PT Management of Knee OA Flashcards
What are pathological characteristics of knee OA?
erosion of articular cartilage, sclerosis or bone underneath cartilage, formation of osteophytes
What is a typical knee OA pt demographic?
mostly over age 65, usually more load on medial compartment of knee
What is clinical criteria for knee OA?
knee pain, crepitus with AROM, morning stiffness more than 30 minute, bony enlargement
What is typical subjective history for knee OA pt?
insidious onset, progressively worsens, stiffness after immobility, history of past knee trauma (ACL)
What is classification scale of knee OA based on radiology?
minimal- no narrowing
mild- loss of 1/3 jt space
mod- loss of 2/3 joint space
severe- bone to bone
What is important to remember for PT exam for knee OA?
test uninvolved first, AROM then passive then resisted motion (most painful last),
What is important to remember about knee swelling?
it can cause quad inhibition so in order to maximize strength must minimize swelling
What are basic knee OA tx principles?
soft tissue healing, control pain and swelling, early controlled ROM, CV training, proprioceptive training prevent muscle atrophy and promote neuromuscular control
Besides strength training what is another effective mode of exercise for knee OA?
aerobic training- bike can bet great as it promotes ROM and is not as tough weight bearing on joint
What ranges should you avoid during OKC and CKC exercises for knee OA?
OC- 90 to 40 degrees
CC- 0-60
to avoid retropatellar joint reaction forces
What is return to sport criteria for knee OA?
120 degrees AROM, normal gait and run pattern, stairs with no pain
Which type of injection is better in the short term vs long term?
short term- cortisone due to greater effect in reducing pain
long term- hyaluronan
When would a chondroplasty or arthroplasty be indicated for knee OA?
if there is also a menisci tear/loose bodies in joint and if pt complains of catching and locking
What is rehab for chondroplasty or arthroplasty ?
restore ROM and quad hip strength
When would an osteotomy be indicated?
unicompartment of knee OA, patients considered too young for TKA
it removes or adds wedge of bone to tibia or femur which changes forces to preserve cartilage
What is rehab for osteotomy?
long and painful, TDWB 4-8 weeks, PWB 2-4 weeks after can’t start PT for 6-8 weeks as healing is needed
What is the most common type of TKR?
cemented, most common and stable
What is WB status for cemented vs uncemented?
cemented- immediate WB
uncemented/hybrid- TDWB or PWB for up to 6 weeks
What are principals of outpatient rehab for TKR?
ROM and Strength, scar mob, patella mobs, fine tune gait, aerobic exerise
Can you perform mobs after a TKR?
need op report, if sewn then only after 12 weeks , if not sewn then NO
always can do patella mobs tho
What are common complications from a TKR?
excessive blood loss, DVT, Infxn, arthrofibrosis, failure
What is osteolysis?
wear and tear of polyethylene component causes debris to break off and be absorbed into surrounding bone tissue causing inflammation
What is a partial knee replacement?
unicondylar replacement, used for only one compartment of Knee OA
favorable results so far
What is post op rehab for partial KR?
WBAT right away, most return to ADL’s within 4 weeks
