Knee and Hip OA, THR, TKR

Lecture 12

Increased Force

________ is caused by obesity, external force, excessive muscular force, and capsular tightness

force

Ways to decrease _______:

• decrease body weight

• do joint motion with eccentric contraction

• choose good footwear and good surfaces

• stretch tight muscles and/or capsules

decreased ROM, cyclical

capsular tightness causes ______ which leads to certain parts of the joint being more frequently loaded which causes further breakdown of tissue. this is a ______ pattern

F; they CAN

T/F: joint mobs cant help with capsular tightness

area, rapidly

in OA there is decreased _____ for the force to be dispersed which causes the load to be ______ applied to the joints

joint mobility

decreased area for force dispersion ultimately causes decreased _________ as Articular cartilage cannot distribute load as well causing potential fxs and loss of cartilage

osteoarthritis

Ways to help _____:

• slower loading rate

• surgery

• change positions to avoid creep

• increase ROM to WNL

lab results, imaging

Rheumatology uses ____ and _____ in addition to hip pain to rule in Hip OA

test clusters

PT uses _______ to rule in Hip OA

Flexion, 15 degrees

Test cluster 1 for Hip OA includes hip pain, hip ___ less than 115 deg, and hip IR less than ______

IR, greater

Test cluster 2 for hip OA includes hip pain with _____, AM stiffness lasting less than an hr, and _____ than 50y.o.

osteophytes, 3/6

For Knee OA dx, MUST include knee pain and ______ on xray and at least ___ other s/sx

• >50

• short term AM stiffness (<30 min)

• crepitus with AROM

• TTP at joint

• bony enlargement

• no palpable warmth

strength, balance

focus on _____, aerobic exercise, water programs, ROM/flexibility exercise, joint mobs/manual, ______ and perturbations for OA rehab

True; allows cartilage to be loaded and unloaded

T/F: a walking program is great for OA patients

protection, tylenol

it is important to teach pts about joint _____ techniques and the use of _____ or NSAIDs to control pain sx during pt education

EXERCISE

what is the most recommended CPG for knee and hip OA pts???

joint mobs

TENS, taping, _____, heat therapy and ultrasound actually have been shown to have little to no effect on OA rehab

exercise, aerobic

The primary PT treatments for OA include: ______ (specifically for quads and hip girdle), pt education, weight loss strategies, and _______ exercise

effusion, degradation

OA patients typically have pain caused by ______, joint damage or joint ______

closed packed

high pressure position for the hip is ______ position which is also IR and Extension

open packed

low pressure position for the hip is ______ position which is flexion and abd

mid range

the knee should be in ______ position

move, gentle

Two things to remember for OA rehab are _____ frequently and be _____

depends

to decrease effusion in OA joints, using ice or heat _____ on the patient

AROM, stress

you SHOULD be doing _____ and decreasing joint ____ during daily activities by slowly loading the joints

Stiffness

_____ is caused by degradation and stress located at 1 point in the joint and decreased ROM

FREQUENT

to treat stiffness, encourage _____ motion to treat the ROM loss

A/PROM

_____ loss is caused by pain, effusion, tightness and weakness

differentiate

as the PT, you must _____ which tissue is tight or weak when there is A/PROM loss

stretch

If a patient has decreased knee ext A/PROM, you should _____ via LLPS, do joint mobs, strength, treat the pain and swelling

eccentric

It is VITAL to focus on ______ strength especially in the quads since they are so involved in daily activities

Strength

Loss of _____ is caused by pain, swelling and inhibition, and disuse

Motor Control, proprioception

________ loss is caused by pain, strength, ______, and ROM loss

eccentric/concentric, functional loss

For strength and motor control, focus on _____/_____ exercises for quads, calves, hamstrings, and any other mms. that are weak and contributing to __________

DO NOT USE ISOMETRICS FOR OA (they cause jt compression)

DO NOT USE ISOMETRICS FOR OA (they cause jt compression)

F; it’s an isometric for the knee, so might be painful

T/F: SLR is a perfectly fine exercise for knee OA pts

Proprioceptive, can

________ training is crucial and (can/cannot) increase strength

isometric

standing on one leg is an _____ exercise for the hip

Balance loss

______ is caused by disuse or weak/dysfunctional motor control, pain, and proprioceptive loss

balance

the components of _____ are somatosensory, vestibular, and visual

Somatosensory

______ involves ROM, strength, Wbing ability, motor control and proprioception

BAPS board

Use the _______ to train early stages of proprioception then progress to SLS and steamboats

True

T/F: taping could decrease knee pain, unload the fat pad, and dispense force better along the patella

distraction

For OA, doing low grade _________ mobs would help to decrease pain

• anterior for hip

• ant/post for knee

protection, preservation

for OA rehab, joint ______ and _____ is KEY

both are effective, but supervised slightly better

is it better to do HEP or HEP + supervised?

80%

with aquatic exercise, chest deep level unloads the knee by ______

true

T/F: effectiveness of exercise is independent of presence or severity of x-ray findings

BMI, intensity

Predictors of poor function at 18 months include:

• increased age

• increased _____

• increased anxiety

• high ____ of knee pain

testing criteria

Examples of _______ include:

• pain

• rom

• I with HEP

• fxn + dysfxn

• balance

• motor control

outcomes

Examples of ______ include:

• pain

• I with HEP

• gait quality/quantity

• GROC

• pt satisfaction with fxn

1 year

Treatment programs have long term benefits of ______ for pain and function but it is dependent on the consistency of the patient’s HEP compliance

education, quads, proprioception

with TKR rehab, we should be doing pt _____, eccentric strengthening for _____, looking at gait especially dysfunction and _____ and balance — how it all relates to ADLs

influence

Mental health, psychological disorders and health-related beliefs like self efficacy all _____ rehab both pre and post surgery

assess pain, strength, ROM, need for meds from MD, or need for more pt education

how do I know my TKR pt is responding to PT or not?

TKR, ROM, DVT/PE

ACUTE _____ complications include limited _____/contractures, fxs, displacement or infection of prosthesis, ____/____, or delirium!!

Dementia

____ is the SLOW onset of mental status change

• might have to check with family members to see if there is a baseline

Delirium

_____ is the ACUTE onset of mental status change

UTI, pneumonia, meds

Delirium is due to _____, _____, ______, or peri-operative reasons

dementia

The strongest risk factor for developing delirium is ____

heterotopic ossification, infection

CHRONIC TKR complications include ______, peri-prosthetic bone loss, ______, or loosening of the prosthesis

• HAVE TO GO BACK IN

F; they dont normally need outpatient PT

T/F: in OP, it is very common to see THR patients in the clinic

six

THR Rehab includes:

• rom

• strength

• balance

• transfer

• gait

MUST follow precautions for first _____ weeks

6 months-1year

Some surgeons require precautions for ________ or forever

flexion

With THR precautions, avoid extreme positions of the hip ______ forever

ACUTE

______ THR complications include:

• fx

• dislocation

• infection

• dvt/pe

• post op anemia

• delirium

• perioperative neurologic injury

CHRONIC

_______ THR complications include:

• heterotopic ossification

• periprosthetic bone loss

knee and hip OA exercises OVERLAP a lot!!

knee and hip OA exercises OVERLAP a lot!!

walk

before AND after jt replacement, you should ______

run

before jt replacement, you should maybe not _____. after jt replacement, MD will say you shouldn’t at all if you want prosthesis to last forever

definitely

before replacement, you could play tennis based on your sx. after jt replacement, you _____ can play tennis

eccentric quad control

ULTIMATELY, you should be restoring ____________