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Acute Care Module 1 > Ortho Part 2 > Flashcards

Ortho Part 2 Flashcards

(51 cards)

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1
Q

what two things indicate a joint arthroplasty?

A

functional mobility loss and degenerative arthritis

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2
Q

what percentage is associated with PWB

A

20-50%

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3
Q

what is the ROM of the knee

A

130-140 - 0 - 10

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4
Q

what knee ROM is needed to ascend stairs?

A

0 - 83

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5
Q

what knee ROM is needed to descend stairs

A

0 - 90

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6
Q

what knee ROM is needed for normal gait

A

0 - 67

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7
Q

what knee ROM is need to tie shoes?

A

0 - 106

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8
Q

which TKA approach leads to post op quad inhibition?

A

medial parapatellar approach

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9
Q

what are two major surgical complications specific to TKA (hint: infection is not one of them in this case)

A

intercondylar fracture and peroneal nerve injury (foot drop)

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10
Q

what are expected outcomes for discharge to home following a TKA

A
  1. HEP independence
  2. safety in household mobility
  3. knowledgeable about precautions
  4. 0 - 90 flexion
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11
Q

when is a posterior extension splint used for a TKA patient? when is it DC?

A

when OOB and during WB activities until quad control is reestablished

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12
Q

what are the holy trinity of post op precautions following TKA?

A
  1. avoid agressive flexion ROM
  2. avoid SLR in SL
  3. avoid pillow under the knee
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13
Q

why do you avoid aggressive flexion ROM post op TKA?

A

excessive tension can open incision site

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14
Q

why do you avoid SLR in SL post op TKA?

A

varus/valgus stress to operated knee

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15
Q

where do you recommend a pillow under an elevated TKA extremity to minimize knee flexion contracture?

A

under the calf

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16
Q

what two activities for TKA patients reduce the risk of CVP complications post op?

A

incentive spirometry and ankle pumps

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17
Q

relative to 100% pre op, how would you rate 1 month post op quad strength (despite PT 24 hours after surgery)

A

60% 1 month post op

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18
Q

what provides the greatest benefit to strength and function 48 hours post op TKA?

A

NMES to quads 2x/day 48 hours post op

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19
Q

when can you start stretching following TKA?

A

immediately, but be wary of incision site closure

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20
Q

how much hip flexion is needed for sitting on an average seat

A

112

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21
Q

how much hip flexion is needed to ascend stairs? descend?

Study These Flashcards
A

up: 67
down: 36

22
Q

what hip ROM is needed for normal gait

Study These Flashcards
A

30-40 flexion
10 extension
5 abd/add/IR/ER

23
Q

how does the surgeon access the hip joint in a posterolateral approach

Study These Flashcards
A

split the glute max, ERs reflected

24
Q

what are the posterolateral hip precautions

Study These Flashcards
A

for a minimum of 6 weeks

  1. no flexion >90
  2. no IR past neutral
  3. no adduction past neutral
  4. avoid trunk twists
25
how does the surgeon access the hip join in an anterolateral approach
between TFL and glute med, fascia latae and vastus lateralis dissected at origin
26
what are the anterolateral hip precautions
for a minimum of 8 weeks 1. no extension past neutral 2. no bridging 3. no prone 4. no hip extension plus ER
27
what are additional anterolateral hip precautions that are surgeon dependent?
for 6-8 weeks: 1. no active abduction 2. no hip flexion >90 3. no crossing legs (adduction or trunk twists)
28
what are the anterior hip precautions
generally, there are no hip precautions for the anterior approach
29
what are precautions following a trochanteric osteotomy
for 8 weeks: 1. no active/resisted abduction 2. restricted WB
30
what are three common intraoperative complications specific to a THA
1. malpositioning of components 2. femoral or acetabular fx 3. sciatic nerve injury
31
when do THA dislocations most likely occur?
first 2-3 months post op
32
in the first six weeks, the femoral head is only held in position by what two things
muscle tension and scar tissue formation
33
what are the signs of THA dislocation (which is most important - put in all caps)
1. excessive pain with motion 2. abnormal or limited IR/ER 3. LIMB SHORTENING 4. abnormal WB
34
what percentage of SLS load is relieved by a contralateral cane?
60%
35
unsupported one-legged stance produces loads of body weight across the hip
4-7x
36
walker/cane supported one-legged stance produces loads of body weight across the hip
2-3x
37
supine SLR produces loads of body weight across the hip
>3x
38
rising from a low chair produces loads of body weight across the hip
8x
39
what are the expected outcomes following a THA to DC home?
1. independence with HEP 2. safe household mobility 3. understands precautions
40
what is the holy trinity of post THA treatment precautions
1. avoid max isometrics of extensors and abductors 2. avoid SLR 3. use hip abduction pillow
41
what activities can reduce CVP complications risk?
ankle pumps and incentive spirometry
42
what strengthening exercises should you employ post op THA? avoid?
pro: submax isometric quad and glute sets con: SLR
43
what RFs increase risk for post TKA/THA infections
1. immune deficient/compromised 2. DM 3. PVD 4. oooooobesity
44
exhaustive list of sxs of an infected joint
redness, warmth, swelling, stiffness, drainage, fever, chills, night sweats, fatigue
45
how do infections resolve?
IV antibiotics, debridement, staged surgery
46
how does THA/TKA infection debridement work
contaminated tissue removed, all parts thoroguhly cleaned, IV antibiotics for 6 weeks
47
what is stage 1 of staged surgery for post op infection
remove the joint, wash out joint and soft tissues, place an antibiotic spacer, IV antibiotics
48
what is stage 2 of staged surgery for post op infection
remove antibiotic spacer and get replacement parts
49
what are rehab considerations for debridement following a post op infection
WBAT, pain/edema limit ROM and mobility, SEE THE PATIENT ONCE PER DAY, usually longer stay
50
what are rehab , for staged surgery following a post op infection
WBAT, pain/edema limit ROM and mobility, SEE THE PATIENT TWICE PER DAY, usually longer stay, NO KNEE FLEXION PAST 90 FOR ANTIBIOTIC SPACER
51
what are precautions for antibiotic knee spacers
if in the knee, no flexion past 90

Acute Care Module 1 (6 decks)

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