THR and TKR

Question 1

Posterior Approach

Answer 1

unstable in flexion and IR and ADD
restricted WB for varying amounts of time
hip precautions for 6-12 weeks (sometimes more)

Question 2

Anterior Approach

Answer 2

Newer

• decreased risk of posterior dislocation
• preferable in those with muscle imbalances

Question 3

Anterior Approach Precautions

Answer 3

Post- Op: OOB day 1 w PT
extensive pain control protocol
WBAT- w/w
no extremes of motion ( extension and no greater than 90 degrees ER 
DVT risk 

NO extremes of motion
NO pillow under knee / foot- encourages flexion
No elevated toilet seat- extreme extension getting off
you CAN cross your leg- shouldn’t b/c decreased blood flow but no restriction
you CAN extend (just don’t ER at the same time)
ALL pt stop at 90 degrees of ER
you CAN shower

Question 4

Standard Hip Precautions (POSTERIOR)

Answer 4

No hip beyond 90 degrees
No leg crossing
No stand pivot- don't plant foot and rotate off hip (pick up and move feet during transfers) 
No hip rotation
No hip adduction

instruct on footwear- reinforce PT
triangle wedge pillow- help w decrease adduction
put pillow btw legs at home and can lay on side

Question 5

Occupational Therapy Role

Answer 5

BADL’s- 1st thing- bathing, toileting, LE dressing
IADL’s- premorbid
Transfers- see all surfaces/proper height
Tub
Toilet
Chair
Bed
Car
Bed mobility- sometimes can WB on affected leg (depend on surgeon)pillow btwn knee? supine?
Endurance Building- moving, walking around, light weights
Standing balance- WB to both sides if able/bend, reach
Education- about precautions, meds, pain
Family training- how to prevent further falls
Equipment- ordering/insurance doesn’t cover everything
ADL
DME

Question 6

Equipment

Answer 6

LH reachers
Sock aid
LH Bath sponge
LH shoehorn
Elastic shoe laces- hit or miss/depends on kind of show pt wears 
W/c cushion
Raised toilet seat
Tub bench/seat
Grab bars
Walker basket/bag- kitchen act
Portable phone- incase of fall (life-line) 

*be aware of cost, what thye already have

Question 7

Knee Arthroplasty

Answer 7

Advanced arthritis
Implant types:
Conforming
Bone cement
Cementless
(MOSTLY PT, OT tx with obesity, COPD, bilateral knee, psychosocial, ADL's, typically less than a weeks

Question 8

TKR rehab

Answer 8

Mobility-transfer/all surfaces/bed mobility
Self-care- LB (shoes, socks, footcare)
Proper weight bearing- no compensating- normal stance/ walking smoothly w device
Home assessment- go home quickly/ home PT
ROM (CPM)- machine
Balance-act., symmetrical WB/WS tasks (kitchen/safety)
Endurance- building

basic shower stool/seat