TKA Flashcards
How old are most of the candidates for a TKA?
60-75
What are other options for people younger than 50?
High tibial osteotomy
Unicompartmental arthroplasty
Bicompartmental arthroplasty
What are some contraindications for a TKA?
Healing affect
Increased risk for complications or death (active local systemic infection, sepsis, severe vascular disease)
Device will fail (inability to control knee motion, extensor mechanism disruption (quads wont work), severe recurvatum due to weakness)
What are relative contraindications for a TKA?
Akin conditions within area
Diabetes
Severe peripheral vascular disease
Obesity (accelerates device wear)
What are some goals for a TKA?
Decrease pain
improve function
patient goals & expectations must meet surgeons expected outcomes
What are some complications to a TKA?
Bone Fracture Joint instability, stiffness, malalignment Nerve palsies Vascular injury Osteolysis (causes loosening)
Are the majority of DVTs after TKA Symptomatic or Asymptomatic?
Asymptomatic
What are some signs of a DVT?
Sudden bilateral swelling
What are some acute care goals for TKA?
Get them mobile, (Transfers, Stairs, Walking) Initiate exercises (Isometrics, open chain exercises, heel slides)
Besides DVT, what are some other things you want to watch out for with a TKA?
SOB and chest pain-PE possible, De-conditioning, Cardiac Issues Pulse Ox & BP Hypotension Calf pain and swelling UTI
What is some post-surgical rehab the patient may go through?
They will have a Hemovac Epidural often for 25 hours Wound management Ankle PUMPS EARLY MOBILIZATION
What are some typical exercises with TKA?
Stretches-Manual, Self
Isometrics-Quad sets, Glut sets
Active-SLR, ankle pumps, heel slides (helps with pain), LAQ/SAQ, standing hip exercises
What are some goals for discharge?
Safe ambulation with AD
Most go home unless commodities
What are some Home PT goals?
Used for people that are considered homebound
Progress exercises initiated at hospital
Progress ROM
Patient mobility-gait training and transfers
Muscle endurance and CV endurance
What differences in rehab does a Uni vs TKA surgery have?
No rehab differences
Uni may start PT sooner
Uni recovers faster
What plays a role in the longevity of TKA?
Age Male-wear out faster Dx of OA Obesity Comorid conditions
What are some complications after surgery?
Implant loosening Infection (can lead to loosening and revision) Implant wear Crack in cement Femur, tibia, or implant fracture
What are some warning signs for something going wrong?
Recurrent Pain Walking becomes painful becomes stiff and hard to bend or straighten redness and swelling appear skin is warm to touch change in appearance or alignment
What are some signs of infection?
Pain elevated WBC count Fever Wound drainage Loss of ROM Pain with WB
What are some risk factors for revision needs?
Get surgery younger than 55 Male Dx of OA Obesity Comorbid Conditions Activity Level
Are revisions easier or harder than primary TKA?
Primary is easier
70% in good to excellent range in revision compared to 90% in primary
How long do you need to get antibiotics after a dental procedure after total joint replacement?
2 years
What are some post-op goals in outpatient for TKA?
Improvement of flexion to at least 110 degrees Full extension Improve strength/endurance Improve CV fitness Full functional activity performance Independence in HEP
What are some impairments you’ll see in outpatient?
Pain Swelling/effusion Reduced Knee ROM Reduced Strength Impaired function (stairs) Lateral numbness
How long can pain last after surgery?
6 months to a year
How long can swelling last in TKA?
up to a year
Warm to touch can last 6 months
Why do you want full extension before DC in TKA?
Gait needs full extension PFJ wear Instability Compensations with gait-altered loading patterns Wear of the component can be changed
What are some knee extension ROM exercises?
Patellar mobilization
Prolonged low load stretch (let gravity do the work)
Seated extension stretch
Encourage PF
How much flexion do you need to DC
110 degrees
120-130 more typical
How can you work on flexion ROM?
patellar mobilizations
Heel slides
Knee flexor strengthening (hamstring usually recovers fast) can do reciprocal exercises
What are some things you can do if your not getting any gains in ROM with therapy?
Manipulation under anesthesia-breaks up scar tissue without pain
How much do pt do in the clinic for PT?
Pt discharged at about 70% of nonoperative side
Would benefit from wellness program after
In return to activity what do you want to avoid with TKA?
High-impact activities
High-risk injury
rough contact sports
What are some things you can engage in after TKA?
Lower stress activities-golfing, hiking, walking, biking, stationary skiing
Check with surgeon-tennis, skiing, horseback riding, rope jumping
