Ortho- Post OP

Question 1

_ _ is recommended 6 weeks prior to surgery

Answer 1

Smoking cessation

Question 2

After hip replacement WBC levels will be? Tx is?

Answer 2

Will be above 11K (is a normal inflammatory response)- leukocystosis

Treatment is still indicated

Question 3

Risk of DVT post op peaks at? (Time frame) Risk remains high?

Answer 3

Peaks at 2-3 weeks

Risk remains high 3 mos post op

Question 4

Post surgery you should never underestimate the? Always use?

Answer 4

Never underestimate the surgical stress response

Always use gait belt or have a second person on hand

Question 5

_ affects PT intervention in post-op patients. Should know?

Answer 5

Anesthesia

Should know what type was used

Question 6

A _ is a one time shot of anesthesia that lasts - hours. It is injected into the? Requires a _ _ hospital stay. Often used in?

Answer 6

Spinal, lasts for 24-48 hours

It is injected into the subarachnoid space/ CSF at L3-4

Requires min 24 hour hospital stay

Often used for LE surgeries

Question 7

What are the 4 side effects of spinal?

Answer 7

P III

Pruritis
Itchiness
Increased hypotension
Increased urinary retention

Question 8

3 common types of canal/ nerve blocks?

Answer 8

Femoral Nerve block

Adductor canal block

Inter scalene block

Question 9

With a femoral nerve block patient will have decreased _ strength, and an increased?

Answer 9

Decreased quad strength

Increased fall risk

Question 10

With a adductor canal block which nerve is targeted? Primarily a _ block, spares? Reduced? Time frame?

Answer 10

Saphenous nerve block

Primarily a sensory block, spares motor control of the quads

Reduced fall risk

Lasts 12=24 hours

Question 11

An interscalene block affects the _ _. Is contraindicated for patients with _ _ function because it can affect the _. Lasts?

Answer 11

Affects the brachial plexus

Is contraindicated in patients with decreased respiratory function because it can affect the diaphragm

Lasts 12-24 hours

Question 12

Which type of injection/ anesthesia is often injected into the posterior capsule, collateral ligaments, quads, pes anserinus, Anteromedial capsule, periosteum, IT band and subcutaneous tissue of the knee? AKA? Consists of?

Answer 12

Local infiltrate anesthesia (LIA)

AKA: peri-articular injection

Consists of a cocktail of drugs

Question 13

LIA is not used in the _ knee, but can still _ _ _ causing?

Answer 13

Not used in the posterolateral knee, but can still bathe the Peroneal nerve and cause foot drop

Question 14

Patients with a TKA are typically _ with no _ precautions. Should avoid _ stress and watch for _ _. Position used post surgery? Why?

Answer 14

Typically FWB (day of surgery) with no ROM precautions

Should avoid valgus stress and watch for genu recurvatum

90/90 position is used 18-24 hours post surgery, helps reduce/ prevent swelling and bleeding post surgery

Question 15

Absent heel strike, hip hike/ hip Abd, foot drop, and shorter stride on uninvolved side are common?

Answer 15

Gait deviations seen post TKA

Question 16

TKA patients: goal of full AROM within? Kneeling usually after? _ _ for complete recovery. Should avoid?

Answer 16

Full AROM within 3 months

Kneeling usually after 9 months

Full year for complete recovery

Should avoid propping knee up with pillows

Question 17

What is the primary elevator of the arm in a reverse TSA?

Answer 17

Deltoid becomes primary elevator (instead of RC muscles)

Question 18

Precautions with TSA?

Answer 18

No lifting

Question 19

Precautions with reverse TSA (3)?

Answer 19

No ER past 20 degrees

PWB only, do not push up onto elbow (in affected UE)

Keep hands in front of you/ in sight

Question 20

What is the difference in WB status for a patient who had THA using cemented vs. uncemented procedure?

Answer 20

Cemented- FWB

Uncemented- PWB

Question 21

Advantages of anterior approach for THA: _ sparing, easier _, reduced chance of _ and more accurate control of _ _.

Answer 21

Muscle sparing
Easier recovery (less blood loss/ pain)
Reduced change for dislocation
More accurate control of leg length

Question 22

Disadvantages with anterior approach THA: more difficult _ _, over traction can cause _ _ _. Is avoided in patients with _, due to increased risk of _, and patients who already have significant _ _ _.

Answer 22

More difficult for surgeon
Over traction can cause femoral nerve palsy

Is avoided in patients with pannus (large gut) due to increased risk of infection, and patients who already have significant hip flexion contractures

Question 23

With anterior approach there is no _, because _ _ is not affected. Full _ and _ _ can occur more quickly.

Answer 23

No limping, because gluteus medius is not affected

Full ROM and weight bearing more quickly

Question 24

2 precautions for anterior approach THA?

Answer 24

No hip hyperextension

Avoid hip ER

Question 25

With posterior approach to THA surgeon _ _, usually through _ _. Greater risk of _. Preserves _ _, and offers good exposure _ _.

Answer 25

Surgeon splits muscle, usually through gluteus Maximus

Greater risk of dislocation

Preserves abductor function

Offers good exposure to femur and acetabulum for surgeon

Question 26

3 precautions with posterior approach THA?

Answer 26

No hip flexion past 90 degrees (no soft sofa sitting- must add pillows to chair or couch)

Avoid IR

No adduction past midline

Question 27

The _ _ to THA is not as common. Incision occurs through _. Greater risk of post op _ and _ _.

Answer 27

Lateral approach not as common

Incision occurs through TFL

Greater risk of post-op limp and trendelenburg gait

Question 28

What are 3 common impairments seen post op with hip replacement surgery?

Answer 28

Flexion contracture

Abduction contracture

Abductor weakness

Question 29

Strict indications for spinal surgery: _ pain, _ symptoms, _, and progression of _.

Answer 29

Intractable pain

Neuro symptoms

Claudication

Progression of slippage

Question 30

What are 3 signs of spinal cord compression?

Answer 30

Positive babinski

Positive Hoffman’s

Clonus

Question 31

_ _ syndrome is considered a neurological emergency, resulting in _ disturbances, LE _ and loss of _, saddle _, and loss of _ and _ control

Answer 31

Cauda Equina Syndrome

REsulting in gait disturbances, LE weakness and loss of reflexes, saddle anesthesia and loss of bowel and bladder control.

Question 32

Severe postural headache, photophobia*, nausea and vomitting are all signs of a _ _. Notify _, occurs in approximately -% of lumbar surgeries.

Answer 32

All signs of a dural tear

Notify surgeon, occurs in approximately 5-14% of lumbar surgeries

Question 33

With a dural tear patient is on strict bed rest for _ - _ _. _ is ok, but no _ for 36 hours.

Answer 33

Strict bed rest 24-48 hours

Rolling is okay, but no sitting for 36 hours