Joint Arthroplasty and Post-Surgical Rehabilitation Flashcards Preview

PTRS 746 Exam 1 > Joint Arthroplasty and Post-Surgical Rehabilitation > Flashcards

Flashcards in Joint Arthroplasty and Post-Surgical Rehabilitation Deck (87):
1

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

4.7, 2.5

2

Q: What is the lifespan of a joint replacement?

~15 years

3

Q: What does R for TKR stand for?

Resurfacing

4

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

Q image thumb

PT intervention indicated

5

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

1. Restore function

2. Decrease pain 

3. Gain muscle control/strength

6

Content: Primary Causes of JA (5)

1. OA

2. RA

3. Traumatic arthritis 

4. Avascular necrosis 

5. Fracture repair

7

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

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)

 

9

Content: Relative contraindications for JA (3)

1. Obesity

2. Diabetes

3. < 50 yo or > 90 yo

10

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

False: may be used

11

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)

 

12

Q: When did hip arthroplasty begin?

In the 1820s

13

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

True

14

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

15

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

Polyethylene debris may lead to aseptic loosening 

16

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

1. Low friction/wear

2. Lower dislocation risk

17

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

18

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

1. Low friction/wear

2. Inert material 

19

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

20

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

1. Lower risk of CV and VTE events

2. Bone conserving

21

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

22

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

1. More stable initially 

2. Better short and mid term outcomes

23

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 

24

Q: How many approaches are there for HA?

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

25

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

26

Diagram: Standard THA vs. Mini-Incision

A image thumb
27

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

Total = femoral head and acetabulum replaced

Hemi = femoral head only replaced

28

Q: Who typically receives THR?

Younger, more active pts. 

29

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

False; increased

30

Content: 3 advantages of THR

1. Lower dislocation risk (<1%)

2. Bone conserving

3. Lower wear/friction

31

Content: 2 disadvantages of THR

1. Technically difficult 

2. Little long term data

32

Content: 3 advantages of THA

1. Well studied

2. Easier to perform 

3. Suitable for wider range of pt. pops

33

Content: 2 disadvantages of THA

1. Higher risk of dislocation (~5%)

2. More difficult to revise

34

Diagram: Study on THA vs. THR

A image thumb
35

Content: 3 precautions for the posterior lateral THA

1. Avoid adduction past nuetral

2. Avoid hip flexion > 90

3. Avoid hip IR

36

Content: 3 precautions for the anterior lateral THA 

1. Avoid abduction

2. Avoid hip extension 

3. Avoid hip ER

37

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

True 

38

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

39

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

40

Q: What are the functional concerns with posterior precautions?

Getting into/out of chairs/car

41

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

42

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 

43

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

1, 90-95, 85

44

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 (?)

45

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 

46

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

True

47

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 

48

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

49

Q: When did TKAs begin?

1860s

50

Defn: Geometric knee

Allows for correction of valgus/varus/flexion deformities

51

Defn: Anametric knee

Separate right and left femoral components with decreasing radii or rotation 

52

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

53

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

54

Q: Who is unicompartmental arthroplasty used on?

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

55

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

56

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

1. > 60 yo

2. < 180 lbs

57

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

58

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

1. Obesity

2. Anemia 

3. Malnutrition

4. Diabetes

59

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

60, 20

60

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

5, <1

61

Content: Risk factors for VTE following TKA (6)

1. BMI > 25

2. COPD

3. Atrial fibrillation

4. Anema

5. Depression 

6. History of DVT

62

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

WELLS score

63

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

64

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

65

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

False; too small to justify 

66

Content: TKA Late Intervention (chronic) (4)

1. Emphasize functional activity 

2. Increase ROM

3. strengthening

4. limit high impact

67

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

False, more

68

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

True

69

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

concurrent, staged, longer, inpatient

70

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

1, 6

71

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

False, increased risk 

72

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

True

73

Q: When did TSA begin?

Early 1950s

74

Q: What components are involved in a TSA?

Humeral and (optional) glenoid component

75

Content: conventional TSA (2)

1. Cemented or un-cemented

2. Indicated for OA and intact RC

 

76

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 

77

Content: TSA Rehab Phase 1 (4)

1. 2-4 wks

2. PROM/AAROM

3. Immobilization

4. No AROM 

78

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

120, 30, 45

79

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 

80

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 

81

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

140, 45, neutral 

82

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

False: often 

83

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

1. Pre-op education

2. Nutritional supplementation

3. Pain management

4. Early mobilization 

84

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

85

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

86

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

False: according to physiological principles

87

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