Total Joint Arthroplasty/ERLP

Total hip WB precautions for cemented prosthesis vs non-cemented

cemented: FWB

non-cemented: WB per physician preference

Total hip precautions for posterior/lateral approach

no medial rotation

no flexion past 90

no adduction

Total hip precautions for anterior/lateral approach

no external rotation/flexion

limit extension

Post operative THA exercises that are safe

\-ankle pumps

\-quad sets

\-heel slide

\-short arc/full arc quads

\-supine hip abduction

\-SLR

Walker and crutches are typically used for __ weeks after a THA

3

OA accounts for __% of all total knee replacements (2017)

87

In a total knee arthroplasty, the release of contracted soft tissues is on the _____ side of deformity

concave

In TKA, valgus deformity may release __ structures, and varus may release __ structures

lateral, medial (side of concavity)

Absolute contraindications for TJA

active joint infection or severe neurosensory deficits

Evidence based interventions can decrease pain and improve function before __ but not __

THA, TKA

According to Nankaku/Holstege in 2011-2013, what three things were predictive of post-operative function (THA)

pre-operative age

knee extensor strength

TUG score

Post-op gait training for a THA is normally initiated __

POD 1-2

T/F: unsupervised activity programs may be as efficacious as supervised physical therapy after surgery (TKA/THA)

true

There is strong evidence that PT should include what types of training following a TKA?

balance, gait training, movement symmetry - as soon as 24 hrs after surgery

Modality to consider after TKA especially if there are significant quad strength deficits (>15-20%)

NMES (mod evidence according to CPG)

There is moderate evidence that PT’s should design, implement, teach, and progress patients who have undergone TKA in ___ during the early subacute period (within 7 days)

high intensity strength training

Tibiofemoral joint forces with walking, cycling, and running

walking: 1.5-4x body weight

cycling: 1.2x body weight

running: 2-8x body weight

Indications for a total ankle arthroplasty

end stage ankle arthrosis in patients who are not morbidly obese and do not require to return to high impact activities

TAA contraindications? Most frequent complication?

severe contractures/ligamentous instability

high activity level

complication: aseptic loosening

Two different types of total shoulder arthroplasty prosthetic components

unconstrained: relies on soft tissue integrity (most common)

\
constrained: glenoid and humerus are fixed to bone

Total shoulder arthroplasty indications

mod/severe OA

acute trauma (fracture)

cannot perform ADLs

non-functional ROM

reconstruction following tumor removal

Describe total shoulder arthroplasty vs hemiarthroplasty in terms of operative time, risk of instability, and relief of pain

hemi: shorter operative time/less risk of instability, less consistent relief of pain

total: longer operative time, more risk of instability, more consistent relief of pain

What type of shoulder arthroplasty is indicated in patients who have long-standing RC tears

hemiarthroplasty

Total shoulder patients are restricted in what ROM after surgery?

ER (

Good exercises for the protective phase of a total shoulder arthroplasty (days 0-6)? Begin strength exercises (isometrics) at week _

pendulum or table top exercises, week 6

Most important predictor of the outcome of a total shoulder replacement is the __

preoperative ROM

Want to avoid what motions in the first 4-6 weeks of a reverse total shoulder

extension, adduction, IR

Reverse total shoulder complications

AC fracture, scapular notching, instability (#1)

First 6 weeks, which motion to avoid in total elbow arthroplasty

active extension

Lifting restrictions for total elbow arthroplasty

1kg for 10 reps or 5kg for 1 rep

After a total wrist arthroplasty, AROM/PROM is limited to digits in first two weeks, when can you start wrist A/PROM?

6 weeks

Four causes of exercise related leg pain

1) medial tibial stress syndrome

2) stress fracture

3) chronic exertional compartment syndrome

4) tendinopathy

Presentation:

* Exercise-induced pain (“dull/achy”) along distal 2/3 of posteromedial border of tibia; considered an overuse injury
* Worse at start of exercise but decreases after awhile
* Pain with palpation of posteromedial tibia
* Lack of neuro symptoms
* RF: Female, high BMI, footwear, excessive STJ pronation

medial tibial stress syndrome

Pathogenesis of MTSS (three types)

Type 1: inadequate bone strength - stress reaction/microfractures

Type 2: Persistent pain at the junction of the periosteum and fascia

Type 3: Distal posterior chronic compartment ischemic syndrome

Main educational piece with MTSS?

relative rest from exacerbating activity, shock absorbing orthoses may improve symptoms

A microtraumatic injury representing a maladaptation to smaller repetitive forces; a fatigue fracture (load is repetitively placed on bone at a rate where the body does not have time to recover)

stress fracture

Bone health is dependent on what four factors?

mechanical, hormonal, nutritional, and genetic factors

Presentation:

* Insidious onset of point tenderness
* Begins as a mild ache with exercise, pain will then persist after exercise/affect ADLs
* Pain with direct or indirect percussion over bone
* Hard to distinguish from MTSS
* Tibia (46%), navicular (15%), fibula (12%)
* RF: distance runners, female, ballet dancers

Stress fracture

Loading with a stress fracture should not provoke s/s > __ during or after activity completion

2/10

What external device has been proven redistribute impact forces and decrease pain in athletes with a stress fracture

pneumatic leg bracing

NSAIDs for stress fracture?

Avoid use of NSAIDs because they may delay tissue healing, only use if they have night pain/pain at rest

If a stress fracture is not treated seriously with relative rest, what can happen?

complete bone fracture