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Acute Care Module 1 > Ortho Part 2 > Flashcards

Ortho Part 2 Flashcards

1
Q

what two things indicate a joint arthroplasty?

A

functional mobility loss and degenerative arthritis

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2
Q

what percentage is associated with PWB

A

20-50%

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3
Q

what is the ROM of the knee

A

130-140 - 0 - 10

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4
Q

what knee ROM is needed to ascend stairs?

A

0 - 83

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5
Q

what knee ROM is needed to descend stairs

A

0 - 90

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6
Q

what knee ROM is needed for normal gait

A

0 - 67

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7
Q

what knee ROM is need to tie shoes?

A

0 - 106

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8
Q

which TKA approach leads to post op quad inhibition?

A

medial parapatellar approach

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9
Q

what are two major surgical complications specific to TKA (hint: infection is not one of them in this case)

A

intercondylar fracture and peroneal nerve injury (foot drop)

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10
Q

what are expected outcomes for discharge to home following a TKA

A
  1. HEP independence
  2. safety in household mobility
  3. knowledgeable about precautions
  4. 0 - 90 flexion
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11
Q

when is a posterior extension splint used for a TKA patient? when is it DC?

A

when OOB and during WB activities until quad control is reestablished

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12
Q

what are the holy trinity of post op precautions following TKA?

A
  1. avoid agressive flexion ROM
  2. avoid SLR in SL
  3. avoid pillow under the knee
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13
Q

why do you avoid aggressive flexion ROM post op TKA?

A

excessive tension can open incision site

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14
Q

why do you avoid SLR in SL post op TKA?

A

varus/valgus stress to operated knee

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15
Q

where do you recommend a pillow under an elevated TKA extremity to minimize knee flexion contracture?

A

under the calf

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16
Q

what two activities for TKA patients reduce the risk of CVP complications post op?

A

incentive spirometry and ankle pumps

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17
Q

relative to 100% pre op, how would you rate 1 month post op quad strength (despite PT 24 hours after surgery)

A

60% 1 month post op

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18
Q

what provides the greatest benefit to strength and function 48 hours post op TKA?

A

NMES to quads 2x/day 48 hours post op

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19
Q

when can you start stretching following TKA?

A

immediately, but be wary of incision site closure

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20
Q

how much hip flexion is needed for sitting on an average seat

A

112

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21
Q

how much hip flexion is needed to ascend stairs? descend?

A

up: 67
down: 36

22
Q

what hip ROM is needed for normal gait

A

30-40 flexion
10 extension
5 abd/add/IR/ER

23
Q

how does the surgeon access the hip joint in a posterolateral approach

A

split the glute max, ERs reflected

24
Q

what are the posterolateral hip precautions

A

for a minimum of 6 weeks

  1. no flexion >90
  2. no IR past neutral
  3. no adduction past neutral
  4. avoid trunk twists
25
Q

how does the surgeon access the hip join in an anterolateral approach

A

between TFL and glute med, fascia latae and vastus lateralis dissected at origin

26
Q

what are the anterolateral hip precautions

A

for a minimum of 8 weeks

  1. no extension past neutral
  2. no bridging
  3. no prone
  4. no hip extension plus ER
27
Q

what are additional anterolateral hip precautions that are surgeon dependent?

A

for 6-8 weeks:

  1. no active abduction
  2. no hip flexion >90
  3. no crossing legs (adduction or trunk twists)
28
Q

what are the anterior hip precautions

A

generally, there are no hip precautions for the anterior approach

29
Q

what are precautions following a trochanteric osteotomy

A

for 8 weeks:

  1. no active/resisted abduction
  2. restricted WB
30
Q

what are three common intraoperative complications specific to a THA

A
  1. malpositioning of components
  2. femoral or acetabular fx
  3. sciatic nerve injury
31
Q

when do THA dislocations most likely occur?

A

first 2-3 months post op

32
Q

in the first six weeks, the femoral head is only held in position by what two things

A

muscle tension and scar tissue formation

33
Q

what are the signs of THA dislocation (which is most important - put in all caps)

A
  1. excessive pain with motion
  2. abnormal or limited IR/ER
  3. LIMB SHORTENING
  4. abnormal WB
34
Q

what percentage of SLS load is relieved by a contralateral cane?

A

60%

35
Q

unsupported one-legged stance produces loads of body weight across the hip

A

4-7x

36
Q

walker/cane supported one-legged stance produces loads of body weight across the hip

A

2-3x

37
Q

supine SLR produces loads of body weight across the hip

A

> 3x

38
Q

rising from a low chair produces loads of body weight across the hip

A

8x

39
Q

what are the expected outcomes following a THA to DC home?

A
  1. independence with HEP
  2. safe household mobility
  3. understands precautions
40
Q

what is the holy trinity of post THA treatment precautions

A
  1. avoid max isometrics of extensors and abductors
  2. avoid SLR
  3. use hip abduction pillow
41
Q

what activities can reduce CVP complications risk?

A

ankle pumps and incentive spirometry

42
Q

what strengthening exercises should you employ post op THA? avoid?

A

pro: submax isometric quad and glute sets
con: SLR

43
Q

what RFs increase risk for post TKA/THA infections

A
  1. immune deficient/compromised
  2. DM
  3. PVD
  4. oooooobesity
44
Q

exhaustive list of sxs of an infected joint

A

redness, warmth, swelling, stiffness, drainage, fever, chills, night sweats, fatigue

45
Q

how do infections resolve?

A

IV antibiotics, debridement, staged surgery

46
Q

how does THA/TKA infection debridement work

A

contaminated tissue removed, all parts thoroguhly cleaned, IV antibiotics for 6 weeks

47
Q

what is stage 1 of staged surgery for post op infection

A

remove the joint, wash out joint and soft tissues, place an antibiotic spacer, IV antibiotics

48
Q

what is stage 2 of staged surgery for post op infection

A

remove antibiotic spacer and get replacement parts

49
Q

what are rehab considerations for debridement following a post op infection

A

WBAT, pain/edema limit ROM and mobility, SEE THE PATIENT ONCE PER DAY, usually longer stay

50
Q

what are rehab , for staged surgery following a post op infection

A

WBAT, pain/edema limit ROM and mobility, SEE THE PATIENT TWICE PER DAY, usually longer stay, NO KNEE FLEXION PAST 90 FOR ANTIBIOTIC SPACER

51
Q

what are precautions for antibiotic knee spacers

A

if in the knee, no flexion past 90

Acute Care Module 1 (6 decks)

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