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Advanced MSK > TKA > Flashcards

TKA Flashcards

1
Q

Types of knee arthroplasties

A
  1. Unicompartmental Knee Arthroplasty (UCKA)
  2. TKA
  3. LPS-Flex Fixed Bearing Knee (Hi-Flex TKA)
  4. LPS-Flex Mobile Bearing Knee (Hi-flex TKA)
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2
Q

What is the minimal goal for knee flexion for ADLs

A

120 degrees minimal

What we need for sitting, walking, and stairs

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3
Q

Unicompartmental Knee Arthroplasty advantages

A
  1. Replace only diseased bone — preservation of bone stock and more normal kinematics since cruciate ligs are preserved
  2. Decreased blood loss and extent of surgery
  3. “Feels” more like a normal knee
  4. Greater arc of motion (0-135 deg)
  5. Shortened hospital stay
  6. Normalized gait
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4
Q

indications for UCKA

A
  1. OA
  2. Single compartment disease (medial most often)
  3. Activity and rest pain
  4. > 120 degrees ROM
  5. No instability — ACL intact
  6. Usually <55 yo
  7. Informed patient.
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5
Q

Hi-Flex fixed and mobile TKAs

A

Designed to mechanically sustain the loads during flexion angles up to 155 deg and to accommodate patients that have the requirements, need and ability to continue their flexible lifestyle.

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6
Q

Considerations for Hi-Flex TKA

A
  1. Patient activity level — more active and young
  2. Need for high flexion — higher level activities
  3. Adherence to rehab
  4. Surgeon’s judgement that the patient will flex beyond 125 deg post op
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7
Q

If the patient has desire to be able to kneel, squat, and sit cross-legged what knee?

A

LPS-Flex Mobile Bearing Knee!!

Plus if patient is young, active, and pretty flexible beforehand

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8
Q

Max Protection phase post op TKA

A
  • Control pain and swelling
  • Achieve independent ambulation and transfers with AD
  • Prevent early post op medical complications
  • Regaining quad muscle strength and improving knee ROM
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9
Q

Mod Protecion phase post op TKA

A
  • Achieve about 110 deg of knee flexion an full extension
  • Regain LE strength and muscular endurance, balance, CardioPulm endurance
  • Functional mobility
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10
Q

Min protection phase post op TKA

A
  • Task- Specific strengthening exercises
  • Proprioceptive and balance training
  • Advanced functional training as well as strengths, power, balance, and endurance to return to a full level of functional activities/recreation in community
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11
Q

What should PTs know from surgeon

A
  1. Ligament stability
  2. Soft tissue status
  3. Extensor mechanism integrity
  4. Intraoperative ROM

Not much precautions for the knee otherwise

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12
Q

Key points in rehab

A
  1. Emphasize terminal extension ROM
    — when possible, measure in prone
    — Quick standing is energy efficient
    — In standing, weight bearing line falls slightly anterior to axis of knee.
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13
Q

What happens with knee flexion contracture

A
  • Excessive load on femoral and polyethylene components
  • Increased quad force during weight bearing
  • If 30 deg flexion contracture = quad demand rises to 50% of max contractile effort
  • Imparied endurance
  • Impaired function clinically
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14
Q

Etiology for TKA ROM loss

A

Pre-op ROM
Underlying disease like RA
Primary vs. Revision knee arthro
Post-op pain
Complex regional pain syndrome
Aseptic loosening or infection
Arthrofibrosis
Technical errors

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15
Q

ROM loss results in…

A
  1. Altered gait mechanics
  2. Quad fatigue
  3. Increased VO2 demand
  4. Hip/back discomfort
  5. Unhappy patient/poor outcome
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16
Q

Red flags for ROM loss

A
  1. No increase in extension range
  2. Hard end feel in flexion
  3. Increased co-contraction of quads and hams
17
Q

What do you do if patellar instability/sublux/dislocation

A

Contact surgeon!!

18
Q

What to do if there is not at least 90 deg knee flexion by week 3-4?

A

Contact surgeon!!

19
Q

Returning to recreational activities

A

Pre-op activity level prior to TKA important.
If they were sedentary = no post op sports activity
If they were sports active in year prior = 77% able to return to sport

most important determinant of the likelihood of sports participation after TKA is pre-op participation in the sport itself

20
Q

If patient wants to return to low impact sports post op what knee would you recommend

A

UCKA

Advanced MSK (7 decks)

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