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PHYSICAL THERAPY > Total Knee Arthroplasty > Flashcards

Total Knee Arthroplasty Flashcards

1
Q

Refractory

A

Resistant to treatment

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2
Q

TKA

A

(Total Knee Arthroplasty)

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3
Q

TKA Indications

A

Arthritic knee pain that is refractory to:

  1. Non-steroidal anti-inflamm meds
  2. PT
  3. Cortisone injections
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4
Q

TKA: OA Impairments

A

(Osteoarthritis)

  1. Decreased ROM
  2. Decreased knee strength
  3. Gait deviations
  4. Decreeased balance/proprioception
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5
Q

Proprioception

A

Sensory system detecting positions and movement of various parts of body

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6
Q

TKA: Functional Limitations

A

Difficulty with:

  1. Ambulation
  2. Transfers
  3. Stairs
  4. ADLs
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7
Q

TKA: Goals

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

*Rehab post-surgery is crucial to success

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8
Q

TKA: Contraindications

A
  1. Severe PVD
  2. Hx of infection
  3. Morbid obesity
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9
Q

JRP

A

(Joint Replacement Program)

Satisfactory clinical outcomes

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10
Q

TKA: Preoperative Evaluation

A
  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
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11
Q

Muscle Tone

A

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

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12
Q

Graded Muscle Control

A

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
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13
Q

Genu Valga

A

(Knock-kneed)

Knee alignment with ABDucted tibia in relation to femur

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14
Q

Genu Vara

A

(Bow-legged)

Knee alignment with ADDucted tibia in relation to femur

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15
Q

Genu Recurvatum

A

Knee hyperextension

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16
Q

Antalgic Gait

A

Gait abnormality adopted to min or avoid pain:

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

17
Q

TKA: Preoperative X-ray

A

WB film better than bilateral to show alignment and stance:

Rosenberg view: 45* flexion with patella touching
image receptor

18
Q

TKA: Surgical Overview

A

-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

19
Q

PCR

A

(Posterior Cruciate Retaining TKA Design)

20
Q

PCS

A

(Posterior Cruciate Substituting TKA Design)

21
Q

LCL / MCL

A

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

*Left untouched in TKA

22
Q

PCL

A

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

23
Q

Sprains

A

Injury to ligament

  • Grade 1: Slight stretch, mild damage
  • Grade 2: Partial tear, stretch –> loose
  • Grade 3: Complete tear
24
Q

ACL

A

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

25
Q

TKA:

Deformities

A
  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
26
Q

TKA:

Phases of Rehabilitation

A
  1. Preoperative (JRP)
  2. Phase I: Inpatient AC
  3. Phase IIA: Acute Care or SNF
  4. Phase IIB: Home Health
  5. Phase III: Outpatient
27
Q

TKA Preoperative Phase

A

Implement HEP
-ROM, strength training, and gait training with AD

Surgery, anesthesia, nursing, rehab, discharge planning

28
Q

TKA Phase I:

Inpatient AC

A 
Days 1-5
Goals:
  1. Reduce pain and swelling
  2. Prevent complications
  3. Promote ROM
  4. Restore safety and independence
       -Bed mobility, transfers, ADLs
29
Q

Performance-Based Measures of Activity

A
  1. TUG Test
  2. Stair Climbing Test
  3. Six Minute Walk Test
30
Q

TKA Phase I:

Inpatient AC

A 
Days 1-5
Goals:
  1. Reduce pain and swelling
  2. Prevent complications
  3. Promote ROM
  4. Restore safety and independence
       -Bed mobility, transfers, ADLs
31
Q

Physical Impairment Measures

A
  1. Pain
  2. Knee Girth
  3. Knee ROM
  4. Quad strength
32
Q

TKA: Complications

A
  1. DVT
  2. Infection
  3. PE
  4. Joint effusion
  5. Peroneal Neuropraxia
  6. Muscle imbalance: quad AMI and hamstrings ratio
33
Q

TKA: Functional Considerations during Rehab

A
  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
34
Q

TKA: Functional Considerations for Discharge

A
  1. AROM 80-90*
  2. Transfers: supine to sit / sit to stand
  3. Ambulate 50-100ft (LRAD)
  4. Ascend and descend 3 stairs
35
Q

TKA Phase IIA:

Extended Care Inpatient / SNF

A 
Days 6-14
Goals:
  1. Reduce pain and swelling
  2. Prevent complications
  3. Promote ROM
  4. Restore safety and independence
         -Bed mobility, transfers, ADLs
36
Q

Neuropraxia

A

Physiological block of impulse conduction without anatomical damage to nerve

37
Q

AMI

A

(Arthrogenic Muscle Inhibition)

Inability to activate quadriceps

PHYSICAL THERAPY (13 decks)

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