Total Knee Arthroplasty Flashcards
Refractory
Resistant to treatment
TKA
(Total Knee Arthroplasty)
TKA Indications
Arthritic knee pain that is refractory to:
- Non-steroidal anti-inflamm meds
- PT
- Cortisone injections
TKA: OA Impairments
(Osteoarthritis)
- Decreased ROM
- Decreased knee strength
- Gait deviations
- Decreeased balance/proprioception
Proprioception
Sensory system detecting positions and movement of various parts of body
TKA: Functional Limitations
Difficulty with:
- Ambulation
- Transfers
- Stairs
- ADLs
TKA: Goals
- RELIEVE PAIN
- Restore soft tissue balance
- Optimize biomechanics of knee
- Max function
*Rehab post-surgery is crucial to success
TKA: Contraindications
- Severe PVD
- Hx of infection
- Morbid obesity
JRP
(Joint Replacement Program)
Satisfactory clinical outcomes
TKA: Preoperative Evaluation
- Type of arthritis
- Walking distance
- Current / expected activity level + sports involvement
- DVT / PE Hx
- Previous surgeries
- Joint alignment (varus or valgus), stablity, ROM
- Muscle tone
- Leg lengths
Muscle Tone
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
Graded Muscle Control
Variations in degree of strength of muscle contraction in response to command.
-necessary for proper control of skeletal movement
Graded (Varied) in 2 ways:
- Freq of stimulation
- Number of motor units stimulated
Genu Valga
(Knock-kneed)
Knee alignment with ABDucted tibia in relation to femur
Genu Vara
(Bow-legged)
Knee alignment with ADDucted tibia in relation to femur
Genu Recurvatum
Knee hyperextension
Antalgic Gait
Gait abnormality adopted to min or avoid pain:
-Short stance phase (WB) in relation to swing phase
TKA: Preoperative X-ray
WB film better than bilateral to show alignment and stance:
Rosenberg view: 45* flexion with patella touching
image receptor
TKA: Surgical Overview
-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
PCR
(Posterior Cruciate Retaining TKA Design)
PCS
(Posterior Cruciate Substituting TKA Design)
LCL / MCL
(Lateral / Medial Collateral Ligaments)
Side to side stabilizers of knee joint
*Left untouched in TKA
PCL
(Posterior Cruciate Ligament)
Connects posterior tibia to medial condyle of femur
-Resists tibial posterior translation
Sprains
Injury to ligament
- Grade 1: Slight stretch, mild damage
- Grade 2: Partial tear, stretch –> loose
- Grade 3: Complete tear
ACL
(Anterior Cruciate Ligament)
Connects anteromedial tibia to lateral condyle of femur
-Resists tibial anterior translation
TKA:
Deformities
- Varus Deformity
= osteophytes on medial tibia removed - Valgus Deformity
= lateral components altered (released / lengthened) - Flexion Deformity
= osteophytes on posterior femur removed to reduce
contracture limiting flexion - Genu Recurvatum
= implantation to create slight flexion contracture –>
more tight to prevent hyperextension
TKA:
Phases of Rehabilitation
- Preoperative (JRP)
- Phase I: Inpatient AC
- Phase IIA: Acute Care or SNF
- Phase IIB: Home Health
- Phase III: Outpatient
TKA Preoperative Phase
Implement HEP
-ROM, strength training, and gait training with AD
Surgery, anesthesia, nursing, rehab, discharge planning
TKA Phase I:
Inpatient AC
Days 1-5
Goals:
1. Reduce pain and swelling
2. Prevent complications
3. Promote ROM
4. Restore safety and independence
-Bed mobility, transfers, ADLsPerformance-Based Measures of Activity
- TUG Test
- Stair Climbing Test
- Six Minute Walk Test
TKA Phase I:
Inpatient AC
Days 1-5
Goals:
1. Reduce pain and swelling
2. Prevent complications
3. Promote ROM
4. Restore safety and independence
-Bed mobility, transfers, ADLsPhysical Impairment Measures
- Pain
- Knee Girth
- Knee ROM
- Quad strength
TKA: Complications
- DVT
- Infection
- PE
- Joint effusion
- Peroneal Neuropraxia
- Muscle imbalance: quad AMI and hamstrings ratio
TKA: Functional Considerations during Rehab
- CPM
- PT on POD 2
- Breathing exercises
- Ankle pumps
- Isometric exercises
- Therapeutic exercises
- Bed mobility training / transfers
- ADL training
- Gait training (WB, AD)
- Stair training
- Postioning to facilitate knee extension
TKA: Functional Considerations for Discharge
- AROM 80-90*
- Transfers: supine to sit / sit to stand
- Ambulate 50-100ft (LRAD)
- Ascend and descend 3 stairs
TKA Phase IIA:
Extended Care Inpatient / SNF
Days 6-14
Goals:
1. Reduce pain and swelling
2. Prevent complications
3. Promote ROM
4. Restore safety and independence
-Bed mobility, transfers, ADLsNeuropraxia
Physiological block of impulse conduction without anatomical damage to nerve
AMI
(Arthrogenic Muscle Inhibition)
Inability to activate quadriceps
