THA/TKA Flashcards
common post op issues
altered level of consciousness generalized weakness hypotension depressed respirations decreased Hgb bleeding at surgical site DVT/PE nausea, vomiting, dizziness urinary retention/constipation
hip surgical procedures
ORIF hardware
hemiarthroplasty - usually femoral head, bipolar prosthesis
both - THA and THR
ORIF
open reduction, internal fixation
commonly used after fall fx
typically NWB, sometimes 50% WB
location of break determines approach used
common indications for hip replacement
OA (most common) RA avascular necrosis of femoral head injury to hip bone tumor in hip little to no response to conservative treatment
cemented THA
provides immediately stability
often WBAT/FWB for amb.
generally used for older/less active ptr or w/ poor bone regeneration
cemented THA disad
loosens over time and w/ activity
loosens over time and w/ activity
non cemented THA
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
hybrid THA
non cemented acetabular component w/ cemented femoral prosthesis
WB status per MD
the most sig risk of THA pts in acute
dislocation
rates increase if it is a revision surgery
posterolateral/posterior
most common appraoch
- no hip flexion past 90
- no IR beyond neutral
- no hip add past neutral
lateral
same as posterolateral
anterior
- avoid hip extension past neutral
- no excessive ER
if trochanteric osteotomy performed, no active hip abduction or passive adduction along w/ WB restriction
total hip precautions
- 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
eval of pt w/ THA pt 1
- 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
eval of pt w/ THA pt 2
- mobility to EOB
- sitting at EOB
- transfers
- gait when appropriate w/ AD
acute
- 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
THA-PT interventions acute
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
partial knee arthoplasty
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
total knee arthroplasty
- femoral condyles, tibial articulating surfaces, dorsal surface of patella
- cemented
- noncemented
- any additional procedures may impact PT w/ ROM limits
- WB per MD
desired outcomes of TKA
- decrease pain
- decrease inflammation
- decrease deformity
- increase joint stability
- increase ROM and mobility
- restore functions
the most common post op complication TKA
inadequate ROM
TKA- PROM
manually assist pt
CPM
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
AAROM
maintain limitation in muscle guarding due to pain/swelling
pt can assist self w/ uninvolved LE
use of contract-relax
things to consider TKA
- 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
eval of pt TKA
- 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
Walker fit
- 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
bilateral TKA or THA
- 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
BMI
(weight in KG)/(height in m)^2
kg = weight *0.45
meters = height * 0.025
TUG
looks at mobility/balance/coordination when walking 3 meters. units is seconds and can be compared to norms for various ages
minimally invasive surgeries
smaller incision less tissue damage shorter hospital stay and revoery less blood loss major concern is alignment issues w/ prostheses further research needed
general exercises for both THA and TKA
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
top then things to know about acute (1-5)
- review chart daily
- get everything you need BEFORE you enter the room
- make friends w/ your nurse
- be thorough w/ documentation
- be flexible
top then things to know about acute (5-10)
- be efficient
- “read” your pt
- know WHY
- use your brain
- know your limits
Lbs to kg
Lbs*0.45
Inches to meters
In*0.025
BMI
Kg / m^2
Underweight (BMI)
<18.5
Normal weight (BMI)
18.5-24.9
Overweight (BMI)
25-29.9
Obese (BMI)
> 30
TUG 60-69
M 7.3
F 8.1
TUG 70-79
M 6.8
F 8
TUG 80-89
M 13.5
F 13.6
TUG 90-100
M 23.4
F 17
TUG fall risk
> 13.5 sec
