Total Knee Arthroplasty

Question 1

Refractory

Answer 1

Resistant to treatment

Question 2

TKA

Answer 2

(Total Knee Arthroplasty)

Question 3

TKA Indications

Answer 3

Arthritic knee pain that is refractory to:

1. Non-steroidal anti-inflamm meds
2. PT
3. Cortisone injections

Question 4

TKA: OA Impairments

Answer 4

(Osteoarthritis)

1. Decreased ROM
2. Decreased knee strength
3. Gait deviations
4. Decreeased balance/proprioception

Question 5

Proprioception

Answer 5

Sensory system detecting positions and movement of various parts of body

Question 6

TKA: Functional Limitations

Answer 6

Difficulty with:

1. Ambulation
2. Transfers
3. Stairs
4. ADLs

Question 7

TKA: Goals

Answer 7

1. RELIEVE PAIN
2. Restore soft tissue balance
3. Optimize biomechanics of knee
4. Max function

*Rehab post-surgery is crucial to success

Question 8

TKA: Contraindications

Answer 8

1. Severe PVD
2. Hx of infection
3. Morbid obesity

Question 9

JRP

Answer 9

(Joint Replacement Program)

Satisfactory clinical outcomes

Question 10

TKA: Preoperative Evaluation

Answer 10

1. Type of arthritis
2. Walking distance
3. Current / expected activity level + sports involvement
4. DVT / PE Hx
5. Previous surgeries
6. Joint alignment (varus or valgus), stablity, ROM
7. Muscle tone
8. Leg lengths

Question 11

Muscle Tone

Answer 11

Continuous partial muscle tension at rest that allows full contraction on command.

High tone: too much tension, very tight / tense
(Cerebral palsy –> tight, need stretch –> contracture –>
decreased ROM)

Low tone: not enough tension, very loose / mushy, lack of
graded control

Question 12

Graded Muscle Control

Answer 12

Variations in degree of strength of muscle contraction in response to command.
-necessary for proper control of skeletal movement

Graded (Varied) in 2 ways:

1. Freq of stimulation
2. Number of motor units stimulated

Question 13

Genu Valga

Answer 13

(Knock-kneed)

Knee alignment with ABDucted tibia in relation to femur

Question 14

Genu Vara

Answer 14

(Bow-legged)

Knee alignment with ADDucted tibia in relation to femur

Question 15

Genu Recurvatum

Answer 15

Knee hyperextension

Question 16

Antalgic Gait

Answer 16

Gait abnormality adopted to min or avoid pain:

-Short stance phase (WB) in relation to swing phase

Question 17

TKA: Preoperative X-ray

Answer 17

WB film better than bilateral to show alignment and stance:

Rosenberg view: 45* flexion with patella touching
image receptor

Question 18

TKA: Surgical Overview

Answer 18

-Bicondylar vs Unicondylar replacement
-Minimally invasive ~4in, spares quad tendon
-Traditional incision ~8-10in and through quad tendon
(Both parapatellar / midline)
-Osteotomies
-ACL removed, PCL –> removed, PCR or PCS, CLs left
in tact
-Spinal / epidural anesthesia + femoral nerve block

Question 19

PCR

Answer 19

(Posterior Cruciate Retaining TKA Design)

Question 20

PCS

Answer 20

(Posterior Cruciate Substituting TKA Design)

Question 21

LCL / MCL

Answer 21

(Lateral / Medial Collateral Ligaments)
Side to side stabilizers of knee joint

*Left untouched in TKA

Question 22

PCL

Answer 22

(Posterior Cruciate Ligament)
Connects posterior tibia to medial condyle of femur
-Resists tibial posterior translation

Question 23

Sprains

Answer 23

Injury to ligament

• Grade 1: Slight stretch, mild damage
• Grade 2: Partial tear, stretch –> loose
• Grade 3: Complete tear

Question 24

ACL

Answer 24

(Anterior Cruciate Ligament)
Connects anteromedial tibia to lateral condyle of femur
-Resists tibial anterior translation

Question 25

TKA: | Deformities

Answer 25

1. Varus Deformity = osteophytes on medial tibia removed 2. Valgus Deformity = lateral components altered (released / lengthened) 3. Flexion Deformity = osteophytes on posterior femur removed to reduce contracture limiting flexion 4. Genu Recurvatum = implantation to create slight flexion contracture --> more tight to prevent hyperextension

Question 26

TKA: | Phases of Rehabilitation

Answer 26

1. Preoperative (JRP) 2. Phase I: Inpatient AC 3. Phase IIA: Acute Care or SNF 4. Phase IIB: Home Health 5. Phase III: Outpatient

Question 27

TKA Preoperative Phase

Answer 27

Implement HEP -ROM, strength training, and gait training with AD Surgery, anesthesia, nursing, rehab, discharge planning

Question 28

TKA Phase I: | Inpatient AC

Answer 28

``` Days 1-5 Goals: 1. Reduce pain and swelling 2. Prevent complications 3. Promote ROM 4. Restore safety and independence -Bed mobility, transfers, ADLs ```

Question 29

Performance-Based Measures of Activity

Answer 29

1. TUG Test 2. Stair Climbing Test 3. Six Minute Walk Test

Question 30

TKA Phase I: | Inpatient AC

Answer 30

``` Days 1-5 Goals: 1. Reduce pain and swelling 2. Prevent complications 3. Promote ROM 4. Restore safety and independence -Bed mobility, transfers, ADLs ```

Question 31

Physical Impairment Measures

Answer 31

1. Pain 2. Knee Girth 3. Knee ROM 4. Quad strength

Question 32

TKA: Complications

Answer 32

1. DVT 2. Infection 3. PE 4. Joint effusion 5. Peroneal Neuropraxia 6. Muscle imbalance: quad AMI and hamstrings ratio

Question 33

TKA: Functional Considerations during Rehab

Answer 33

1. CPM 2. PT on POD 2 3. Breathing exercises 4. Ankle pumps 5. Isometric exercises 6. Therapeutic exercises 7. Bed mobility training / transfers 8. ADL training 9. Gait training (WB, AD) 10. Stair training 11. Postioning to facilitate knee extension

Question 34

TKA: Functional Considerations for Discharge

Answer 34

1. AROM 80-90* 2. Transfers: supine to sit / sit to stand 3. Ambulate 50-100ft (LRAD) 4. Ascend and descend 3 stairs

Question 35

TKA Phase IIA: | Extended Care Inpatient / SNF

Answer 35

``` Days 6-14 Goals: 1. Reduce pain and swelling 2. Prevent complications 3. Promote ROM 4. Restore safety and independence -Bed mobility, transfers, ADLs ```

Question 36

Neuropraxia

Answer 36

Physiological block of impulse conduction without anatomical damage to nerve

Question 37

AMI

Answer 37

(Arthrogenic Muscle Inhibition) | Inability to activate quadriceps