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Total hip and knee
Scorebuilders 2010
| Question | Answer |
|---|---|
| What are the surgical indications for a total hip arthroplasy? | Osteoarthritis, Rheumatoid arthritis, failed internal fixation of a fracture, developmental dysplasia, osteomyelitis, and avascular necrosis |
| What are the surgical contraindications for a total hip arthroplasty? | Poor periarticular support, sepsis, active infection |
| What are the two types of THA? | Cemented and non cemented |
| What type of THA can you weight bear immediately as tolerated? | Cemented; Noncemented is toe touch wb for up to 6 weeks |
| What type of THA has a longer life expectancy secondary to allowing a larger amount of bone tissue to remain intact and allows for continued tissue growth | Noncemented |
| What type of THA requires more bone tissue removal and may experience loosening of the prosthesis? | Cemented |
| Which of the following nerves may get damaged with a THA?A)Tibial B)Peroneal C)Sciatic | Sciatic |
| Where would the THA be at risk for fracture?A) Through the prostheticB) Around the prosthetic (periprosthetic)C) Along the femoral headD) At the neck of the femur | periprosthetic |
| What four potential post-surgical complications can occur both in THA and TKA? | DVT, infection, pulmonary embolus,periprosthetic fracture |
| Which of the following are not a potential post-surgical complication of a THA?A)chronic joint effusion B) heterotopic ossification C) disclocation/subluxation of the femoral head D) infection | chronic joint effusion |
| What motions are limited and to what degree with a posterolateral approach to a THA? | Avoid hip adduction, avoid medial rotation, avoid hip flexion > 90 degrees |
| What types of advice can you give to a patient to help them avoid going past 90 degrees of hip flexion after a THA? | Do not sit on low surfaces, do not bend over towards the ground, do not lean over to get up from a chair, do not bend over to tie shoes |
| What types of advice can you give to a patient to help them avoid hip adduction after a THA? | Use an abduction pillow,do not cross the legs when sitting or lying down, use a pillow between the legs when in sidelying. |
| What types of advice can you give a patient to help them avoid hip medial rotation after a THA? | Do not pivot towards the surgical side |
| What should PT do with patients after a THA? | Maintain appropriate wb status, mobility training and early ambulation using hip precautions, initiate strengthening with isometric exercises and progress as tolerated, gentle stretching |
| What are the surgical indications of a TKA? | Disabling pain, failed conservative treatment, impaired mobility due to advanced arthritis |
| What are the surgical contraindications of a TKA? | Active infection, advanced osteoporosis, severe peripheral vascular disease, sepsis, morbid obesity |
| What are the types of a TKA? | Cemented, hybrid,noncemented |
| What type of TKA allows you to be wb immediately as tolerated? | Cemented |
| What does the hybrid TKA consist of? | Cemented tibial component and noncemented femoral and patellar components |
| What types of TKA want you to be toe touch wb for up to 6 weeks? | Hybrid and noncemented |
| What type of TKA has a longer life expectancy than cemented? | Non-cemented |
| What does the noncemented TKA consist of? | Femoral, tibial and patellar components are all noncemented |
| What nerve can be damaged after a TKA?A) SciaticB) TibialC) PeronealD) Radial | Peroneal |
| It is important to perform strengthening exercises and passive motion early after a TKA because the post surgical complications include: | Chronic joint effusion, restricted ROM, pulmonary embolus, DVT |
| Where would a TKA fracture post surgically? | periprosthetic |
| Why is a post surgical knee immobilizer used post operative TKA? | For stability |
| When you perform early ambulation after a TKA, would you use the knee immobilzer? | Yes, there will likely be swelling and inhibition of the quads and decreased stability, you will wean them from the knee immoblizer once the quad gains control |
| How would you gain ROM in a TKA patient post-op? | CPM and also passive ROM to gain 90 flexion and 0 degrees extension |
| Who developed the CPM machine and what did his research say? | Robert Salter first developed this device based on research that CPM had beneficial healing effects for joints and surrounding soft tissue |
| Is the research consistent that CPM is beneficial? | NO, some studies show no significant difference in short-term outcome for CPM use versus an alternate form of early motion, other say YES that using CPM results in shorter hospitilizations |
| What is the primary use of CPM and for what joint? | Improve ROM after surgery, knee joint |
| What are the therapeutic effects of CPM? | May lessen the debilitating effects from immobilization May improve the rate of recovery May provide a stimulating effect on tissue healing May provide a quicker increase in ROM May decrease post-operative pain May reduce edema by assisting veno |
| Why is particular anticoagulant therapy a contraindication for CPM? | May place patient at risk for an intracompartment hematoma |
| the patient has more pain with the use of CPM, what should your actions be? | Discontinue the CPM because pain is a contraindication |
| If the patient has unwanted translation of opposing bones with the use of CPM, what should your actions be? | Discontinue the CPM because pain is a contraindication |
| How soon can CPM be applied and to what degrees should it be applied? | Immediately after surgery; different protocols are specific to each joint regarding time of use and degrees of motion |
| What must you do in order to receive effective and safe treatment from the CPM? | Align the joint with the fulcrum of the CPM |
| How many degrees per day do you add for patients on the CPM? | Begin with small arc of motion and progress about 10 degrees per day or as tolerated |
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mbutterfly
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