Flashcards in TKA Deck (34)
How old are most of the candidates for a TKA?
What are other options for people younger than 50?
High tibial osteotomy
What are some contraindications for a TKA?
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)
What are relative contraindications for a TKA?
Akin conditions within area
Severe peripheral vascular disease
Obesity (accelerates device wear)
What are some goals for a TKA?
patient goals & expectations must meet surgeons expected outcomes
What are some complications to a TKA?
Joint instability, stiffness, malalignment
Osteolysis (causes loosening)
Are the majority of DVTs after TKA Symptomatic or Asymptomatic?
What are some signs of a DVT?
Sudden bilateral swelling
What are some acute care goals for TKA?
Get them mobile, (Transfers, Stairs, Walking)
Initiate exercises (Isometrics, open chain exercises, heel slides)
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
Calf pain and swelling
What is some post-surgical rehab the patient may go through?
They will have a Hemovac
Epidural often for 25 hours
What are some typical exercises with TKA?
Isometrics-Quad sets, Glut sets
Active-SLR, ankle pumps, heel slides (helps with pain), LAQ/SAQ, standing hip exercises
What are some goals for discharge?
Safe ambulation with AD
Most go home unless commodities
What are some Home PT goals?
Used for people that are considered homebound
Progress exercises initiated at hospital
Patient mobility-gait training and transfers
Muscle endurance and CV endurance
What differences in rehab does a Uni vs TKA surgery have?
No rehab differences
Uni may start PT sooner
Uni recovers faster
What plays a role in the longevity of TKA?
Male-wear out faster
Dx of OA
What are some complications after surgery?
Infection (can lead to loosening and revision)
Crack in cement
Femur, tibia, or implant fracture
What are some warning signs for something going wrong?
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
What are some signs of infection?
elevated WBC count
Loss of ROM
Pain with WB
What are some risk factors for revision needs?
Get surgery younger than 55
Dx of OA
Are revisions easier or harder than primary TKA?
Primary is easier
70% in good to excellent range in revision compared to 90% in primary
How long do you need to get antibiotics after a dental procedure after total joint replacement?
What are some post-op goals in outpatient for TKA?
Improvement of flexion to at least 110 degrees
Improve CV fitness
Full functional activity performance
Independence in HEP
What are some impairments you'll see in outpatient?
Reduced Knee ROM
Impaired function (stairs)
How long can pain last after surgery?
6 months to a year
How long can swelling last in TKA?
up to a year
Warm to touch can last 6 months
Why do you want full extension before DC in TKA?
Gait needs full extension
Compensations with gait-altered loading patterns
Wear of the component can be changed
What are some knee extension ROM exercises?
Prolonged low load stretch (let gravity do the work)
Seated extension stretch
How much flexion do you need to DC
120-130 more typical