed for sitting on an average seat
112
how much hip flexion is needed to ascend stairs? descend?
up: 67
down: 36
what hip ROM is needed for normal gait
30-40 flexion
10 extension
5 abd/add/IR/ER
how does the surgeon access the hip joint in a posterolateral approach
split the glute max, ERs reflected
what are the posterolateral hip precautions
for a minimum of 6 weeks
- no flexion >90
- no IR past neutral
- no adduction past neutral
- avoid trunk twists
how does the surgeon access the hip join in an anterolateral approach
between TFL and glute med, fascia latae and vastus lateralis dissected at origin
what are the anterolateral hip precautions
for a minimum of 8 weeks
- no extension past neutral
- no bridging
- no prone
- no hip extension plus ER
what are additional anterolateral hip precautions that are surgeon dependent?
for 6-8 weeks:
- no active abduction
- no hip flexion >90
- no crossing legs (adduction or trunk twists)
what are the anterior hip precautions
generally, there are no hip precautions for the anterior approach
what are precautions following a trochanteric osteotomy
for 8 weeks:
- no active/resisted abduction
- restricted WB
what are three common intraoperative complications specific to a THA
- malpositioning of components
- femoral or acetabular fx
- sciatic nerve injury
when do THA dislocations most likely occur?
first 2-3 months post op
in the first six weeks, the femoral head is only held in position by what two things
muscle tension and scar tissue formation
what are the signs of THA dislocation (which is most important - put in all caps)
- excessive pain with motion
- abnormal or limited IR/ER
- LIMB SHORTENING
- abnormal WB
what percentage of SLS load is relieved by a contralateral cane?
60%
unsupported one-legged stance produces loads of body weight across the hip
4-7x
walker/cane supported one-legged stance produces loads of body weight across the hip
2-3x
supine SLR produces loads of body weight across the hip
> 3x
rising from a low chair produces loads of body weight across the hip
8x
what are the expected outcomes following a THA to DC home?
- independence with HEP
- safe household mobility
- understands precautions
what is the holy trinity of post THA treatment precautions
- avoid max isometrics of extensors and abductors
- avoid SLR
- use hip abduction pillow
what activities can reduce CVP complications risk?
ankle pumps and incentive spirometry
what strengthening exercises should you employ post op THA? avoid?
pro: submax isometric quad and glute sets
con: SLR
what RFs increase risk for post TKA/THA infections
- immune deficient/compromised
- DM
- PVD
- oooooobesity
exhaustive list of sxs of an infected joint
redness, warmth, swelling, stiffness, drainage, fever, chills, night sweats, fatigue
how do infections resolve?
IV antibiotics, debridement, staged surgery
how does THA/TKA infection debridement work
contaminated tissue removed, all parts thoroguhly cleaned, IV antibiotics for 6 weeks
what is stage 1 of staged surgery for post op infection
remove the joint, wash out joint and soft tissues, place an antibiotic spacer, IV antibiotics
what is stage 2 of staged surgery for post op infection
remove antibiotic spacer and get replacement parts
what are rehab considerations for debridement following a post op infection
WBAT, pain/edema limit ROM and mobility, SEE THE PATIENT ONCE PER DAY, usually longer stay
what are rehab , for staged surgery following a post op infection
WBAT, pain/edema limit ROM and mobility, SEE THE PATIENT TWICE PER DAY, usually longer stay, NO KNEE FLEXION PAST 90 FOR ANTIBIOTIC SPACER
what are precautions for antibiotic knee spacers
if in the knee, no flexion past 90
