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Advanced Musculoskeletal > TKA & THA > Flashcards

TKA & THA Flashcards

1
Q

What is the Comprehensive Care for Joint Replacement Model

A
  • Moves away from payment per patient and more toward outcomes
  • Hospitals given a target price that includes all costs of surgery and all related care 90 days s/p
  • Encourages hospitals to coordinate care and collaborate
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2
Q

Required hospital reporting for CJR

A
  • Risk Standardized Complication Rate
  • Patient Satisfaction Survey
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3
Q

CJR Implications for Rehab - Recommended outcomes

A
  • Pt reported outcome measurement information system (PROMIS)
  • Hip disability and osteoarthritis outcome score
  • knee injury and osteoarthritis outcome score
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4
Q

why is prevalence of osteoarthritis increasing?

A
  • Expanding age population
  • obesity
  • trauma
  • higher participation in high impact sports
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5
Q

Ceramic on Ceramic

A
  • Wear and scratch resistant
  • Decreased revision rates, osteolysis, aseptic loosening, dislocation
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6
Q

Different types of implants

A
  • short stem total hip arthroplasty
  • hip resurfacing
  • total hip arthroplasty
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7
Q

what is hip resurfacing?

A
  • Femoral head preserved
  • no femoral stem
  • capped head
  • fastest growing orthopedic procedure in the world
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8
Q

Hip resurfacing candidate

A
  • male, <60 years old
  • Normal functioning kidneys
  • active lifestyle
  • BMI <30
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9
Q

Hip resurfacing benefits

A
  • higher ROM
  • decreased chance of dislocation
  • significant gains in ROM by 6 mo and 1 year
  • not as many restrictions
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10
Q

Anterolateral THA

A
  • anterior 1/3 of glute med and min released and repaired; ERs usually left intact
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11
Q

Posterolateral THA

A
  • short ERs and piriformis released and repaired; glute med and TFL intact
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12
Q

Minimally invasive surgery THA

A
  • posterior approach: incision between interval between glute meds and piriformis; short ERs may/may not be released and repaired
  • Anterior approach: all muscles left intact; sartorus and RF retracted medially; TFL laterally
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13
Q

Traditional Anterolateral THA precautions

A

no hip flex past 90
no ext, Abd. and ER past neutral

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14
Q

Traditional posterolateral THA precautions

A
  • no hip flex past 90
  • no ADD past neutral
  • no IR past neutral
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15
Q

Minimally invasive surgery THA approaches precautions

A

may have some, may not have some
ask surgeon

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16
Q

hip resurfacing precautions

A

not usually any
ask surgeon

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17
Q
A
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18
Q

max protection phase

A
  • prevent vascular complications
  • prevent dislocation/sublux
  • achieve independent functional mobility
  • maintain functional level of strength in non-op extremities
  • regain active mobility and control of op limb
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19
Q

mod protection phase

A
  • regain strength and muscular endurance
  • improve cardiopulm endurance
  • restore ROM with precautions
  • improve postural stability, balance, gait
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20
Q

min protection phase

A
  • continued training for restoration of strength, muscular, and cardiopulmonary endurance, balance, and symmetrical gait pattern
  • gradual resumption of functional/rec activities
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21
Q

designing a rehab program for athroplasty

A
  • maximize strength
  • maximize flexibility
  • limit abnormal forces across the hip or knee
  • prevent hip dislocation
  • prevent excessive wear
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22
Q

full squat ROM

A
  • flex: 130
  • ER: 5-36
  • Abd: 10-30
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23
Q

Cross legged ROM

A
  • flex: 90-100
  • ER: 35-60
  • abd: 40-45
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24
Q

structure leg length discrepancy

A

a true leg length difference

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25
Q

functional leg length discrepancy

A

most due to:
- pelvic obliquities
- mm contractures
- tight capsular structures
- other joint abnormalities
** usually responses by 12 mo s/p THA

26
Q

muscular-balance length and strength

A
  • abd/add contracture
  • quad lumborum tightness
  • hamstring tightness
  • hip flex tightness (psoas, RF, TFL)
27
Q

faulty gait patterns secondary to:

A
  • pre-op gait pattern
  • implant design
  • decreased joint proprioception due to OA
  • PT related issues (muscle weakness, decreased muscle flexibility, capsular changes)
28
Q

Gait: chronic locomotion issues one year after THA

A
  • decreased gait speed
  • decreased hip ext early push off
  • decrease hip ext moment of force during early stance
  • decrease peak abd moment at end of weight bearing
  • decrease peak ER moment during mid-stance
29
Q

rehab for gait

A
  • address specific joint limitations
  • incorporate exercise into gait activities
  • CKC
  • eccentric training
  • Symmetry: arm swing, strength, pelvic, WB
  • posture
  • flexibility
  • coordination
  • agility
  • proximal and distal joint
30
Q

theres some research stuff if you wanna look at it

A

I dont

31
Q

important considerations for recreational activity post THA

A
  • pre-op activity
  • surgical reconstruction, anatomic and biomechanic reconstruction, well-designed implant, properly balanced
  • implant failure/fracture
  • implant fixation/loosening
  • joint bearing surface wear
  • traumatic complications
  • load, repetition, frequency, risk of fall, risk of contact
32
Q

return to activity

A
  • start slowly, build stamina
  • minimize joint loading
  • no jumping
  • no extreme motion
  • pain free for 24 hours after activity
33
Q

recommended activities post THA

A

Golf
Swimming
Doubles tennis
Stairclimber
Walking
Stationary Skiing
Bowling
Treadmill
Station Bicycling
Elliptical
Low-Impact Aerobics
Rowing
Dancing
Weight Machines

