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Musculoskeletal Studies > Surgical Management of OA > Flashcards

Surgical Management of OA Flashcards

1
Q

What are the indications for a total knee replacement or total hip replacement?

A
  • patient has been offered ALL non-surgical (core) treatments
  • Joint symptoms that have substantial impact on QoL and have not responded to core treatments - e.g. pain, stiffness and reduced function
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2
Q

What are the surgical options for OA hip?

A 
Resurfacing procedure
Hip arthroplasty (THR)
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3
Q

What occurs during resurfacing procedures?

A

femoral head is covered in a polyethylene cup - involves a smaller incision but less efective than the THR

more suitable for younger patients - shorted recovery time

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4
Q

What occurs during the THR?

A

Acetabulum is replaced with cemented in polyethylene cup

Femoral head is replaced with metal ball attached to a stem which is cemented into the medullary cavity of femur

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5
Q

What are the risks of the THR?

A 
Infections
Loosening of the prosthesis
DVT
PE
Chest infections 
Dislocation
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6
Q

What are the surgical approaches of a THR?

A

10-20cm incision:

  • Antero-lateral (between TFL and glutes)
  • Posterior (through posterior JC)
  • Posterolateral (between glutes and vastus lateralis)
  • Lateral (by the detachment of the greater trochanter - which is then wired back in)
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7
Q

Why is there a risk of dislocation following THR?

A

Division of the joint capsule and surrounding musculature - must heal and repair (which takes 6-12 weeks) - until this point there is a risk of dislocation

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8
Q

What positions increase the risk of dislocation?

A

adduction, flexion and rotation

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9
Q

How soon following THR can a patient WB?

A

As soon as possible - On the day or day 1 post op - with zimmer or elbow crutches (depending on pre-op mobility)

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10
Q

When will a patient be discharged after a THR?

A

Once able to independently mobilise including stairs (usually day 3 or 4)

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11
Q

How should physiotherapy be progressed?

A

Start with mobilisation - no agressive ROM as risk of dislocation

Main aim is to strengthen hip abd and ext & obtain good mobility

Gait re-education with walking aids

Advice and education

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12
Q

when can full ROM be obtained?

A

after 6 weeks

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13
Q

What advice and education should be given?

A 
care of the THR
wound care
swelling management
appropriate levels of activities
GEP
stairs
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14
Q

What are the surgical options for OA knee?

A

Arthroscopic wash out
tibial osteotomy
arthroplasty - uni- or bi- compartmental
Arthrodesis

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15
Q

What is an arthroscopic wash out?

A

key hole surgery to debride the joint - i.e. remove the flakes of cartilige and other debris

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16
Q

What is a tibial osteotmy?

A

removal of a chunk of tibial bone - to try and realign the joint surfaces and improve weight distribution

17
Q

What is arthrodesis?

A

fusion of the joint into extension

18
Q

What are the different types of knee replacement?

A

uni-condylar or bi-condylar - with a patella button (resurfacing of the posterior surface)

19
Q

What are the three linkage methods of a knee replacement?

A

unconstrained - no linkage - least stable

semi-constrained - partial linkage

constrained - linkage of the components - hinged - less ROM but most stable

20
Q

What is the surgical approach of a knee replacement?

A

medial parapatellar inscision
ACL is removed (sometimes PCL)
tibial component is cemented

21
Q

why is a medial parapatellar approach used?

A

the least disruption to the extensor mechanism - quads and patellar tendon

22
Q

What are the complications of the TKR?

A

No risk of dislocation

Risk of prosthetic loosening over time due to rotatory forces

23
Q

what is the post-operative care of the TKR?

A

Compression in the first 48 hrs for swelling
Mobilisation on day of surgery or day 1 - once sufficient quads control
Gait re-education, ROM and quads strengthening

24
Q

What quads exercises are appropriate?

A

Static quads, inner range quads, straight leg raises

25
Q

When will a patient be discharged after a TKR?

A

by day 3 - when able to mobilise independantly with E/C or sticks

26
Q

What ROM should be acheived following TKR?

A

0-100 degrees

27
Q

What is a CPM?

A

continuous passive movement machine - used to progressively increase knee flexion

Should only be used in conjunction with active strengthening

28
Q

What advice and education should be given following TKR?

A

Wound Care
Swelling management
HEP
Progressive increase in activity (i.e. walking distance)
Stair climbing
Checking for complications - e.g. DVT or chest infections

Musculoskeletal Studies (38 decks)

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