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PTRS 746 Exam 1 Combined and Randomized > JA > Flashcards

Flashcards in JA Deck (87):
1

Content: conventional TSA (2)

1. Cemented or un-cemented

2. Indicated for OA and intact RC

 

2

Content: 3 advantages of THA

1. Well studied

2. Easier to perform 

3. Suitable for wider range of pt. pops

2

Defn: Geometric knee

Allows for correction of valgus/varus/flexion deformities

2

Q: What is the name of the scoring system for DVT and PE?

WELLS score

3

Q: What are the 3 disadvantages of ceramic on ceramic as a bearing surface for HA?

1. Expensive

2. Requires expert inseriton technique

3. Possible joint noise

4

Q: What are the 3 disadvantages of cemented fixation for HA?

1. Longer operative time

2. More difficult to revise

3. Potential for adverse reaction to cement 

4

Content: 2 disadvantages of THA

1. Higher risk of dislocation (~5%)

2. More difficult to revise

4

Q: Bilateral TKA can be ____________ or ________ and involves _________ recovery, may require ____________ rehab.

concurrent, staged, longer, inpatient

4

Content: TSA Rehab Phase 2 (4)

1. 4-6 wks

2. AAROM/AROM

3. PROM into full ER, flexion < 140 (not OP)

4. Initiate AROM esp into flexion 

5

Q: When did TSA begin?

Early 1950s

6

Q: When did hip arthroplasty begin?

In the 1820s

6

Q: Who typically receives THR?

Younger, more active pts. 

7

Q: What is the disadvantage of metal on polyethylene as a bearing surface for HA?

Polyethylene debris may lead to aseptic loosening 

7

Defn: Anametric knee

Separate right and left femoral components with decreasing radii or rotation 

8

Content: Contraindications for JA (5)

1. Infection 

2. Severe or uncontrolled HTN

3. Progressive neurological disease

4. Dementia (may be considered relative contraindicaiton)

5. Latent renal or respiratory insufficiency (may be considered relative contraindicaiton)

 

8

Q: TKA complication of infection - ~______% risk in 1st 2 years, cumulative risk of _____% over 10 years, _________ site or _____ peri-prosthetic, ~____% assocaited with MRSA.

1.8, 2.47, surgical, deep, 20

9

Content: Early Post-Op THA Intervention (Acute & Sub-Acute) (7)

1. Ice and positioning

2. Education - PRECAUTIONS

3. Strengthening (AAROM,  AROM, isometrics, SAQ, LAQ, ankle pumps) 

4. Mobility (bed, transfers, tait, stairs, car transfer)

5. Edema management

6. Equipment recommendations

7. DC planning/recommendations 

10

Q: What is the difference between a total and hemi hip arthroplasty?

Total = femoral head and acetabulum replaced

Hemi = femoral head only replaced

11

T/F: With THA you should progress to CC and functional activities as soon as possible.

True

11

T/F: Adherence to bilateral posterior hip precautions is difficult.

True

12

Q: What does R for TKR stand for?

Resurfacing

13

Content: Unicompartmental Arthroplasy is ideally indicated for... (6)

1. Fexion > 90,

2. Full extension

3. < 15 varus/valgus deformity

4. Mobile patella

5. Intact tibial plateau/femoral condyles

6. Satisfactory ligamentous stability

14

Content: Late THA Intervention (chronic) (5)

1. Emphasize functional activities

2. Strengthen hip flexors, extensors, and abductors

3. Include resistance training if possible

4. Wean from AD if appropriate 

5. Limit high impact actiivty or activities with rotational forces 

14

Q: Who is unicompartmental arthroplasty used on?

Often older, lower demand pts.; increasingly used in younger pops.

15

T/F: THR results in a decreased risk for femoral neck fracture.

False; increased

15

Q: Prosthetic fialure rate of < ___% per year, _______% survive 10 yr, ____% survive 20 yr.

1, 90-95, 85

16

T/F: Bilateral TKA is less common than bilateral THA/THR.

False, more

18

Q: What are the 3 advantages of metal on polyethylene as a bearing surface for HA?

1. Cost effective

2. Evidence supports use

3. Predictable lifespan

19

T/F: Pts may assume they have posterior precautions based on their own "research" or the experiences of friends and family.

True 

19

Q: Regarding THA outcomes; ~____% of function is recovered within 8 months, ____% report satisfactory outcomes at 10 years; as many as ____% return to athletic activites within 3 yrs.

