PT Management of Knee OA

Question 1

What are pathological characteristics of knee OA?

Answer 1

erosion of articular cartilage, sclerosis or bone underneath cartilage, formation of osteophytes

Question 2

What is a typical knee OA pt demographic?

Answer 2

mostly over age 65, usually more load on medial compartment of knee

Question 3

What is clinical criteria for knee OA?

Answer 3

knee pain, crepitus with AROM, morning stiffness more than 30 minute, bony enlargement

Question 4

What is typical subjective history for knee OA pt?

Answer 4

insidious onset, progressively worsens, stiffness after immobility, history of past knee trauma (ACL)

Question 5

What is classification scale of knee OA based on radiology?

Answer 5

minimal- no narrowing
mild- loss of 1/3 jt space
mod- loss of 2/3 joint space
severe- bone to bone

Question 6

What is important to remember for PT exam for knee OA?

Answer 6

test uninvolved first, AROM then passive then resisted motion (most painful last),

Question 7

What is important to remember about knee swelling?

Answer 7

it can cause quad inhibition so in order to maximize strength must minimize swelling

Question 8

What are basic knee OA tx principles?

Answer 8

soft tissue healing, control pain and swelling, early controlled ROM, CV training, proprioceptive training prevent muscle atrophy and promote neuromuscular control

Question 9

Besides strength training what is another effective mode of exercise for knee OA?

Answer 9

aerobic training- bike can bet great as it promotes ROM and is not as tough weight bearing on joint

Question 10

What ranges should you avoid during OKC and CKC exercises for knee OA?

Answer 10

OC- 90 to 40 degrees
CC- 0-60

to avoid retropatellar joint reaction forces

Question 11

What is return to sport criteria for knee OA?

Answer 11

120 degrees AROM, normal gait and run pattern, stairs with no pain

Question 12

Which type of injection is better in the short term vs long term?

Answer 12

short term- cortisone due to greater effect in reducing pain

long term- hyaluronan

Question 13

When would a chondroplasty or arthroplasty be indicated for knee OA?

Answer 13

if there is also a menisci tear/loose bodies in joint and if pt complains of catching and locking

Question 14

What is rehab for chondroplasty or arthroplasty ?

Answer 14

restore ROM and quad hip strength

Question 15

When would an osteotomy be indicated?

Answer 15

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

Question 16

What is rehab for osteotomy?

Answer 16

long and painful, TDWB 4-8 weeks, PWB 2-4 weeks after can’t start PT for 6-8 weeks as healing is needed

Question 17

What is the most common type of TKR?

Answer 17

cemented, most common and stable

Question 18

What is WB status for cemented vs uncemented?

Answer 18

cemented- immediate WB

uncemented/hybrid- TDWB or PWB for up to 6 weeks

Question 19

What are principals of outpatient rehab for TKR?

Answer 19

ROM and Strength, scar mob, patella mobs, fine tune gait, aerobic exerise

Question 20

Can you perform mobs after a TKR?

Answer 20

need op report, if sewn then only after 12 weeks , if not sewn then NO

always can do patella mobs tho

Question 21

What are common complications from a TKR?

Answer 21

excessive blood loss, DVT, Infxn, arthrofibrosis, failure

Question 22

What is osteolysis?

Answer 22

wear and tear of polyethylene component causes debris to break off and be absorbed into surrounding bone tissue causing inflammation

Question 23

What is a partial knee replacement?

Answer 23

unicondylar replacement, used for only one compartment of Knee OA

favorable results so far

Question 24

What is post op rehab for partial KR?

Answer 24

WBAT right away, most return to ADL’s within 4 weeks