Introduction Rehabilitation requires coordinated effort from orthopaedic surgeon physical therapist occupational therapist case manager nursing staff patient and patient's family Care can be broken down into different phases including Inpatient management post-operative anemia Inpatient Management Pain management preoperative NSAIDS and opioids given immediately before procedure reduce postoperative pain intraoperative regional anesthesia (spinal and/or epidural) preferred over general anesthesia peripheral nerve blocks useful adjuvant to decrease postoperative pain periarticular multimodal drug injection decrease postoperative pain with minimal risks postoperative multimodal oral drug therapy gold standard and includes NSAIDs: Inhibit COX-1 and COX-2 ? inhibition of inflammatory mediators ( PGs, TXA, AA) opioids Mu agonist leading to neuron hyperpolarization and reduced excitability NSAIDs inhibit COX-1 and COX-2 inhibition of inflammatory mediators (PGs, TXA, AA) selective COX-2 inhibitors inhibits transformation of AA to PG precursors minimizes GI effects may inhibit bone healing gabapentin/pregabalin reduce hyper-excitability of voltage dependent Ca2+ channels in activated neurons. pregabalin= better oral bioavailability. SNRIs inhibition of serotonin and noradrenergic reuptake in the CNS Physical therapy therapy should start on the day of surgery reduces length of hospital stay reduced pain and improves function Range of motion requirements swing phase of gait 65° of flexion activities of daily living 90° of flexion stairs 95° of flexion rise from a chair 105° of flexion Continuous passive motion (CPM) machine improve early knee flexion has not been shown to have a long-term benefit Drain Placement has not demonstrated any difference in complications or outcomes Discharge home criteria medically stable 80-90° AROM knee flexion ambulate 75-100 feet ascend or descend stairs Post-Operative Anemia Intra-operative less intraoperative blood loss with the use of tourniquet Earlier discharge to rehab from hospital associated with improved outcomes Discharge criteria to home similar to those in hospital
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next (OBQ19.50) A 73-year-old undergoes the procedure depicted in Figure A. Which of the following statements below related to his procedure is most accurate? QID: 213952 FIGURES: A Type & Select Correct Answer 1 The use of continuous passive motion (CPM) postoperatively correlates with early ambulation 4% (61/1436) 2 Compared to the use of adductor canal blocks, femoral nerve blocks results in superior pain control 7% (99/1436) 3 The use of adductor canal blocks results in earlier postoperative ambulation compared to femoral nerve blocks 84% (1210/1436) 4 Adductor canal blocks results in sensory and quadriceps musculature blockade 2% (25/1436) 5 The use of a longer-acting spinal anesthetic results in earlier ambulation 2% (35/1436) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ18.124) Of the following, which has the highest strength of recommendation according to the AAOS Clinical Practice Guidelines (CPG) for Surgical Management of Osteoarthritis of the Knee? QID: 213020 Type & Select Correct Answer 1 Preoperative physical therapy improves pain and physical function postoperatively 28% (663/2392) 2 Tourniquet use during total knee arthroplasty (TKA) decreases short-term postoperative function 1% (29/2392) 3 Continuous passive motion (CPM) after TKA improves outcomes 1% (26/2392) 4 Rehabilitation started on the day of TKA reduces length of hospital stay 69% (1660/2392) 5 Surgical navigation should be used because there is a decrease in pain and functional outcomes 0% (4/2392) L 3 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ12.225) A 62-year-old female undergoes an uncomplicated primary total knee replacement. Her knee range-of-motion pre-operatively was 0-135 degrees of flexion. Which of the following is true regarding the immediate post-operative use of a continuous passive motion machine in this patient? QID: 4585 Type & Select Correct Answer 1 Reduced risk of venous thromboembolism 1% (80/5540) 2 No long-term difference in ROM compared to patients not using CPM 94% (5231/5540) 3 Increased passive knee flexion at 6 months 3% (145/5540) 4 Increased length of hospitalization 1% (41/5540) 5 Decreased risk of surgical site infection 0% (3/5540) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ10.109) Which of the following statements regarding the use of continuous passive motion (CPM) devices following total knee arthroplasty is true? QID: 3203 Type & Select Correct Answer 1 The use of CPM decreases the incidence of knee flexion contracture at 6 months following surgery. 3% (103/3148) 2 The use of CPM has been associated with a decreased incidence of secondary surgery for knee manipulation. 2% (57/3148) 3 The use of CPM has not demonstrated any difference in clinical outcomes at one year following surgery. 92% (2886/3148) 4 The use of CPM has been associated with increasing analgesic pain requirements in the first 3 days following surgery. 2% (78/3148) 5 The use of CPM decreases knee flexion at one year following surgery. 0% (7/3148) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos 2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: Acetaminophen Injection For Postoperative Pain Can Make A Difference In Your Patient Satisfaction - Michael P. Ast, MD (OSET 2018) Michael P. Ast Recon - TKA Postoperative Inpatient Management A 7/25/2019 199 views 4.0 (3) Login to View Community Videos Login to View Community Videos California Orthopaedic Association Annual Meeting - 2018 Pain and Blood Loss Management after Total Hip and Knee Arthroplasty - The Secret Sauce for Rapid Recovery Total Joints - Charles DeCook, MD, Arthritis & Total Joint Specialist, Atlanta (COA 2018, 1.1) Recon - TKA Postoperative Inpatient Management A 8/24/2018 1358 views 4.8 (8) Recon | TKA Postoperative Inpatient Management Recon - TKA Postoperative Inpatient Management Listen Now 16:46 min 2/22/2022 95 plays 0.0 (0)