80, 90, 60

19

T/F: The effects of CPM on knee ROM are justifiable.

False; too small to justify 

19

Q: A bilateral THA is usually staged by at least ___ wk, but often > ___wks between surgeries.

1, 6

19

Q: During phase 3 of TSA Rehab overhead activity/forceful stretching > _____ flexion, ______ ER, and horizontal ADD beyond _________ should be avoided

140, 45, neutral 

19

T/F: Oral pain medications rarely contribute to post-op nausea, dizziness, constipation, etc.

False: often 

20

Q: What is malnutrition associated with in regards to JA? (4)

1. Infection

2. Delayed wound healing

3. Increased LOS and rehab time

4. Mortality

22

Q: What are the (PT) goals of rehabilitation for JA (3)

1. Restore function

2. Decrease pain 

3. Gain muscle control/strength

22

Content: Factors associated with increased risk of revision (5)

1. Younger age

2. Male gender

3. Multiple comorbidities

4. Avascular necrosis (vs. OA)

5. Femoral head size (?)

23

T/F: Activities should be prescribed according to the standard 3 sets of 10.

False: according to physiological principles

24

Content: Risk factors for THA dislocation (8)

1. Neuromuscular impairment

2. Cognitive dysfunction

3. Fracture

4. Hx of srugery 

5. Posterior approach

6. Small femoral head size 

7. Prosthetic alignment

8. Surgeon experience

24

T/F: Bilateral THA is associated with no change in the risk for VTE.

False, increased risk 

26

Q: Which approach allows for better functional compliance?

Anterior, the precautions are less likely to interfere with functional activity but the procedure is more difficult

28

Q: What is the lifespan of a joint replacement?

~15 years

29

Content: Reverse TSA (3)

1. Normal ball and socket arrangement is switched

2. Allows use of deltoid to lift arm (vs. RC)

3. Indicated if RC is fully torn, cuff tear arthropathy is present or hx of failed replacement 

30

Content: High Tibial Osteotomy (4)

1. Surgical realignment of joint

2. Delays TKA (gain ~9 yrs)

3. Indicated for unicompartmental disease or agnular deformity

4. Allows reasonable joint stability and an active lifestyle

32

Content: Relative contraindications for JA (3)

1. Obesity

2. Diabetes

3. < 50 yo or > 90 yo

32

Content: Unicompartemntal Arthroplasty (4)

1. Obseity is associated with high failure rates

2. bone conserving procedure benefits younger pts. 

3. Post-op rehab < than TKA rehab

4. 8-10 year surivial of hardward

33

Diagram: Study on THA vs. THR

A image thumb
34

Q: When did TKAs begin?

1860s

36

T/F: Epidural anesthiesia is not used for higher-risk pts.

False: may be used

38

Diagram: Treatment pyramid for OA. What do the red arrow indicate?

Q image thumb

PT intervention indicated

40

Diagram: Standard THA vs. Mini-Incision

A image thumb
41

Content: Primary Indications for JA (6)

1. Marked, disabiling pain

2. Decreased fucntion

3. Marked impairment in ROM 

4. Instability and/or deformity 

5. Recurrent dislocation 

6. Failure of prior interventions/surgeries

42

Content: Effect of pre-op education of JA process (3)

1. Reduces pre-op anxiety and pain 

2. Reduces post-op pain medication use

3. May reduce LOS

44

Content: Mini-Incision arthroplasty (4)

1. Performed through 2 smaller incisions (2-6 vs. 8-10 inch)

2. Possible short term advantages (less pain/bleeding/time to d/c)

3. little long term evidence

4. technically demanding

45

Content: TKA Rehabilitation (acute and subacute) (7)

1. Ice and positioning

2. ROM (DC goal of 0 extension, 90 flexion includes PROM)

3. Strengthening (isometrics, ankle pumps, heel slides, SAQ, LAQ, SLR)

4. Mobility (normalize gait, functional knee ROM)

5. Education (WBing precautions, gait quality)

6. Edema and pain management

7. DC planning/recommendations

46

Content: Risk factors for infection following a TKA (4)

1. Obesity

2. Anemia 

3. Malnutrition

4. Diabetes

48

Q: How many approaches are there for HA?

7 (Direct anterior, anteriolateral, direct lateral/transgluteal, lateral transtrochanteric, posterolateral, posterior mini, anterior mini)

50

T/F: In the past materials such as, ivory, glass, rubber, stainless steal, polyethylene, and acrylic, were used in hip arthroplasty.

