orthopedic: joint arthroplasty

what are THREE reasons to have a knee joint arthroplasty?

increased arthritic pain (OA)
decline in physical function
lack of response to conservative treatment

____ pain is the leading cause of musculoskeletal disability in the US

knee

a _______ / _______ knee arthroplasty can be done when damage is contained to a single compartment of the knee → damaged part of cartilage is replaced with prothesis

partial/unicompartmental

prosthesis → ________ __ ________ is becoming an increasingly popular option as it allows more motion in the hip

ceramic on polyethylene (CoP)

in the posterior lateral THA approach, it is important to instruct the client to _______ rotate the leg before turning during ambulation

externally

true or false: it is likely to dislocate after the anterior lateral THA approach

false

the following are predictors of _______ outcomes:

- higher pre-op HH or WOMAC

- higher pre-op knee extension MMT on affected side

- TUG < 10 4 weeks after surgery

- younger age

- male

- better walking scores post-op

better

Reason for TSA:
______ ______ ______ _______: very large & long-standing RC tear → changes shoulder joint → arthritis & destruction of joint cartilage

rotator cuff tear arthropathy

the following are considerations for _____ ______:

- mobilization / weight bearing
- age, gender, ethnicity
- nutrition (vitamin D, calcium & protein)
- limit alcohol consumption
- no smoking / vaping or any form of nicotine
- avoid marijuana
- healthy weight

bone health

medications like _________ have an unfavorable impact on bone healing

corticosteroids

total knee arthroplasty (TKA) → LOS = ___-___ days

0-1

total hip arthroplasty (THA) → LOS = ___-___ days

1-2

total shoulder arthroplasty (TSA) → LOS = ___-___ days

1-3

TKA → prosthetic replacement parts last about ____ years

25

true or false: guidelines recommend bilateral knee replacement

false

true or false: there is a shorter recovery period with a partial/unicompartmental knee arthroplasty due to smaller incision & less extensive procedure

true

a partial/unicompartmental knee arthroplasty is associated with better _____ preservation, but less predictable pain relief & potential for more surgery

ROM

after a partial/unicompartmental knee arthroplasty, it takes __-__ weeks to return to "normal" and PT should continue to 3-4 months

6-8

minimally invasive TKA spares the _____ tendon from being cut

quad

true or false: a person should be advised to participate in high impact exercises after a TKA

false

after TKA, the optimal position of the knee is in ______

flexion

TKA → the risk of periprosthetic fractures increases with client's ____

age

what is the most common complication after TKA?

blood clots

_____ _____ is a complication after TKA when fibrous nodules / scar tissue develops under the quad tendon which causes pain

patellar clunk

after TKA, an individual may need assistance in the home for about ___-__ days post surgery

5-7

true or false: a continuous passive motion (CPM) machine should be used following TKA

false

should the following be used following TKA?

- TENS

- glucosamine

- bisphosphonates

- hydroxychloroquine

- methotrexate

- biologics

no

preoperative programs before TKA include education and exercise particularly _______ and _______ which has a better effect on outcome and decreased LOS/costs

strengthening; flexibility

the following are _________ _________ for TKA:

- cryotherapy
- physical activity
- motor function training (balance, walking, movement, symmetry)
- ROM & strengthening
- flexion position in resting for first 7 days (30-90º)
- NMES for quad strength

rehabilitation interventions

the following are patient reported outcome measures for _____:

- WOMAC and modified WOMAC
- KOOS JR
- LEFS

TKA

the following are functional outcome measures for ____:

- TUG
- 30 second STS
- 6MWT(D)
- stair climbing test (9 steps in 10 seconds or less)

TKA

the following are rehabilitation considerations for ____:

- use of AD with quad weakness or perhaps anesthesia
- pain control
- RAPID discharge
- supervised PT sessions

TKA

TKA → post-op supervised PT sessions should begin within ____ hours and prior to dc

24

true or false: discharge to IRF is better than discharge home for individuals post TKA

false

individuals who are discharged to a ____ following TKA are associated with higher readmission rate and higher complications

SNF

reasons for total hip arthroplasty (THA) are similar to that of TKA and additionally for _____ ______ (trauma or pathological) and osteonecrosis

fracture management

during a hip arthroplasty, the head of the femoral is replaced with a prosthetic head on a shaft, and the joint surface of the _________ is lined with a bowl-shaped synthetic joint surface

acetabulum

a partial hip arthroplasty can also be performed for femur ______ (mostly displaced) where only the femoral part is replaced

fractures

true or false: there are APTA clinical practical guidelines for THA

false

true or false: diagnosis for THA is similar to TKA

true

which THA approach is minimally invasive?

direct anterior

the following are precautions for which THA approach?