34
Q

Activities not recommended post THA

A

Jogging
Racquetball
Squash
Contact sports
High impact aerobics
Baseball/Softball
Snowboarding
Martial Arts
Singles Tennis
Waterskiing
Handball

35
Q

Types of knee arthroplasties

A
  • Unicompartmental Knee Arthroplasty
  • TKA: 90% cases successful, survivorship 12-13 years, newer polyethylene approach (20 years)
  • LPS- Flex Fixed Bearing Knee (Hi-Flex TKA)
  • LPS- Flex Mobile Bearing Knee (Hi-Flex TKA)
36
Q

knee flexion activities that require less than 120 degrees

A

sitting
walking
stairs

37
Q

knee flexion activities that require more than 120 degrees

A

sitting criss cross apple sauce
kneeling
gardening I guess

38
Q

advantages of unicompartmental knee arthroplasty (UCKA)

A
  • replace only diseased bone (preservation of bone stock, more normal kinematics because cruciate preserved)
  • decreased blood loss and extent of surgery
  • feels more like a normal knee
  • greater arc of motion
  • shortened hospitalization
  • normalized giat
  • mobile UCKA
39
Q

arc of motion of UCKA vs TKA

A
  • UCKA: 0-135
  • TKA: 0-120
40
Q

UCKA indications

A
  • osteoarthritis
  • single compartment disease (most often medial)
  • activity and rest pain
  • > 120 degrees ROM
  • No instability: ACL INTACT
  • Age: usually <55 years
  • Informed patient
41
Q

if a patient does not have an ACL can they have UCKA

A

N O N O N O N O N O
NO

42
Q

LPS-Flex Fixed and Mobile Bearing Knee (Hi-Flex TKA)

A

TKAs designed to mechanically sustain the loads during flexion angles up to 155 degrees and to accommodate patients tat have the requirements, need and ability to continue their flexible lifestyle

(younger, more active)

43
Q

Considerations for Hi-Flex TKA

A
  • patients activity level
  • need for high flexion
  • adherence to rehabilitation
  • surgeons judgement that the patient will flex beyond 125 post op
44
Q

LPS-Flex Mobile Bearing Knee

A

beneficial for active patients, preferable for those who have the desire and ability to kneel, squat or sit cross-legged

45
Q

Parameters for Hi-Flex TKA patient

A

younger
more active
more flexible to begin with

46
Q

TKA general guidelines - max protection phase

A
  • control pain and swelling
  • achieve independent ambulation and transfers using AD
  • prevent early post op complications
  • regain quads strength and improve knee ROM
47
Q

TKA general guidelines - mod protection phase

A
  • achieve approx 110 flex and 0 ext
  • regain LE strength and muscular endurance, balance, cardio endurance
48
Q

TKA general guidelines - min protection phase

A
  • task specific strengthening
  • proprioceptive and balance training
  • advanced functional training
49
Q

what a PT should know from surgeon

A
  • ligament stability
  • soft tissue status
  • extensor mechanism integrity
  • intraoperative ROM
50
Q

key point in rehab - emphasize terminal ext ROM

A
  • when possible measure in prone
  • quiet standing is energy efficient
  • instancing, WB line falls slightly ant to axis of knee
51
Q

TKA - knee flex contracture

A
  • excessive load on femoral and polyethylene components
  • increased quads force during WB
  • 30 degree flex contracture = quads demand rises to 50% of max contractile effort
  • impaired endurance
  • impaired function clinically
52
Q

TKA ROM loss etiology

A
  • pre op ROM
  • underlying disease (RA)
  • primary vs revision TKA
  • post op pain
  • CRPS
  • Aseptic loosening or infection
  • arthrofibrosis
  • technical errors
53
Q

ROM loss results in

A
  • altered gait mechanics
  • quads fatigue
  • increased VO2 demand
  • hip/back discomfort
  • unhappy patient/poor outcome
54
Q

TKA reg flags

A
  • no increase in ext range
  • hard end feel in flexion
  • increase co-contraction of Q+H
55
Q

Patellar instability post TKA

A
  • sublux or dislocation
  • 2-7% incidence
  • malalignment with increased Q angle and lateral pull
  • contact surgeon
56
Q

if there isnt at least 90 degrees of knee flex by week 3-4 what should you do

A

call the surgeon

57
Q

intervention - STM

A
  • myofascial release
  • patellar/ scar mobilization
58
Q

talk about importance of hip abductors

A
  • they have higher correlation w/ measures of physical function than did demographics, anthropometric measures, or Quad strength
59
Q

whats the most important determinant of the likelihood of sports participation after TKA

A

pre-op participation in the sport itself

60
Q

what does UCKA more predictably allow

A

return to low impact sports

Advanced Musculoskeletal (21 decks)

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