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What is the definition of Total Knee Arthroplasty? Surigical Procedure that removes the degenerated articular surfaces of the proximal tibia, distal femur and occasionally the articular surface of the patella, replacing those surfaces with metal, plastic or a combination.
What are two idications of TKA? 1. Eliminate or reduce knee pain. 2. Improve Indep with functional activities.
What are two causes of TKA? 1. Osteoarthritis (pts usually 60+). 2. Rhematoid arthritis (pts usually under 60).
What are three different types of degeneration? Unicompartmental, Bicompartmental, and Tricompartmental.
What does Unicompartmental mean? Medial or lateral side of the knee has degenerative changes with pain and dysfunction. (Valgum and varum).
What does Bicompartmental mean? Degeneration of both the medial and lateral joint compartments.
What does Tricompartmental mean? Degenration of medial, lateral and patellogemoral compartments fof the knee joint.
What are four contraindications of TKA? 1. Active or recent septic arthritis. 2. "Non-Funtioning extensor mechanism". 3. Sever neuroligic dysgunction that prevents extention or control of the knee. 4. Neuropathic joint.
What are the two prosthetic designs? Constrained(conforming implants), Non-Constrained(cruciate-sparing)
What does the Constrained prosthetic design do? Cruciiate ligaments (ACL, PCL or both) but rely of the complete conformity of compnents for stability.
What does the Non-Constrained prosthetic design do? Resurfacing implants retain ACL and PCL for stabilization.
What are two types of Prostheses? Cemented and Non-cemented
What is used more commonly now Cemented or Non-cemented? Cemented
What is the Cemented protheses? Prosthesis secured with cement usually WBAT within a few days. May loosen over time, especially in active patients.
What is the Non-Cemented prosthesis? Bone grows into proshtesis May be PWB TTWB for 1-2 weeks.
What types do you do for rehab after a TKA surgery? Weight bearing, CPM, Patellar Mobilization, Bed mobility, transfer training, and Gait Training.
How often do you use Weight Bearing rehab? For Cemented patients almost always, WBAT, Non-cemented may be PWB.
What do you do for CPM rehab? Surgeon may prescribe if pt has limited ROM or depending what type of procedure was done, Use with ice or E-stim.
What do you do for Gait training rehab? With a walker or crutches. Progress to SEC and stairs, dynamic surfaces.
What do you do for exercise in rehab? Initially do AAROM, progress to AROM. Hamstrings stretch.
What do you do for rehab after TKA? Start with QS, HS, GS, AP. progress to SAQ, SLR, ABD, seated KF KE, isometric ADD.
What are some indications of High Tibial Osteotomy? 1. Pt's with advanced OA/DJD of just one compartment of the knee. 2. Varus defomity-degeneration of hte medial component (more common). 3. Valgus Deformity-degeneration of lateral component.
What is the goal of the surgical procedure? The goal is to redistribute the forces and compressive loads more evenly across the joint line.
What do you attempt to do in the surgical procedure? Attempts to realign the tibiofemoral joint by surgically creating a wedge in the proximal tibia or distal femur depending on if they have a varus or valgus deformity.
What is Varus? Varus is deformity with medial compartment degeneration- remove leteral wedge form proximal tibia.
What is Valgus? Valgus is the deformity with lateral compartment degeneration-remove wedge form distal femur.
What do you do for rehab after HTO? 1. Ambulation-usually TDWB-PWB with brace and crutches or walker. Usually limited weight bearing for about 12 weeks but it is dependent on bone healing 2. At about 3-4 weeks post-op strengthenin PRE's can be initiated 3.assitive device D/C CKC can begin
What do you do for Exercise after HTO? isometrics- QS, GS, Hs progress to SLR in splint
What can be used occasonaly for valgus in HTO? CPM.
When can ROM and patellar mobilization begin? Once incision has healed.
What do you use for HTO? A knee immobolizer in full extension with a suction drain to help evacuate the excess blood.
What is HTO? High Tibial Osteotomy
What is a CPM used for? Valgus
What is involved with rehab of HTO? Ex iso. QS GS HS progress to SLR in splint and ROM and patellar mobs once incision has healed
Created by: demiller243