TKA - knee OA

Question 1

Arthritis

Answer 1

• joint inflammation
• natural reposes to disease and injury
• wearing out
• Erosion process
• accelerated: disease injury, alignment etc)
• various types

Question 2

Types of arthritis

Answer 2

• osteoarthritis: most common (DJD)
• rheumatoid - autoimmune
• psoriatic arthritis
• post-traumatic arthritis
• crystalline induced (GOUT)
• reactive arthritis
• infectious septic arthritis

Question 3

Degenerative and inflammatory arthritis

Answer 3

• inflammatory process suffocates the cartilage

Question 4

Presenting symptoms of arthritis

Answer 4

• stiffness
• decreased ROM
• swelling: effusion
• grinding crepitation
• pain
• functional limitations
• impaired activity
• limb deformity: late

Question 5

X-rays for knee OA

Answer 5

• must be done in WB
• NWB = no forces across the joint
• as cartilage thins subchondral bone has more forces = more calcium/sclerosis on a X-ray

Question 6

Non-surgical initial treatments for DJD of the knee

Answer 6

• activity modification
• exercise/weight reduction (cycling/swimming)
• shoe wear: shock absorb sole
• medication (Tylenol/NSAIDs)
• vitamins/supplements

Question 7

Therapeutic injections

Answer 7

• corticosteroids
• viscoelastic gels
• platelet-rich plasma
• stem cell therapy

Question 8

Corticosteriods

Answer 8

• intra-articular anti-inflammatory agent
• potent and targeted
• frequency3-4 x year
• indications: acute arthritic flare up
• too much of this can kill chondrocytes

Question 9

Viscoelastic Gels

Answer 9

• hyaluronic acid (holds onto fluids)
• augments joint fluid
• lubrication
• anti-inflammatory
• chondrites-protective
• selective candidates

Question 10

Platelet rich plasm a

Answer 10

• preparatin
• 30 cc blood –> 3-5cc PRP
• centrifuge 1-2 times
• complex growth factors from the platelets
• attempts to take advantage of natural healing properties
• regeneraties dagamen knee cartilage

Question 11

stem cell therapy for Knee DJD

Answer 11

• stem cells = self renew differentiate
• sources of stem cells: fat, blood, bone marrow, placenta
• bone marrow aspirate = best source
• clinical studies have not shown to rebuild cartilage in joints has the potential to regenerate lost cartilage, stop/reverse degeneration, pain relief, improve mobility
• not covered by insurance

Question 12

Other nonsurgical and non injection treatments arthritis

Answer 12

• knee KG
• APOS therapy
• IOVERA
• vehicular nerve ablation
• indicated when: surgical treatment, non-operative candidate

Question 13

Knee KG

Answer 13

• principle: gait root cause of patient’s symptoms; gait analysis study with biomechanics markers

Question 14

Knee KG evaluation process

Answer 14

• exoskeleton is attached to knee
• 3-D kinematics captured during routine treadmill walking
• date capture 3 planes of movement (optical tracking systme)
• identifies and measures biomechanics deficits

Question 15

Knee KG treatment

Answer 15

• targeted exercise and education to patient
• patient specific treatment plan
• look at where mechanics are off

Question 16

APOS therapy for knee DJD

Answer 16

personalized footwear to off-load pressure from knee and lower back

Question 17

APOS therapy: evaluation process

Answer 17

• specialist evaluates patient
• computerized gait analysis

Question 18

APOS treatment

Answer 18

• customized shoes off-load affected knee joint by calibrating shoe/sole devices
• therapy component to improve LE muscle
• requires re-calibration periodically
• customize the shoes contact areas to change where forces come from

Question 19

IOVERA

Answer 19

• cryoneurolysis - periarticular nerves using nitrous oxide
• works via wallerian degeneration of nerve
• targets sensory nerve branches to knee
• effects can last up to 90 days, repeat treatment every few month; majority of patients have some pain relief

Question 20

Contraindications for IOVERA

Answer 20

• cryoglobulinemia
• paroxysmal cold
• hemoglobinuria
• cold urticaria
• Raynaud’s open and/or infected wound nearby

Question 21

Genicular nerve ablation

Answer 21

• radiofrequency used to heat up and disrupt sensory nerves around capsule
• pre-test – successful nerve block

Question 22

Knee capsule innervation (in relation to vehicular nerve ablation)

Answer 22

• tibial neve branches
• common peroneal: 2 articularbranches
• posterior branch of obturator nerve
• saphenous nerve branche s
• femoral nerve branches

Question 23

Indications for surgical treatments

Answer 23

• pain significantly interferes with ADLs
• quality of life is unacceptable
• non-surgical interventions unsuccessful
• advanced joint disease demonstrated on X-ray
• age limitation –relative
• patient driven decision–guided by surgeon

Question 24

Partial replacement

Answer 24

• uni-compartmental
• medial or lateral
• patellofemoral joint

Question 25

selection criteria for TKA or partial

Answer 25

• type of arthritis
• location of arthritis
• ligamentous factors
• angular deformity limits
• ROM requirements
• body weight
• bone quality

Question 26

Uni-compartmental ideal candidates

Answer 26

• isolated OA
• symptoms isolated
• <250 lbs
• knee ROM >90
• <10 genu varus/vaglum
• non-inflammatory arthritis
• intact ACL
• failed conservative treatments

Question 27

Pre-op considerations for TKA

Answer 27

• medical optimization
• set expectations –motivated patient
• education class/engage family
• pre-habilitation: self-preformed
• pain management - preemptive multimodal analgesics

Question 28

correct modifiable risk factors before. TKA

Answer 28

• obesity
• smoking
• DM AC1 >7%
• anemia
• malnutrition
• deconditioned
• narcotics use (stop)