Total Joint Arthroplasty Flashcards
True or False: While TKA surgeries are on the rise significantly, THA operations are projected to be stagnant over the next 10 years in the aging population
False, THA is projected to grow 171% and TKAs are projected at 185% increase
What are the 4 main categories of contextual factors affecting patient outcomes after primary TJA or OA? What are some examples of each?
Behavioral/psychosocial (expectations, satisfaction w/ care, motivation, coping skills, anxiety/depression, level of education)
Support and Attitudes (support from family, friends, and community as well as attitude of health professionals)
Biological/Intrinsic (pain, age, gender, comorbidities, fitness/activity level, obesity, post-op complications)
Provider and System Factors (surgical wait time, access to providers, health professional skills, access to transportation)
What are the main intervention goals for Pre-operative PT?
- high intensity strength training
- patient training on assistive devices
- planning for recovery
- managing expectations
True or False: Engaging in a pre-op PT strengthening program has highly correlated stats that show decreased length of stay at hospital post-op.
False, there needs to be more studies because the jury is still out
Overall pre-op PT may or may not decrease hospital LOS or d/c disposition just like it may or may not affect post-op function
What are the goals of a pre-op educational class for patients?
- prepare patient for the surgery and recovery related issues
- decrease post-op complications
- increase likelihood of discharge to home vs a facility and decrease length of stay/hospital costs
- help patient identify post-op support system and decrease anxiety
- encourage pt’s active role in recovery process
When can you begin acute care PT for THA/TKA patients?
as early as post-op day 0
What is early intensive rehab associated with for THA/TKA?
- decreased risk of DVT/PE risk, chest infections, urinary retension and HAI
- Results in accelerated functional recovery and earlier hospital d/c
What should early intensive rehab focus on for TKA/THA?
- emphasize function for otpimal d/c dispo of home
- education is very important (not all THA have posterior prec)
- early strengthening (possibl e-stim for TKA)
True or False: TKA usually has a longer rheba time than a THA but THA surgeries lead to longer lingering gait abnormalities
True
True or False: While TSA surgeries are more common in males, females have higher rates of complications
True
True or False: If you have TSA surgery before your 6th decade of life usually you will not need a revision procedure later on in life
False, men w/ first procedure at less than 59 y.o o were more likely to need revision procedure
If a patient has an intact rotator cuff but has a degenerative disease that has caused damage to the shoulder joint, what surgery will they normally have for a TSA?
Anatomic TSA
If a patient has a complete tear of the rotator cuff and a fracture in the proximal humerus, but has an intact deltoid, what TSA surgery ill they most likely have?
Reverse TSA
True or False: There is not an extensive pre-op education pathway for TSA patients like there is for THA/TKA patients
True
What acute post-op factors can you work with a patient on that has just had a TSA surgery?
- work on gait abnormalities and balance
- work on joint mobility at other shoulder joint complex components
- functional reach using alternate strategies
- core strengthening
- one-armed ADL strategies
- functional mobility and bed mobility strategies
What age do low trauma/low energy hip fractures typically occur?
~80 years old (75% of pts. are over 70)
Roughly how many hip fracture deaths may be causally related to pre-existing medical conditions rather than the fracture itself?
3 out of 4
True or False: Initial mortality after a hip fracture is relatively low considering the level of disability caused by fractures
False, initial mortality is very high and 1/3 of elderly pts are dead one year after fracture and this increased mortality is sustained up to ten years post hip fracture
True or False: Unlike a TJA, hip fracture surgery is considered urgent.
True
If a patient has a hip fracture, what three factors could highly increase their mortality risk?
- advanced age (over 90)
- presence of several co-morbidities
- new acute medical condition
What are the two main types of hip fractures?
Intracapsular (involved femoral head and neck and is roughly 45% of cases)
Intertrochanteric (approx. 45% of cases)
there can be others which are known as subtrochanteric (10%)
What does surgical management type for hip fractures depend on?
- type and severity of fracture
- preference of ortho MD
- pt age
- co-morbidities
- prognosis
What is the typical surgical management for femoral neck fractures?
- if less than 65 years old then internal fixation
- older pts or those with already limited mobility: THA
What is the typical surgical management for intertrochanteric fractures?
- sliding hip screws
- intermeduallary nails
- often PWB
What is the typical surgical management for subtrochanteric fractures?
hemiarthroplasty
What is the goal of the acute stage of hip fracture rehab?
Restore mobility ASAP because there is a much higher risk of complication with bed rest
What are some pre-fracture factors that indicate poor functional recovery?
- decrease pre-fracture functional independence
- greater co-morbid disease burden
- cognitive impairment
- affective status/depression
- poor nutritional status
- poor social support
- presence of frailty
