quiz on Hip and knee replacements

Question 1

The acetabulum and the femoral head are covered in __________________, which reduces friction and absorbs shock, allow- ing the bony surfaces to move against each other without causing damage

Answer 1

articular cartilage

Question 2

acetabular labrum

Answer 2

A ring of fibrocartilaginous material that surrounds the acetabulum. The acetabular labrum adds to the depth of the acetabulum, thereby increasing the surface and strength of the hip joint.

Question 3

What are the ROM of the hip?

Answer 3

Hip motions include flexion, extension, abduction, adduction, medial (internal) rotation, lateral (external) rotation, and circumduction.

Question 4

What is the most common and problematic joint disease affecting middle-age and older adults.

Answer 4

OA

Question 5

Avascular necrosis

Answer 5

a condition that results from poor blood supply to an area of bone, causing bone death. Avascular necrosis is also known as aseptic necrosis or osteonecrosis. It has been associated with alcoholism, cortisone medication use, Cushing’s syndrome, radiation exposure, sickle-cell disease, pancreatitis, Gaucher disease, and systemic lupus erythematosus.

Question 6

Rheumatoid arthritis:

Answer 6

a chronic systemic inflammatory disorder that causes synovitis of multiple joints. Refer to the “Musculoskeletal and Immunological Disorders”

Question 7

What are some issues, diseases and conditions of the hip

Answer 7

OA, RA, Avascular necrosis, hip displasia and hip fractures

Question 8

Hip dysplasia:

Answer 8

a developmental abnormality in which the hip joint is not formed properly. The socket is shallow, and the head of the femur is not well rounded, which increases local stresses on the cartilage.

Question 9

Hip fractures:

Answer 9

a break in the upper part of the femur. Refer to the “Hip Fractures” section for detailed information on causes, treatment, and prevention of hip fractures.

Question 10

When might a pt elect to have a hip replacement

Answer 10

when conservative treatments, such as lifestyle and activity modification, medication, occupational and physical therapy, and alternative or complementary treatments, have failed or are no longer effective.

Question 11

Hip arthroplasty

Answer 11

is joint replacement surgery in which all or part of the hip joint is replaced with an artificial device.

Question 12

Total hip replacement is also known as total hip arthroplasty (THA) and involves three parts:

Answer 12

1. Stem: fits into the femur usually made of titanium-based or cobalt-chromium-based alloys
2. Ball: replaces the femoral head made of cobalt-chromium-based alloys or ceramic materials and polished smooth to allow easy rotation in the hip socket and
3. Cup: replaces the hip socket can be made of plastic, metal, ceramic, or ultra-high molecular-weight polyethylene, or a combination of polyethylene backed by metal.

Question 13

A prosthesis in which the ball and stem are combined into a single component is called

Answer 13

a bipolar prosthesis.

Question 14

Partial hip replacement (hemiarthroplasty) is indicated when

Answer 14

only one half of the joint needs to be replaced. The component replaced is generally the femoral component (i.e., the ball and stem

Question 15

why would a person get each of these kinds of THA
posterior, posterolateral, anterior (also known as direct anterior), anterolateral, and direct lateral ap- proaches.

Answer 15

The choice is based on surgeon preference, surgeon experience, and the patient’s premorbid condition.

Question 16

minimally invasive hip replacement is an umbrella term that refers

Answer 16

to variations of conventional THA techniques in which there is less soft tissue and bony dissection.
Minimally invasive surgery (MIS) may require specialized equipment to enhance visualization through the smaller incision and special operating table

Question 17

What is Hip resurfacing?

Answer 17

an alternative to THA in which the femoral head is reshaped and covered with a metal shell rather than removed.

Question 18

Hip resurfacing is considered to be a more difficult surgery to perform compared with THA. The disadvantages of hip resurfacing include

Answer 18

Risk of femoral neck fracture, which is not a risk in THA because the femoral neck is removed and ■ ■ High levels of circulating metal ions (i.e., metallosis) from the metal ball moving within the metal socket which may cause pain, swelling, or an allergic reaction in some patients

Question 19

revision total hip arthroplasty

Answer 19

part or all of the old pros- thesis is removed and replaced with new components.

Question 20

THA may fail for several reasons, including

Answer 20

mechanical loosen- ing, dislocation, implant failure, periprosthetic fracture, or infection. Patient factors such as obesity, diagnosis of RA or avascular necrosis versus OA, younger age, and higher activity level are associated with higher revision rates

Question 21

hip resection arthroplasty, also known as a Girdlestone procedure, was commonly performed after failure of a primary THA. In a Girdlestone procedure, the

Answer 21

head of the femur is removed. Al- though pain is alleviated, the limb is shortened, the hip is stiff, and an assistive device is required for walking. In some cases, a Girdlestone can be converted to a THA.

Question 22

Girdlestone procedures are now considered a last resort or salvage procedure when (4 reasons)

Answer 22

(1) infection has occurred after THA, (2) a failed hip replacement cannot be revised, or (3) THA is not a viable option for a painful hip that is affecting quality of life.

4. A Girdlestone procedure may also be performed in cases of primary infective (septic) arthritis.

Question 23

Which THA approach has a greater risk of dislocation anterior or posterior?

