Total Knee Arthroplasty CAT Flashcards
What warrants a TKA?
- Progressive and disabling pain w/in the knee
- Often due to severe OA
Most common indication for TKA
Destruction of articular cartilage secondary to OA
Risk factors for knee OA
- High-impact sports
- Trauma to knees
- Obesity
- Varus/valgus deformity
- Previous mechanical derangement
- Infection
- RA
- Hemophilia
- Crystal deposition diseases
- Avascular necrosis
- Bone dysplasia
Clinical presentation for knee OA
- Severe knee pain (worsens w/ WB and movement)
- Impaired ROM
- Possible deformity
- Impaired mobility skills
- Night pain
- Stiffness, swelling, locking, giving way
Labs/imaging for knee OA
X-ray, CT, MRI for viewing joint
Contraindications for TKA
- Active infection
- Severe obesity
- Significant genu recurvatum
- Arterial in sufficiency
- Neuropathic joint
- Certain mental illnesses
Post-surgical complications post-TKA
- Infection
- Vascular damage
- Patellofemoral instability
- Fracture surrounding prosthesis
- Pulmonary embolism
- Nerve damage
- Loosening of the prosthesis
- Arthrofibrosis
Medical management of TKA
- Anticoagulants
- Pain meds
- Knee immobilization
- Limb elevation
- Cryotherapy
- Intermittent ROM using continuous passive motion machine
- Initiate knee protocol exercises
WB status initially for cemented knee prosthesis
Partial WB or WB as tolerated
WB status initially for uncemented knee prosthesis
Toe touch WB for up to 6 weeks
PT management of TKA
- Mobility training
- Early ambulation training
- Ankle pumps, quad sets, hamstring sets
ROM goal of PT before discharge
90 degrees of knee flexion
0 degrees of knee extension
Precautions for knee post-op
Avoid
- squatting
- quick pivoting
- pillows under the knee in bed
- low seating
for several months
When can closed-chain and functional exercises be introduced?
Once the pt is cleared for WB as tolerated
Timeline for healing w/ TKA
8-12 weeks for full return to previous functional activities
