TJR Flashcards by Main Kim

What are common complications to TJR?

infection
dislocation
protrusion of prosthesis
loosening of prosthesis
fracture during or after surgery

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What are pre-op assessments?

LLD, MMT, ROM, neuro, functional mobility, gait and assessment outcome measures.

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What are some assessment outcome measures?

LEFS
HSS-Hip Society Score
KSS-Knee Society Score

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What is the greatest limiter to rehab post-TJR?

pain

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What is the therapeutic INR level?

2.0-3.0

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What are the main goals for TKA post-op?

restore soft tissue balance
optimize biomechanics
relieve pain!
maximize function
improve the quality of life

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What are the two types of TKA? which is most common?

cemented (most common) and Non-cemented or porous operation

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What is 1 pro, 1 con, and common demographic of cemented TKA?

pro: allow for early WB
con: can deteriorate over time
demo: commonly used in elderly

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What is 1 pro, 1 con, and common demographic of porous TKA?

pro: won’t deteriorate over time
con: must be non-WB for a period of time
demo: younger clients

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What type of TKA has non-cemented femoral and patella component with cemented tibial component called?

Hybrid TKA

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What type of TKA has replaced tibial and femoral component on one side only usually medial called?

Uni-compartmental TKA aka Makoplasty

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What type of TKA relies on soft tissue integrity to provide stability called?

Non-constrained TKA

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What type of TKA is most common, and it substitutes the PCL?

Semi-constrained TKA

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What type of TKA is fully constrained in one or more plane used for severe instability, and has high insidence of loosening?

Fully constrained TKA

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What direction of stabilization improves coronal plane stability?

posterior stabilization increases coronal stability

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What is the advantage of preserving the PCL during a TKA?

restores normal knee kinematics esp in stair climbing

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What is the disadvantage of preserving the PCL during a TKA?

impairs rollback of the femur on the tibia since PCL can be tight, and it also has decreased mechanical advantage of the quads

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What are the adequate post TKA ROM?

0-120 degrees, 90 is considered functional and can ambulate with 5-10 flexion contractures.

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Knee flexion ROM during: swing phase?

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Knee flexion ROM during: ascending/descending stairs?

83; 90

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Knee flexion ROM during: sitting?

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Knee flexion ROM during: tying shoes?

106

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Knee flexion ROM during: squatting on the floor?

117

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What are 6 factors affecting post-op ROM of TKA?

pre-op ROM
pre-op tib-fem angle
tightness of retained PCL
elevation of joint line
patellar thickness
patient motivation

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What are the 4 indicators for manipulation (MUA)

<70 flexion at 2 weeks post-op <90 flexion at 1 month post-op progressive loss of flexion <70 motion at 3 months post-op

TKA acute post-op 5 points?

- breathing exercise with spirometry - edema control with cryocuff - ankle pumps, isometrics, slr exercising - CPM or heel slides - out of bed with avoiding rotation

TKA Phase 1: Day 0-3 rehab, 6 points?

- gait training - knee immobilizer for ambulation or untile 3 SLR can be done - transfer, bed mob, stairs, etc - continue pain and edema control - TKE and AA LE exercises - start gentle knee stretching

What are the usual WB protocols for cemented and porous TKA?

cemented: WBAT porous: WBTT/NWB

TKA Phase 2: 7-14 days, subacute or inpatient goals?

decrease pain and edema, optimize ROM, and improve strength

What is Phase 2? 2a? 2b?

phase 2 is rehab (7-14 days) phase 2a is subacute or IP phase 2b is homecare

What phase 3?

OP rehab

What are the two types of THA?

conventional and hip resurfacing

What are the two parts of the conventional THA?

replacement of the acetabular cap | replacement of femoral head

What are the 3 types of the femoral head/stem components?

cemented porous hybrid

Anterior Approach: where? risk? avoid? pro?

TFL and satrorius lateral femoral cutaneous nerve avoid excessive hip extension has shorter recovery time

Anteriorlateral Approach: where? risk? avoid? pro?

TFL and Glut MED abductor muscles can be detached and superior gluteal and femoral nerve avoid excessive hip extension, abd, ER good for CVA pt to allow flexion and add

Posterolateral Approach: where? risk? avoid? pro?

Glut Max risk of traction injury of sciatic and superior glut nerve avoid hip flexion 90, adduction, IR

THA dislocation of an Anterior approach pt and Posterolateral pt may look like what?

Ant: ER PostLat: add & IR

who gets Hip resurfacing vs THA?

young active pt <60 years old

What are 3 major benefits of hip resurfacing?

- load though the hip is better distributed with better ROM - more hip stability - lower incidence of dislocation (0.5% vs 3.0%)

What are 3 major risks with hip resurfacing?

- chromium ion dispersal resulting in inflammation - femoral neck fx - heterotopic ossification

THA phase 1: intiating exercise allowed are?

- iso: quad & glute sets - active and AA: ankle pumps, knee ext, SAQ, heel slides to 45 deg, - breathing exercise spirometry

How long does THA precautions last?

at least 6-8 weeks.

When transferring OOB for THA what side?

Right THA: right side

THA Phase 1: goal?

for independence with ambulation, transfer, stairs using non-reciprocal pattern

THA Phase II: where?

IRF SNF Homecare

THA OP: when and goals?

once no longer homebound | -to normalize gait, improve balance, and improve endurance. Therex: CKC and treadmill

What are the two types of TSA?

Conventional | Reverse ball and socket

Who wants TSA?

OA/RA/Post-traumatic arthritis, RTC arthropathy, AVN/osteonecrosis, failed previous TSA, severe fx

What are 3 indicators for conventional TSA?

- intact RTC - some active ROM - pain is generally the main issue

What are 3 contraindicators for conventional TSA?

- bacterial infection of the shoulder - paralysis of deltoid & RTC, bad bone - pt unwilling to be a good PT pt

Conventional TSA: post-op 0-4 weeks: what is recommended?

- Codman - PROM 90 flexion and abd - PROM MD orders, usually 10 deg below prior - AROM of elbow, wrist, hand

With TSA: post-op 0-6 weeks: what active motion is not allowed?

No active IR. instead provide scapulothoracic mobs. and AAROM with MD clearance

What are 3 conventional TSA OP goals?

- restore AROM and deltoid and rtc strength - maximize scapulothoracic, elbow, and neck mobility - 135 flexion, 90 abd, 45 ER/IR or to L4 spinous process

rTSA is aka what?

reverse ball and socket TSA

What are 5 major indicators for rTSA?

- no RTC - no AROM of shoulder - presents as pseudoparalytic - irreparable RTC - > 65 y.o.

with rTSA it will move the joint line which direction?

lateral

rTSA will improve biomechanics of what muscle in what direction?

Deltoid; flexion * abduction

What are 3 major contra indicators for rTSA?

- structure/neuro lesion of the deltoid - glenoid damage without good bone for anchoring - <65 y.o.

For rTSA how many weeks post-op of no PROM?

4 weeks

rTSA post op allows for what AROM?

elbow, wrist, hand

rTSA in OP what muscle group do you not need to work on?

Since there is no RTC with rTSA, what is precaution?

jamming of prostheses and resulting in loosening, deltoid overpowers @ shoulder

What are the 3 main goals for rTSA in the OP setting?

- increase AROM flex & abd - increase MMT of deltoid - increase mobility of scapulothoracic