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Gen Med > THA/TKA > Flashcards

THA/TKA Flashcards

1
Q

common post op issues

A 
altered level of consciousness
generalized weakness
hypotension
depressed respirations
decreased Hgb
bleeding at surgical site
DVT/PE
nausea, vomiting, dizziness
urinary retention/constipation
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2
Q

hip surgical procedures

A

ORIF hardware
hemiarthroplasty - usually femoral head, bipolar prosthesis
both - THA and THR

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3
Q

ORIF

A

open reduction, internal fixation
commonly used after fall fx
typically NWB, sometimes 50% WB
location of break determines approach used

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4
Q

common indications for hip replacement

A 
OA (most common)
RA
avascular necrosis of femoral head
injury to hip
bone tumor in hip 
little to no response to conservative treatment
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5
Q

cemented THA

A

provides immediately stability
often WBAT/FWB for amb.
generally used for older/less active ptr or w/ poor bone regeneration

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6
Q

cemented THA disad

A

loosens over time and w/ activity

loosens over time and w/ activity

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7
Q

non cemented THA

A 
prosthesis have aprons metal coat on contact surfaces w/ a chem (hydroxyapatite) to promote bony ingrowth
-often NWB/TTWB
generally a younger, active population
pts w/ good bone regeneration
less chance of loosening from wear
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8
Q

hybrid THA

A

non cemented acetabular component w/ cemented femoral prosthesis
WB status per MD

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9
Q

the most sig risk of THA pts in acute

A

dislocation

rates increase if it is a revision surgery

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10
Q

posterolateral/posterior

A

most common appraoch

  1. no hip flexion past 90
  2. no IR beyond neutral
  3. no hip add past neutral
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11
Q

lateral

A

same as posterolateral

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12
Q

anterior

A
  1. avoid hip extension past neutral
  2. no excessive ER

if trochanteric osteotomy performed, no active hip abduction or passive adduction along w/ WB restriction

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13
Q

total hip precautions

A
  • high remains at high risk for dislocation until joint structures heal and supporting muscles are strengthened
  • signs of dislocatoin
  • precautions remain til cleared by MD
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14
Q

eval of pt w/ THA pt 1

A
  • thorough chart review - md orders, tests, hx, op report, lab values meds
  • check w/ nursing- pt status, meds, clear for Rx
  • prep for rx - w/c, AD, hospital socks, gown, oxygen
  • subjective questioning- assess cognition, PLF, home set up, pt goals
  • education re: precautions and there ex
  • ROM w/in precautions
  • Strength - BUE, uninvolved LE
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15
Q

eval of pt w/ THA pt 2

A
  • mobility to EOB
  • sitting at EOB
  • transfers
  • gait when appropriate w/ AD
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16
Q

acute

A
  • abduction wedge
  • drainage tube
  • foley catheter
  • TED hose/sequential compression pumps
  • bedside/3-in-1 commode
  • knoww immobilizer
  • initially, use assist as needed
  • abduction brace
  • care transfers for discharge
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17
Q

THA-PT interventions acute

A

ed re: precautions and WB status

  • increase functional mobility while maintaining precautions
  • rom ad strengthening exercises
  • pt and fam ed re: assist w/ mobility
  • equipment recommendations
  • rollow up recommendations
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18
Q

partial knee arthoplasty

A

replace femoral and tibial articulating surfaces either of medial or lateral compartment

  • conservative RX if necrosis is confied
  • spares cruciate ligs and patello femoral jt
  • normal kinematics of knee preserved
  • eventually TKA secondary to continued degernation
  • WB per MD
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19
Q

total knee arthroplasty

A
  • femoral condyles, tibial articulating surfaces, dorsal surface of patella
  • cemented
  • noncemented
  • any additional procedures may impact PT w/ ROM limits
  • WB per MD
20
Q

desired outcomes of TKA

A
  • decrease pain
  • decrease inflammation
  • decrease deformity
  • increase joint stability
  • increase ROM and mobility
  • restore functions
21
Q

the most common post op complication TKA

A

inadequate ROM

22
Q

TKA- PROM

A

manually assist pt

23
Q

CPM

A

continous passive motion machine

  • fit to pt leg length
  • initial setting usually 0-40 degrees
  • generally increase 10/day
  • watch for proper positioning
  • approximately six-eight hours/day
24
Q

AAROM

A

maintain limitation in muscle guarding due to pain/swelling
pt can assist self w/ uninvolved LE
use of contract-relax

25
Q

things to consider TKA

A
  • pt hx
  • read op report
  • education on importance of positioning (avoid hip ext)
  • encourage carryover of ROM ex
  • pre-meciate for rx
  • ice
  • knee immobilizer
26
Q

eval of pt TKA

A
  • throughout chart review
  • check w/ nursing
  • prep for rx
  • subjective questioning
  • rom
  • strength
  • mobility to EOB, sitting at EOB
  • transfers
  • gain when appropriate w/ AD
27
Q

Walker fit

A
  • handle at wrist level
  • 20-30 degree bend in pt elbow while holding walker
  • sit to stand transfers
  • gait technique
  • clean up after use. once fitted, keep in pt room
28
Q

bilateral TKA or THA

A
  • places increased stress on CV system
  • Card, pull circ fx well
  • <70 yo
  • fit w/ good overall strength
  • one hospital stay = less expensive
  • one surgery = less anesthesia
  • ideally total rehab process is shortned
29
Q

BMI

A

(weight in KG)/(height in m)^2
kg = weight *0.45
meters = height * 0.025

30
Q

TUG

A

looks at mobility/balance/coordination when walking 3 meters. units is seconds and can be compared to norms for various ages

31
Q

minimally invasive surgeries

A 
smaller incision
less tissue damage
shorter hospital stay and revoery
less blood loss
major concern is alignment issues w/ prostheses
further research needed
32
Q

general exercises for both THA and TKA

A 
ankle pumps and circles
heel slides
isometric quads, glutes, hamstrings
short arc quads
SLR
hip ab/ad
knee flex in sitting w/ theraband
may be others per hospital/MD
33
Q

top then things to know about acute (1-5)

A
  1. review chart daily
  2. get everything you need BEFORE you enter the room
  3. make friends w/ your nurse
  4. be thorough w/ documentation
  5. be flexible
34
Q

top then things to know about acute (5-10)

A
  1. be efficient
  2. “read” your pt
  3. know WHY
  4. use your brain
  5. know your limits
35
Q

Lbs to kg

A

Lbs*0.45

36
Q

Inches to meters

A

In*0.025

37
Q

BMI

A

Kg / m^2

38
Q

Underweight (BMI)

A

<18.5

39
Q

Normal weight (BMI)

A

18.5-24.9

40
Q

Overweight (BMI)

A

25-29.9

41
Q

Obese (BMI)

A

> 30

42
Q

TUG 60-69

A

M 7.3

F 8.1

43
Q

TUG 70-79

A

M 6.8

F 8

44
Q

TUG 80-89

A

M 13.5

F 13.6

45
Q

TUG 90-100

A

M 23.4

F 17

46
Q

TUG fall risk

A

> 13.5 sec

Gen Med (20 decks)

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