Answer 23

Posterior

Question 24

Posterior hip precautions

Answer 24

No hip flexion beyond 90° ■■ No hip adduction past neutral ■ No hip internal rotation

Question 25

Anterior hip precautions

Answer 25

No hip extension ■ No hip external rotation

Question 26

Global anterior and posterior hip precautions

Answer 26

No hip flexion beyond 90° ■■ No hip adduction past neutral ■■ No hip internal or external rotation ■■ No hip prone laying ■ No bridging

Question 27

Trochanteric hip precautions

Answer 27

No active hip abductio

Question 28

weight bearing as tolerated (WBAT)

Answer 28

Patient is allowed to put as much weight as tolerated through the operative extremity, with pain being the limiting factor

Question 29

Partial weight bearing (PWB)

Answer 29

Patient is allowed to put up to 50% of his or her body weight on the operative extremity

Question 30

Touchdown weight-bearing (TDWB

Answer 30

Patient is not allowed to bear weight on the operative extremity but is allowed to touch his or her toes to the floor to maintain balanc

Question 31

Non-weight-bearing (NWB

Answer 31

Patient is not allowed to bear any weight on the operative extremity.

Question 32

ORIF

Answer 32

Treatment of a hip fracture usually consists of reducing the fracture and holding it in place with an internal device while the bone heals. This type of surgery is known as open reduction internal fixation (ORIF).

Question 33

Each hip bone is a large, irregularly shaped bone that develops from the fusion during puberty of 3 bones: What are they?

Answer 33

the ilium—the superior, broad, flaring (fan-shaped) portion of the hip bone (2) the ischium—the body of the ischium helps form the acetabular portion of the hip joint and (3) the pubis—the lower, posterior part of the hip bone.

Question 34

Sacrum:

Answer 34

A spade-shaped bone formed by the fusion of 5 originally separate sacral vertebrae.

Question 35

Coccyx:

Answer 35

Formed by the fusion of 4 originally separate coccygeal vertebrae. The coccyx is also called the tail bone

Question 36

The main functions of the pelvis are to support the

Answer 36

spinal column, protect the abdominal organs, transfer weight of the upper body to the lower limbs, and withstand compression and other forces from supporting body weight.

Question 37

What type of joint is knee?

Answer 37

a double condyloid joint,

Question 38

What are the movements of the knee

Answer 38

flexion, extension, and medial and lateral rotation.

Question 39

Between the lateral and medial condyles of the femur and the lateral and medial condyles of the tibia are two articulations:

Answer 39

(1) the inferior joint

(2) the superior tibiofemoral joint.

Question 40

Ligaments are connective tissue that hold

Answer 40

bones together.

Question 41

The stability of the knee joint is provided by

Answer 41

its two collateral ligaments and two cruciate ligaments.

Question 42

The anterior cruciate ligament crosses from the lateral femoral condyle to its insertion site on the medial tibial spine. What does it do?

Answer 42

This ligament restrains anterior subluxation of the tibia relative to the femur.

Question 43

The posterior cruciate ligament crosses from the medial fem- oral condyle to the posterior aspect of the tibia. What does it do?

Answer 43

It prevents posterior subluxation of the tibia on the femur.

Question 44

The medial collateral ligament runs from the

Answer 44

medial aspect of the tibia to the medial aspect of the femur.

Question 45

What does the medial collateral ligament do

Answer 45

stabilizes the knee against valgus (toward the body’s midline) and rotational stresses

Question 46

The lateral collateral ligament runs from

Answer 46

the lateral femoral condyle and attaches at the head of the fibula.

Question 47

It is the main stabilizer against varus stress (away from the body’s midline) and also resists external rotation.

Answer 47

Lateral collateral ligament

Question 48

The menisci are

Answer 48

two semilunar cartilaginous discs, which act as the shock absorbers for the joint.

Question 49

OA in the knee joint is a result of

Answer 49

the menisci of the knees deteriorating as a result of age-related changes, repetitive trauma, or obesity

Question 50

A common procedure that can precede a total knee replacement is

Answer 50

knee arthroscopy, a minimally invasive procedure in which a small scope is inserted into the knee. The scope projects a picture of the knee’s interior to a television. If the damage to the knee is not ex- tensive, the surgeon can use various instruments through this small incision to debride or repair damaged tissues

Question 51

What is a knee arthroplasty?

Answer 51

An arthroplasty is a surgery in which one or more of the articular surfaces of a joint are replaced by a synthetic prosthesis (Figure 22.9). The prosthetic is typically made of a combination of metal and plastic.

Question 52

A prosthetic knee is made up of three components:

Answer 52

1. Tibial component to replace the top of the tibia
2. Femoral component to replace the two femoral condyles and the patellar groove
3. Patellar component to replace the bottom surface of the kneecap

Question 53

What are the restrictions after knee replacement surgery?

Answer 53

After the surgery is completed, patients will be allowed to bear weight through their operated leg as tolerated and will not have any restrictions

Question 54

Continuous passive motion machines

Answer 54

move the operative leg through a controlled, predetermined ROM while the patient is at rest.

Question 55

knee revision surgery,

Answer 55

part or all of the old prosthesis is removed and replaced with new components.

Question 56

joint arthroplasty

Answer 56

replacement of joint

Question 57

what is the most common joint replacement?

Answer 57

total knee replacement

Question 58

how long does a joint replacement last

Answer 58

used to be 10 years but now the materials are better and it seems to be holding longer.