S/P Hip & Knee Arthroplasty & Spinal Surgery

Question 1

posterior hip precautions (3)

Answer 1

1. no hip FLEXion (90+)
2. no hip internal rotation
3. no hip ADDuction beyond neutral (no crossing legs)

Question 2

anterior hip precautions (3)

Answer 2

1. ho hip EXTENSion
2. no hip external rotation beyond neutral
3. no hip ABDuction

Question 3

back precautions

Answer 3

1. no bending
2. no twisting
3. specific limits on how much they can lift
   - stand smart
   - sit smart
   - lift smart

Question 4

weight-bearing precautions

Answer 4

• FWB – 100% weight
• NWB – 0% weight
• PWB – 1-50% weight
• TDWB – foot touch 0%
  weight
• TTWB – toe touch 0%
  weight
• WBAT – to client pain
  tolerance or strength

Question 5

TLSO means:

Answer 5

thoracolumbosacral orthosis

Question 6

spinal fusion

Answer 6

surgery to join, or fuse, two or more vertebrae so there is no movement between them

Question 7

laminectomy

Answer 7

decompression surgery that enlarges the spinal canal to relieve pressure on the spinal cord or nerves (by removing the lamina)

Question 8

foraminotomy

Answer 8

decompression surgery that is performed to enlarge the foramen

Question 9

discectomy

Answer 9

removal of herniated disc material that is pressing on a nerve root or the spinal cord

Question 10

artificial disc replacement

Answer 10

intervertebral disc in the spine is replaced with a mechanical device; helps to restore motion to the spine; newer procedure

Question 11

interlaminar implant

Answer 11

u-shaped implant that fits between the spinous processes located in the lumbar region of the spine; maintains a fixed distance between the spinous processes to support and stabilize without a reduction in the ROM

Question 12

kyphoplasty

Answer 12

procedure used to treat compression fractures of the spine; space is created in a compressed or collapsed vertebrae with a balloon-type device; once fractured bone pieces are in more of a normal position, cement is injected to restore the damaged vertebrae height with goal to relieve pain

Question 13

common hip problems

Answer 13

• osteoarthritis
• rheumatoid arthritis
• avascular necrosis
• fractures

Question 14

common knee problems

Answer 14

• osteoarthritis
• rheumatoid arthritis
• post-traumatic arthritis

Question 15

general orthopedic considerations

Answer 15

• post-surgical complications (DVT, infection)
• safety (low hemoglobin, orthostatic hypotension)
• fall prevention
• debility
• pain
• cognition (temporary, underlying confusion)
• psychosocial impact
• occupational performance

Question 16

main goal for S/P knee surgery

Answer 16

keep the knee moving!!
- consider weight-bearing status
- knee rotation avoided for up to 12 weeks
- may use a knee immobilizer for bed mobility and ambulation to support the knee
- bilateral knee replacements complicate rehab process

Question 17

causes of back pain

Answer 17

• bone spurs
• herniated/ degenerative discs
• arthritis/ ankylosing spondylitis
• fractures
• facet joint problems
• osteomyelitis
• spinal stenosis
• spondylolisthesis
• herniated/ ruptured disc
• disc degeneration

Question 18

neurological symptoms of back pain

Answer 18

• radiculopathy
• sciatica

Question 19

spine (pelvis) interventions

Answer 19

main focus: education & adaptation
- back precautions
- body mechanics
- log rolling techniques
- donning/ doffing TLSO
- sit on higher surfaces with arms
- raised toilet seat
- shower chair
- other AE

Question 20

hip surgery facts to know

Answer 20

• ORIF (open reduction internal fixation)
• THA (posterior, anterior, lateral)
• hemiarthroplasty
• revision surgery

Question 21

back pain classification

Answer 21

• acute
• subacute
• chronic

Question 22

knee surgery facts to know

Answer 22

• TKR/TKA
• partial knee replacement
• knee resurfacing

Question 23

knee surgery interventions

Answer 23

• keep moving joint
• ADLs
• functional mobility
• AE (may be limited by MD to encourage ROM)

Question 24

aquatic therapy can be used to increase or decrease the demand on muscles:

Answer 24

• muscle strength
• muscle tone
• weight-bearing
• joint pain
• joint flexibility
• balance
• healing
• sensory-perceptual