True

52

Q: What are the 2 advantages of ceramic on ceramic as a bearing surface for HA?

1. Low friction/wear

2. Inert material 

54

Q: What are the 2 advantages of cemented fixation for HA?

1. More stable initially 

2. Better short and mid term outcomes

55

Content: TSA Rehab Phase 3 (4)

1. 8-12+ wks

2. AROM into flexion and ER

3. Strengthen shoulder girdle 

4. Avoid overhead activity and forceful stretching 

57

Q: Incidence of dislocation with THA is ~_______% for primary procedures and may increase to as much as ____% with revision; _____% of dislocations occur within ___wks of surgery

0.3-10, 28, 60-70, 6

58

Q: Who is an ideal pt. for a TKA? (2)

1. > 60 yo

2. < 180 lbs

60

Q: What are the 2 advantages of metal on metal as a bearing surface for HA?

1. Low friction/wear

2. Lower dislocation risk

61

Q: What components are involved in a TSA?

Humeral and (optional) glenoid component

62

Q: What are the 2 disadvantages of uncemented fixation for HA?

1. Increased risk of peri-prosthetic fracture

2. Lack of good long term outcome data

63

Content: Recurrent THA dislocation (4)

1. Spica brace may be required

2. May also require WB restrictions/movement precautions

3. Education, ADL, home evaluation 

4. Communication with pt., family, medical team 

64

Q: What are the functional concerns with posterior precautions?

Getting into/out of chairs/car

65

Content: 3 precautions for the anterior lateral THA 

1. Avoid abduction

2. Avoid hip extension 

3. Avoid hip ER

66

T/F: A bilateral TKA should be bilateral WBAT.

True

67

Q: What are the 2 disadvantages of metal on metal as a bearing surface for HA?

1. Possible carcinogenic effect of metal ions

2. Metallosis

68

Content: Risk factors for VTE following TKA (6)

1. BMI > 25

2. COPD

3. Atrial fibrillation

4. Anema

5. Depression 

6. History of DVT

70

Content: 3 precautions for the posterior lateral THA

1. Avoid adduction past nuetral

2. Avoid hip flexion > 90

3. Avoid hip IR

71

Content: TSA Rehab Phase 1 (4)

1. 2-4 wks

2. PROM/AAROM

3. Immobilization

4. No AROM 

73

Content: Primary Causes of JA (5)

1. OA

2. RA

3. Traumatic arthritis 

4. Avascular necrosis 

5. Fracture repair

75

Q: What are the 2 advantages of uncemented fixation for HA?

1. Lower risk of CV and VTE events

2. Bone conserving

77

Content: Complications of JA (16 - just recognize)

1. DVT and PE

2. Infection (acute and long term)

3. Arthrofibrosis

4. CRPS

5. Component loosening/failur

6. Allergic reaction 

7. Pneumonia

8. Hematoma

9. Surgical fracture

10. Mal-alignment of prosthesis

11. Fracture of prosthesis

12. Limb length discrepany

13. Dislocatoin

14. Neural injury 

15. Thermal damage/laceration

16. Heterotrophic ossification (HO)

 

78

Q: TKA complication of venous thromboembolism (VTE) - with prophylaxis up to ____% will developt DVT and up to ____% will developt PE

5,

79

Q: During phase 1 of TSA rehab, no flexion > ______, ER > ______ or ABD > ______.

120, 30, 45

80

Content: 3 advantages of THR

1. Lower dislocation risk (

2. Bone conserving

3. Lower wear/friction

81

Content: TKA Late Intervention (chronic) (4)

1. Emphasize functional activity 

2. Increase ROM

3. strengthening

4. limit high impact

82

Q: On the WELLS scale a score of > ___ means a high pretest probability of DVT and a score of > ___ means a high pretest probability of a PE.

3, 6

83

Q: Does fast tracking work?

Current evidence suggest yes: 

- more rapid return to function 

- reduced opiode consumption

- shorter LOS

- reduced risk of blood transfusion

- reduced mortality 

 

84

Content: Areas of priority for fast-tracking recovery (4)

1. Pre-op education

2. Nutritional supplementation

3. Pain management

4. Early mobilization 

85

Q: TKA complication of venous thromboembolism (VTE) - without prophylaxis up to ____% will developt DVT and up to ____% will developt PE

60, 20

86

Q: ____ million Americans are living with TKA, ____ million American are living with THA.

4.7, 2.5

87

Content: 2 disadvantages of THR

1. Technically difficult 

2. Little long term data