Total Knee Arthroplasty Practice Question Guide With Complete Guide.

TKA- Background - correct answer a) of all the possible surgical interventions, total knee replacement offers the greatest quality of life improvement b) there is a prediction that there will be more THA (THR) than TKA (TKR) surgeries TKA- Indications - correct answer a) to treat pain caused by RA, OA, or post traumatic arthritis b) eliminate pain, correct deformity, improve ROM c) age 64 is the average d) 60 percent females e) 40 percent will be bilateral TKA's within ten years note: - TRAUMA or OA are the two more common causes of TKA - bilateral TKA: just get it both done at same time, traditional course tho is do the more severe knee first - downside: fxnal activities like walking affected and sitting on toilet and going down stairs Knee Anatomy: what is sacrificed in the knee replacement surgery? - correct answer a) femoral component and tibial component b) for the most part, the ACL will be sacrificed too Arthritic Joint - correct answer a) osteoarthritis often results in: - bone rubbing on bone - bone spurs - joint space narrowing TKA Surgery: components - correct answer a) tibia - flat metal plate and stem with a polyethylene liner b) femoral - contoured metal c) patella - native or artificial TKA surgery cont: Types of Implant - correct answer Types of implant: a) fixed bearing - most common b) mobile bearing - more normal kinematics - less forgiving of imbalance in soft tissues c) PCL retaining or substituting - have a raised sloping cam or post which compensates for the missing PCL also: - Cemented vs non cemented note: - the shaping happens in the OR [sometimes there are leg length differences after] Implant Examples: hinge knee - correct answer Hinge Knee: - see this in limb salvage procedures Implant Examples--limb salvage - correct answer a) salvage: - a lot of times associated with osteosarcoma [may have taken out major significant components of upper and lower leg] Uni-compartmental Knee Arthroplasty - correct answer note: - this is the parallel to the hemiarthroplasty for the hip unicompartmental knee arthroplasty: - replace one side of the condyle good candidate for this: - trauma - djd - OA - not sacrificing the ACL for this here because only replacing half of the components note: - most likely will need a total knee later on Complications - correct answer a) DVT, PE b) infection c) patellofemoral complications d) neurovascular: peroneal nerve palsy e) periprosthetic fractures f) septic loosening g) arthrofibrosis (may need MUA) [manipulation or mobilization under anesthesia] --> scar tissue may form around the joint: making ROM difficult --> if PT not successful, medical team may choose MUA: manipulate joint while the patient is under and when they come out they get a lot more ROM note: - early activation of quad is key component! Complication: periprosthic fx - correct answer note: - fix with screws and rods - replace prosthesis with hinge prosthesis [A periprosthetic fracture is a broken bone that occurs around the components or implants of a total hip replacement. It is a serious complication that most often requires surgery.] Consideration during therapy - correct answer a) Labs HEMOGLOBIN men: 14-18 women: 12-16 <8 no activity Hematocrit: men: 41-53 women: 36-46 <35 no activity VITALS - HR, BP, O2 Sat ORTHOSTATIC HYPOTENSION NAUSEA/VOMITTING note: some people are a little anemic, so need to make clinical decision if you want to work with them cause if you wait too long for blood values to go up you might not get to Consideration - correct answer a) Pain control - PCA: patient controlled analgesia - PNI: peripheral nerve infusion --> femoral nerve block --> adductor canal block!! (most commonly seen) --> sciatic nerve catheter b) Braces - knee immobilizer - hinge knee brace - dynasplint (fxnal or resting?) note: - dynasplint: splint that is spring loaded - helps you get into extended or flexed position dependent upon on how spring is placed [gives a consistent pressure to extension to help you get those final degrees of extension ie 2 hrs on 2 hrs off] --used in resting position rather than in functional mobility like walking] Consideration cont - correct answer a) Drains: - stryker (not that common) - hemovac - JP b) Antibiotic spacer c) WB status Physical/Occupational Therapy - correct answer a) early mobilization b) ADL training c) Exercises: - ROM: AAROM, pt assisted, goal 0-90 - bridge position (look at bed positioning) - strengthening, quad activation note: - post op day 0: day after surgery (or post op day 1) - want to make sure that there is AS EARLY QUAD ACTIVATION AS POSSIBLE!!!! - put the towel under ankle to allow gravity to help bring knee into extension Physical/Occupational Therapy cont. - correct answer a) CPM?--8hrs day. goal 0-90 deg flex b) ice c) equipment needs d) DC planning - rehab: AR/SNF - home with home PT - OP PT note: - CPM=continuous passive motion/machine --->upside=movement---> downside= not active movement note: are to send someone with unilateral compartment knee replacement to acute rehab most patients go home with home health PT or OP PT general recommendation is that everyone gets OP PT