- no hip flexion past 90º

- no extreme hip IR

- no hip adduction past neural

- never cross legs or ankles

- extend operated leg in front when transferring sit↔stand

- never sit for too long → change position every 30 minutes

posterior lateral

in the posterior lateral THA approach, it is important to avoid IR and adduction as these motions cause _______

dislocation

the _____ ______THA approach is not commonly used as the incision site is at the iliac crest to the thigh

anterior lateral

true or false: the anterior lateral THA approach is reported to be less painful but recovery is more difficult

true

the following are precautions for which THA approach?

- no hip extension

- no extreme hip ER

- no adduction past neutral

- do not cross legs → use pillow between legs when rolling

anterior lateral

after the anterior-lateral THA approach, the client should sleep on the ______ side when side lying

surgical

which THA approach is associated with quicker recovery and less pain?

direct anterior

which THA approach has less risk of dislocation post operatively and can avoid cutting the hip musculature?

direct anterior

the following are precautions for which THA approach?

- no bridging

- no hip extension

- no extreme hip ER

- no adduction past neutral

direct anterior

true or false: precautions for the direct anterior THA approach are likely not needed due to very low dislocation rate and there is associated risk of delayed independence and overall outcomes

true

true or false: evidence is emerging to suggest that hip precautions do not reduce the rate of dislocation

true

THA → dislocation occurs within the first ____ months after surgery

3

after THA, a sore hip or back may indicate which complication?

leg length discrepancy

which type of orthopedic equipment can be used following hip arthroplasty/revision to assist the client in maintaining hip precautions (adduction, IR, flexion past 90º)?

hip abductor pillow

in a partial/hemi hip arthroplasty, which part is removed & replaced?

femoral head

pre-op rehabilitation considerations for THA includes muscle power specifically in which two muscle groups?

glutes & quads

the following are patient reported outcome measures for ____:

- WOMAC
- HOOS

THA

the following are functional outcome measures for ____:

- TUG
- 6MWT(D)
- harris hip score

THA

preparation for client care: _______ _______

- out of bed orders

- PT orders

- weight bearing precautions

- bracing precautions

- ROM limitations or goals

- lab values

- HPI & PMH

- is the client appropriate for PT intervention?

chart review

preparation for client care: _______ _____

- home set up

- PLOF

- hobbies, interests, goals

- equipment needs

- does client have assistance at home?

- does client care for someone else?

social history

preparation for client care: _______ position

- vital signs

- pain level

- orientation

- ability to follow commands

- sensation

- limited MMT

- general ROM

- proprioception

- ability to move in bed

supine

preparation for client care: _____ ____ _____ position

- orthostatic hypotension

- more specific MMT

- more specific ROM

- seated balance (static & dynamic)

- further assessment of safety awareness

- ability to follow commands

- discuss session goals

- assistive devices

side of bed

preparation for client care: _______ position

- orthostatic hypotension

- standing balance

- maintaining WB precautions

- need to follow with wheelchair or safe to proceed alone

- pain level

standing

preparation for client care: _________

think about potential discharge date & type of mobility they will need to do at home

ambulation

the following are reasons for _________ of TKA or THA:

- loosening of the implant

- instability of the artificial joint

- extensive bacterial infections

- progressive degeneration of parts of the joint

- fractures

revisions

_______ ________ entails the removal & replacement of one or more components of the hip and knee endoprosthesis; it is therefore a follow-up surgical procedure for primary hip or knee arthroplasty that is performed on the same joint

revision arthroplasty

true or false: total shoulder arthroplasty (TSA) is less common than hip and knee but successful in relieving pain & disability

true

the following are reasons for ________ arthroplasty:

- OA, RA, post traumatic arthritis
- rotator cuff tear
- avascular necrosis (AVN)
- severe fractures
- revisions

shoulder

______ shoulder arthroplasty:

- humerus & glenoid

total

______ shoulder arthroplasty:

- metal ball or "stemmed" approach

hemi

______ shoulder arthroplasty:

- completely torn RTC with severe arm weakness

- previously failed shoulder replacement

- socket & metal ball are switched

reverse

in a reverse shoulder arthroplasty (RSA), the metal ball is placed on the _______ bone and the plastic socket is placed on the ______ bone

shoulder; arm

in reverse shoulder arthroplasty (RSA), the ________ is used to lift the arm instead of the rotator cuff

deltoid

after reverse shoulder arthroplasty, an individual may be able to only achieve ___º of shoulder flexion due to loss of RC muscles

90

after shoulder arthroplasty, a shoulder _______ is used for the first week and then at night for the next month → sling

immobilizer

the following are precautions for _____:

- no lifting for 2-4 weeks
- no contact sports
- avoid abduction, IR & other extreme motions for 6 weeks

TSA

what is the wilcox protocol for shoulder arthroplasty?

PROM → AAROM → AROM

recovery after TSA may be __-__ years

1-2

acceptable ROM after TSA is ___-___ shoulder flexion

90-140