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PT 742 Common Medical Conditions > TKA > Flashcards

Flashcards in TKA Deck (34)
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1

How old are most of the candidates for a TKA?

60-75

2

What are other options for people younger than 50?

High tibial osteotomy
Unicompartmental arthroplasty
Bicompartmental arthroplasty

3

What are some contraindications for a TKA?

Healing affect
Increased risk for complications or death (active local systemic infection, sepsis, severe vascular disease)
Device will fail (inability to control knee motion, extensor mechanism disruption (quads wont work), severe recurvatum due to weakness)

4

What are relative contraindications for a TKA?

Akin conditions within area
Diabetes
Severe peripheral vascular disease
Obesity (accelerates device wear)

5

What are some goals for a TKA?

Decrease pain
improve function
patient goals & expectations must meet surgeons expected outcomes

6

What are some complications to a TKA?

Bone Fracture
Joint instability, stiffness, malalignment
Nerve palsies
Vascular injury
Osteolysis (causes loosening)

7

Are the majority of DVTs after TKA Symptomatic or Asymptomatic?

Asymptomatic

8

What are some signs of a DVT?

Sudden bilateral swelling

9

What are some acute care goals for TKA?

Get them mobile, (Transfers, Stairs, Walking)
Initiate exercises (Isometrics, open chain exercises, heel slides)

10

Besides DVT, what are some other things you want to watch out for with a TKA?

SOB and chest pain-PE possible, De-conditioning, Cardiac Issues
Pulse Ox & BP
Hypotension
Calf pain and swelling
UTI

11

What is some post-surgical rehab the patient may go through?

They will have a Hemovac
Epidural often for 25 hours
Wound management
Ankle PUMPS
EARLY MOBILIZATION

12

What are some typical exercises with TKA?

Stretches-Manual, Self
Isometrics-Quad sets, Glut sets
Active-SLR, ankle pumps, heel slides (helps with pain), LAQ/SAQ, standing hip exercises

13

What are some goals for discharge?

Safe ambulation with AD
Most go home unless commodities

14

What are some Home PT goals?

Used for people that are considered homebound
Progress exercises initiated at hospital
Progress ROM
Patient mobility-gait training and transfers
Muscle endurance and CV endurance

15

What differences in rehab does a Uni vs TKA surgery have?

No rehab differences
Uni may start PT sooner
Uni recovers faster

16

What plays a role in the longevity of TKA?

Age
Male-wear out faster
Dx of OA
Obesity
Comorid conditions

17

What are some complications after surgery?

Implant loosening
Infection (can lead to loosening and revision)
Implant wear
Crack in cement
Femur, tibia, or implant fracture

18

What are some warning signs for something going wrong?

Recurrent Pain
Walking becomes painful
becomes stiff and hard to bend or straighten
redness and swelling appear
skin is warm to touch
change in appearance or alignment

19

What are some signs of infection?

Pain
elevated WBC count
Fever
Wound drainage
Loss of ROM
Pain with WB

20

What are some risk factors for revision needs?

Get surgery younger than 55
Male
Dx of OA
Obesity
Comorbid Conditions
Activity Level

21

Are revisions easier or harder than primary TKA?

Primary is easier
70% in good to excellent range in revision compared to 90% in primary

22

How long do you need to get antibiotics after a dental procedure after total joint replacement?

2 years

23

What are some post-op goals in outpatient for TKA?

Improvement of flexion to at least 110 degrees
Full extension
Improve strength/endurance
Improve CV fitness
Full functional activity performance
Independence in HEP

24

What are some impairments you'll see in outpatient?

Pain
Swelling/effusion
Reduced Knee ROM
Reduced Strength
Impaired function (stairs)
Lateral numbness

25

How long can pain last after surgery?

6 months to a year

26

How long can swelling last in TKA?

up to a year
Warm to touch can last 6 months

27

Why do you want full extension before DC in TKA?

Gait needs full extension
PFJ wear
Instability
Compensations with gait-altered loading patterns
Wear of the component can be changed

28

What are some knee extension ROM exercises?

Patellar mobilization
Prolonged low load stretch (let gravity do the work)
Seated extension stretch
Encourage PF

29

How much flexion do you need to DC

110 degrees
120-130 more typical

30

How can you work on flexion ROM?

patellar mobilizations
Heel slides
Knee flexor strengthening (hamstring usually recovers fast) can do reciprocal exercises