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 acute care (hospital) inpatient extended care (rehab/SNF) outpatient home care Inpatient Acute Care (Hospital) Pain management preoperative NSAIDS and opioids given immediately before procedure reduce postoperative pain intraoperative regional anesthesia (spinal and/or epidural) preferred over general anesthesia Adductor canal blockade results in earlier postoperative ambulation 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 *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 Opioids: Mu agonist leading to neuron hyperpolarization and reduced excitability 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 Discharge home criteria medically stable 80-90° AROM knee flexion ambulate 75-100 feet ascend or descend stairs Inpatient Extended Care (Rehab) Earlier discharge to rehab from hospital associated with improved outcomes Discharge criteria to home similar to those in hospital Outpatient Care Physical therapy 2-3 times per week for at least 2 weeks focused on closed-chain concentric exercises gradually advance from crutches to cane to unassisted other modalities include but not limited to aquatic therapy buoyancy attenuates gravity/compressive forces in joint; provides resistance balance training proprioception and postural control cryotherapy correlation between local temp and synovial PGE2 neuromuscular electrical stimulation (NMES) may override deficits in muscle activation caused by CNS impairments Return to activities low-impact closed chain exercises preferred eliptical biking golf handicap will show rise after TKA (stays same with THA) impact activities may decrease longevity of implant running is discouraged Driving recommendations 4 weeks after a right total knee < 4 weeks after a left total knee
Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - High Tibial Osteotomy Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Parapatellar Approach Derek Bernstein Stephen Incavo Recon - High Tibial Osteotomy Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Derek Bernstein Stephen Incavo Recon - TKA Heterotopic Ossification
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (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? Review Topic | Tested Concept QID: 4585 Type & Select Correct Answer 1 Reduced risk of venous thromboembolism 1% (60/4380) 2 No long-term difference in ROM compared to patients not using CPM 94% (4139/4380) 3 Increased passive knee flexion at 6 months 3% (117/4380) 4 Increased length of hospitalization 1% (26/4380) 5 Decreased risk of surgical site infection 0% (2/4380) L 1 PGY1 & PGY2 B Essential Select Answer to see Preferred Response SUBMIT RESPONSE 2 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ11.16) A 68-year-old right handed male golfer presents with significant left knee pain which has not been amenable to conservative management. A radiograph is shown in Figure A. He is interested in pursuing total knee arthroplasty (TKA). What can this patient expect with regards to his golf game after undergoing this procedure? Review Topic | Tested Concept QID: 3439 FIGURES: A Type & Select Correct Answer 1 A significant rise in his handicap 49% (1922/3956) 2 No change in his drive distance 33% (1319/3956) 3 Decreased pain compared to undergoing a right TKA 12% (470/3956) 4 A significant chance of having severe pain during play 3% (109/3956) 5 Patients are required to use a cart while golfing 3% (120/3956) L 4 PGY5 D Tested Select Answer to see Preferred Response SUBMIT RESPONSE 1 You have 100% on this question. Just skip this one for now. Take This Question Anyway (OBQ10.109) Which of the following statements regarding the use of continuous passive motion (CPM) devices following total knee arthroplasty is true? Review Topic | Tested Concept QID: 3203 Type & Select Correct Answer 1 The use of CPM decreases the incidence of knee flexion contracture at 6 months following surgery. 3% (86/2657) 2 The use of CPM has been associated with a decreased incidence of secondary surgery for knee manipulation. 2% (48/2657) 3 The use of CPM has not demonstrated any difference in clinical outcomes at one year following surgery. 92% (2440/2657) 4 The use of CPM has been associated with increasing analgesic pain requirements in the first 3 days following surgery. 2% (65/2657) 5 The use of CPM decreases knee flexion at one year following surgery. 0% (6/2657) L 1 PGY1 & PGY2 B Essential Select Answer to see Preferred Response SUBMIT RESPONSE 3
All Videos (2) Podcasts (0) Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques The Bariatric Patient: Move Over BMI - Percent Body Fat Predicts Function After Total Knee - Michael Bolognesi, MD Michael Bolognesi Recon - TKA Postoperative Rehabilitation & Outpatient Management 4/27/2018 126 views Login to View Community Videos Login to View Community Videos 2017 Orthopaedic Summit Evolving Techniques 47-Year-Old Former Professional Football Player Asks 'Why Does My Knee Still Hurt 1 Year After Surgery' - Fred D. Cushner, MD Fred D. Cushner Recon - TKA Postoperative Rehabilitation & Outpatient Management 4/25/2018 336 views