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MOD 6:TJR
Total Joint Replacements
| Question | Answer |
|---|---|
| With what approach for a THR is there lower dislocation rate and better rehab? | anteriolateral |
| Which type of implants are better for people over the age of 65? | cemented |
| Which type of implants are better for people with osteoporosis? | cemented |
| which type of implants are better for people under the age of 65? | non-cemented |
| Which type of implants are better for people who are more active? | non-cemented |
| Which type of implants have a limited lifetime due to loosening? | cemented |
| Which type of implants have a faster healing time? | cemented |
| which type of implants can the pt be WB immediately? | cemented |
| Which type of implant has a slower healing time? | non-cemented |
| Which type of implant has WB restrictions for up to 6 weeks or WBAT? | non-cemented |
| Which type of implant tends to be more expensive? | non-cemented |
| Which type of implant tends to be more technically demanding? | non-cemented |
| Which type of implant is easier to revise if it fails? | non-cemented |
| With which type of implant do 30% of ppl develop thigh pain? | non-cemented |
| What involves removing and replacing only one side of the joint or one compartment(like in the knee)? | hemiarthroplasty |
| What is the creation of a bony union across a joint? | arthrodesis |
| Fractures that cannot be treated with an ORIF, uncompartmental arthritis and AVN can be treated with what? | hemiarthroplasty |
| What can posttraumatic arthritis, RA, degenerative conditions and AVN that cannot be helped with an arthroplasty be treated with? | arthrodesis |
| If someone has a neurological disease that resulted in an unstable joint, or paralysis of deltoid or quad muscles they may need this type of joint surgery. | arthrodesis |
| If someone has a failed joint arthroplasty caused by infection or chronic osteomyelitis that results in severe bone loss and precludes a revision arthroplasy what type of surgery may they need? | arthrodesis |
| What does a synovectomy entail and with what type of arthritis is it commonly used? | entails removal of the diseased synovium and may be used in patients with RA |
| What is the problem with a synovectomy? | the synovium may grow back several years post-op |
| Name the possible surgical complications following joint surgery (11). | infection, loosening, the need for revision, DVT, pulmonary embolism, neurological damage(if a nerve was cut), death, leg length descrepancies, fx, dislocation, nonunion c gr8er trochanter. |
| Which type of implants have a higher % of fx of bone distal to the components due to metal fatigue. | non-cemented |
| What 4 joints can a synovectomy be used for? | hips, knees, shoulders, elbows |
| What does an osteotomy involve? | cutting of affected joints and repositioning |
| What joints and specific conditions is an osteotomy generally used for? | greater trochanter, knees, spine, CP, tone issues |
| What does a resection entail and what body parts is it typically used for? | involves removal of all or part of a bone, used in hands, wrists, toes, ankles, elbows |
| After a TJR, what population is associated with increased risk of revision. | younger age and males |
| After a TJR, what population is associated with increased risk of death? | men before women |
| After a TJR, what population is associated with decreased function? | old age... women moreso than men |
| After a TJR, what population is associated with the most pain. | depends of the person, their pain tolerance, their culture may determine how they express pain |
| Tell me what you know about the zimmer MIS 2 incision. | IT INVOLVES 2 INCISIONS OF 1.5-2 INCHES, MUSCLES AND TENDONS ARE AVOIDED, ONLY A ONE OR 2 DAY HOSPITAL STAY. |
| What might a physical therapist be required to talk about at a pre-op class? | mobility training (assistive devices)sock aids, equiptment ect, THR precautions, deep breathing (from diaphragm, pursed lip, contolled cough), TEX for UE(lats and triceps, also ms needed c AD) and LE |
| Are pre-op exercises better for recovery? | yes initially, but once u reach 8 weeks theres not much difference. |
| What exercises would you recommend for hip relacement post op days 1 and 2? | breathing and coughing, ankle pumps, glut sets, quad sets, bed mobs, transfers, gait training, pt ed on total hip precautions, AROM? |
| What exercises would u recomment 3-5 days post-op THA | improve UE, LE strength, promote I transfers and gait, evaluate needs @ home, caregiver training |
| what exercises would u recommend 1-6 weeks | improve strength and balance of LE, closed chain minisquats, step ups, heel raises, pool therapy, treadmill, SLR, hip ext, ABD, TKE, open and closed chain exercises, make sure to progress from original AD when needed |
| Following a THA, what precautions do you want to follow while driving? | dont drive if taking meds like coulmodulin, dont drive for like 3 weeks so u dont violate hip precautions. |
| In a TKA what structures are being replaced typically? | tibial plataues, femoral condyles, and patella |
| What are the indications for getting a TKA? | severe pain, gross instability, arthritis that has destroyed articular surfaces, genu valgum or varum, failure of previous surgery, neoplasms on distal femur, proximal tibia |
| How much knee flex and ext do you need for everyday life? | 90deg of flex and full ext. |
| Whats better for a knee... cemented or noncemented? | TRICK QUESTION! all TKA are cemented, |
| How many degrees of knee flexion do you need to walk? | 67 |
| How many degrees of knee flexion do you need to go up stairs? | 83 |
| How many degrees of knee flexion do you need to go down stairs? | 90 |
| How many degrees of knee flexion do you need to sit in a chair? | 93 |
| What is a ROM measurment for a nonsignificant fracture at the knee? | less than or = 10 degrees |
| With a knee flexion contracture of more than 10 degrees what will you see? | limp and fatigue |
| Are preop exercises for knee more effective? | not for function but yeah for strength and reduction of discharge time |
| Interventions for 1-5 days of total knee arthroplasty include | CPM, start at 0-40 and progress as tolerated for 5-20 hrs/day. breathing ex, elevation, ankle pumps, no pillows under kneesisometric ex, AROM ankle, PROM knee, bed mob, transfers, gait training, immobilizer til quad control, progress to SLR TKE BID |
| precaution for TKA following surgery... | you can teach pt how to move their leg w. the other one for support |
| Interventions for 6-14 days of TKA post op include | decr pain and swelling, promote rom 0-110 strengthen, make sure transfers are safe and I, gait for limited community distances of 300-500 ft, improve functional LE strength, self manage pain, aggressive knee flex and ext exercises, become I @home |
| How much knee flex ext ROM should u get 3-8 weeks post op | 100-125 flex or as indicated |
| How long after a TKA can you do single limb stance | 3-8 weeks...during this time u should also do other banance exercises pool ther, return to prev activities, half squat, step up and downs |
| What method should u use to determine max strength after jt arthroplastys ` | 10RM |
| What factor of the surgery is crucial for a good outcome following TSR? | the ability to reconstruct and balance the musculature, tendons, joint capsule, as well as the experience of the surgeon |
| What technique is used to do a TSR. | the surgeon will take down the subscapularis to expose the GH joint and release or lengthen the ms and/or the joint capsule to allow for adequate ER. mey need to repair rotator cuff and size of prosthetic HH |
| Why are UE immobilized after a TSR? | to protect the anterior incision, capsule, reattached rotator cuff, and deltoid ms |
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PTROCKS
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