Lecture Osteoarthritis and Lower Extremity Athroplasty Flashcards Preview

PT - Ortho Class 1 > Lecture Osteoarthritis and Lower Extremity Athroplasty > Flashcards

Flashcards in Lecture Osteoarthritis and Lower Extremity Athroplasty Deck (42):
1

what is osteoarthritis?

generally progressive loss of articular cartilage accompanied by attempted repair of articular cartilage, remodelling, and sclerosis of subchondral bone, and in many instances the formation of subchondral bone cysts and marginal osteophytes

- attributed to both inflammatory and biomechanical factors

2

difference btw primary and secondary OA

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3

prevalence of OA in men and women

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4

incidence of OA in men and women

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5

describe the pathology of OA

- lecture slides 8-12 review

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6

what are the ROM and capsular patterns that are seen with OA patients?

OA knee: SOME evidence of Cyriax’s “capsular” pattern, NEITHER group significantly restricted ROM vs. “norms”

OA hip: NO evidence of Cyriax’s “capsular” pattern, BOTH groups significantly restricted ROM vs. “norms”

*People don’t necessarily need to have less rom to be classified as OA!

7

what are the signs and symptoms of OA?

–joint pain

–restriction of motion (capsular vs. bony)

–crepitus with motion

–joint effusions (fluid shift test)

–deformity (severe oa)

8

explain the progression of OA

Typically slow, over many years

–Occasionally rapid

May spontaneously stabilize or even improve

–partial restoration of the articular surface

–decrease in symptoms

9

describe articular cartilage

Diarhtrodial joint – what you think of when you hear joint – very moveable

Aneural = cant be source of pain, avascular = cant get nutrition well and therefore heals slower/hard to heal

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10

what is articular cartalage composed of?

*composed of: Cells, Extracellular Matrix, Water – very important

11

what are chondrocytes?

–Formation and maintenance of articular cartilage

–Respond to environmental stimuli

•Physiological

•Mechanical

–Loading & hydrostatic pressure

12

describe the extracelular components of cartalage

it is bi-phasic: Fluid phase (Water), Solid phase (Extra-cellular matrix)

- see slides 21-25

13

describe compressive loading in articular cartilage

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14

describe effect of cartilage when unloaded

15

describe effect of cartilage when loaded

1.Stress Shielding

–≤95% of compressive load is borne by FLUID phase

–decrease stress on solid matrix

2.Flow-dependent viscoelastic behaviour

–Hydrodynamic drag force is rate-dependent

–Forces on solid matrix vary with rate of loading

16

describe additional stresses on articular cartilage

- Articular cartilage = good s=with compression not with tensile stresses!

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17

describe the cycle of tissue damage in OA

1) initial injury to collagen matrix (increased permeability and loss of tensile strength)

2) limited repair (avascular and chondrocytes)

3) chondral repair tissue

*slides 35-37

18

explain the importance of joint loading for OA and type of loading

–High loading rates (impact loading) → OA

–Low loading rates (even at high loads) → no OA

•Ie a squat

•Distance running = usually not bad

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19

describe effect of immobilization on cartilage

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20

describe how articular contact forces affect the presentation of OA

- slides 42-44

21

describe for Patients undergoing a 2nd total joint replacement of a hip or knee due to OA or RA where the second replacement is more likely to be

–RA: 2nd joint “random”

–OA: Non-random - most likely to be on same joint, contralateral side OR different joint, contralteral side

* see sldie 45

22

describe the Biomechanical gait analysis in lower limb OA

- peak medial load (varus) before surgery which is still present after surgery

- contralateral>ipsilateral

23

what are the specific recomendations for people with OA?

Minimum ≥150 min/wk of moderate-intensity PA

~250 to 300 min/wk (approximately 2000 kcal/wk)

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24

describe semented vs cementless athroplasty

- Rough surface allows bone to grow into it to hold it in better

acrylic cement

–Generally allows immediate WBAT

cementless

–Porous surface (for bone in-growth) vs. non-porous

–Trend – younger, more active patients (bc will be sturdier than other and they are more likely to be more mobile after)

–May require a period of PWB or NWB

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25

what is not preserved after arthroplasty?

- screwhome mechanism

26

name the 2 surgical approaches for hip athroplasty

1.Anterolateral surgical approach (less common)

2.Posterolateral surgical approach

27

describe the anterolateral surgical approach

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28

describe the posterolateral surgical approach - contraindications? - for how long? - what ligaments are cut?

–no osteotomy of the greater trochanter (abductor function is not compromised)

–Complication – higher post-op dislocation rate (but still very uncommon)

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29

name some of the tissues involved with a posterolateral approach

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30

describe the knee athroplasty surgical approach

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31

describe surgical approach for ankle athroplasty

-Contraindications to movement based on surgical report

-Most nwb for period of time

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32

describe what the prehabilitation process entails

Comprehensive exercise program

•muscle strength, power & endurance

•cardiorespiratory fitness

•flexibility

•+/- balance training (for LE surgery)

Instructions for

•Transfers

•Use of supportive devices / walking aids

•Stair training

•Dislocation precautions (hip)

•Preparation for hospital discharge (OT home visit, etc.)

33

post-op contraindications for hip

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34

post-op contraindications for knee

- note that machines used for ROM, but need active muscle contraction to prevent DVT

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35

post-op contraindications for ankle

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36

knee antroplasty post-op day 1-2

notes

37

knee antroplasty post-op day 3-7

notes

38

knee antroplasty post-op weeks 1-6

notes

39

knee athroplasty post-op day 1-5

notes

40

knee athroplasty post-op day 6-14

notes

41

knee athroplasty post-op weeks 2-3

notes

42

knee athroplasty post-op weeks 3-8

notes