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Total hip and knee

Scorebuilders 2010

QuestionAnswer
What are the surgical indications for a total hip arthroplasy? Osteoarthritis, Rheumatoid arthritis, failed internal fixation of a fracture, developmental dysplasia, osteomyelitis, and avascular necrosis
What are the surgical contraindications for a total hip arthroplasty? Poor periarticular support, sepsis, active infection
What are the two types of THA? Cemented and non cemented
What type of THA can you weight bear immediately as tolerated? Cemented; Noncemented is toe touch wb for up to 6 weeks
What type of THA has a longer life expectancy secondary to allowing a larger amount of bone tissue to remain intact and allows for continued tissue growth Noncemented
What type of THA requires more bone tissue removal and may experience loosening of the prosthesis? Cemented
Which of the following nerves may get damaged with a THA?A)Tibial B)Peroneal C)Sciatic Sciatic
Where would the THA be at risk for fracture?A) Through the prostheticB) Around the prosthetic (periprosthetic)C) Along the femoral headD) At the neck of the femur periprosthetic
What four potential post-surgical complications can occur both in THA and TKA? DVT, infection, pulmonary embolus,periprosthetic fracture
Which of the following are not a potential post-surgical complication of a THA?A)chronic joint effusion B) heterotopic ossification C) disclocation/subluxation of the femoral head D) infection chronic joint effusion
What motions are limited and to what degree with a posterolateral approach to a THA? Avoid hip adduction, avoid medial rotation, avoid hip flexion > 90 degrees
What types of advice can you give to a patient to help them avoid going past 90 degrees of hip flexion after a THA? Do not sit on low surfaces, do not bend over towards the ground, do not lean over to get up from a chair, do not bend over to tie shoes
What types of advice can you give to a patient to help them avoid hip adduction after a THA? Use an abduction pillow,do not cross the legs when sitting or lying down, use a pillow between the legs when in sidelying.
What types of advice can you give a patient to help them avoid hip medial rotation after a THA? Do not pivot towards the surgical side
What should PT do with patients after a THA? Maintain appropriate wb status, mobility training and early ambulation using hip precautions, initiate strengthening with isometric exercises and progress as tolerated, gentle stretching
What are the surgical indications of a TKA? Disabling pain, failed conservative treatment, impaired mobility due to advanced arthritis
What are the surgical contraindications of a TKA? Active infection, advanced osteoporosis, severe peripheral vascular disease, sepsis, morbid obesity
What are the types of a TKA? Cemented, hybrid,noncemented
What type of TKA allows you to be wb immediately as tolerated? Cemented
What does the hybrid TKA consist of? Cemented tibial component and noncemented femoral and patellar components
What types of TKA want you to be toe touch wb for up to 6 weeks? Hybrid and noncemented
What type of TKA has a longer life expectancy than cemented? Non-cemented
What does the noncemented TKA consist of? Femoral, tibial and patellar components are all noncemented
What nerve can be damaged after a TKA?A) SciaticB) TibialC) PeronealD) Radial Peroneal
It is important to perform strengthening exercises and passive motion early after a TKA because the post surgical complications include: Chronic joint effusion, restricted ROM, pulmonary embolus, DVT
Where would a TKA fracture post surgically? periprosthetic
Why is a post surgical knee immobilizer used post operative TKA? For stability
When you perform early ambulation after a TKA, would you use the knee immobilzer? Yes, there will likely be swelling and inhibition of the quads and decreased stability, you will wean them from the knee immoblizer once the quad gains control
How would you gain ROM in a TKA patient post-op? CPM and also passive ROM to gain 90 flexion and 0 degrees extension
Who developed the CPM machine and what did his research say? Robert Salter first developed this device based on research that CPM had beneficial healing effects for joints and surrounding soft tissue
Is the research consistent that CPM is beneficial? NO, some studies show no significant difference in short-term outcome for CPM use versus an alternate form of early motion, other say YES that using CPM results in shorter hospitilizations
What is the primary use of CPM and for what joint? Improve ROM after surgery, knee joint
What are the therapeutic effects of CPM? May lessen the debilitating effects from immobilization May improve the rate of recovery May provide a stimulating effect on tissue healing May provide a quicker increase in ROM May decrease post-operative pain May reduce edema by assisting veno
Why is particular anticoagulant therapy a contraindication for CPM? May place patient at risk for an intracompartment hematoma
the patient has more pain with the use of CPM, what should your actions be? Discontinue the CPM because pain is a contraindication
If the patient has unwanted translation of opposing bones with the use of CPM, what should your actions be? Discontinue the CPM because pain is a contraindication
How soon can CPM be applied and to what degrees should it be applied? Immediately after surgery; different protocols are specific to each joint regarding time of use and degrees of motion
What must you do in order to receive effective and safe treatment from the CPM? Align the joint with the fulcrum of the CPM
How many degrees per day do you add for patients on the CPM? Begin with small arc of motion and progress about 10 degrees per day or as tolerated
Created by: mbutterfly