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Questions and Answers
What is the main purpose of knee arthroplasty?
What is the main purpose of knee arthroplasty?
Which of the following conditions is NOT a contraindication for knee arthroplasty?
Which of the following conditions is NOT a contraindication for knee arthroplasty?
What classification of knee arthroplasty includes replacing both the femur and tibia in both compartments?
What classification of knee arthroplasty includes replacing both the femur and tibia in both compartments?
Which fixation method is characterized by not using cement?
Which fixation method is characterized by not using cement?
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What should be practiced during the preoperative rehabilitation visit?
What should be practiced during the preoperative rehabilitation visit?
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Which of the following is NOT recommended during the early postoperative stage?
Which of the following is NOT recommended during the early postoperative stage?
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What is the purpose of using a CPM machine before surgery?
What is the purpose of using a CPM machine before surgery?
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Which type of knee arthroplasty involves resurfacing the patellofemoral articulation?
Which type of knee arthroplasty involves resurfacing the patellofemoral articulation?
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What is the recommended approach if there is an extensor lag in patients using a continuous passive motion (CPM) device?
What is the recommended approach if there is an extensor lag in patients using a continuous passive motion (CPM) device?
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Which of the following exercises is appropriate for stretching the posterior aspect of a prosthetic knee replacement?
Which of the following exercises is appropriate for stretching the posterior aspect of a prosthetic knee replacement?
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What type of exercises should functional rehabilitation begin with after week 3?
What type of exercises should functional rehabilitation begin with after week 3?
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For a patient with a cemented prosthesis, what mobility aid is recommended initially?
For a patient with a cemented prosthesis, what mobility aid is recommended initially?
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Which statement regarding stair climbing after knee surgery is accurate?
Which statement regarding stair climbing after knee surgery is accurate?
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What type of exercises should be avoided for patients experiencing an extensor lag?
What type of exercises should be avoided for patients experiencing an extensor lag?
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What is a key strategy to mitigate the loss of proprioception after knee joint replacement?
What is a key strategy to mitigate the loss of proprioception after knee joint replacement?
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Which of the following best describes the proper walking technique post knee surgery?
Which of the following best describes the proper walking technique post knee surgery?
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What is the recommended duration to avoid twisting and turning after a knee replacement surgery?
What is the recommended duration to avoid twisting and turning after a knee replacement surgery?
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What is the possible range of motion expected for a cemented knee replacement within 3-4 weeks?
What is the possible range of motion expected for a cemented knee replacement within 3-4 weeks?
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At what week is it advisable to begin ambulation with a cane after a cemented knee replacement?
At what week is it advisable to begin ambulation with a cane after a cemented knee replacement?
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What is the typical function percentage achieved with the best knee replacements compared to total hip replacements?
What is the typical function percentage achieved with the best knee replacements compared to total hip replacements?
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Following a total knee replacement, when should isometric exercises start?
Following a total knee replacement, when should isometric exercises start?
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What is the weight-bearing recommendation for a patient with a cemented knee replacement by the fourth week?
What is the weight-bearing recommendation for a patient with a cemented knee replacement by the fourth week?
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What percentage of body weight should a patient with a cemented-less knee replacement aim to bear by week 6?
What percentage of body weight should a patient with a cemented-less knee replacement aim to bear by week 6?
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If a patient experiences a hot and swollen knee joint after exercise just three days post knee replacement, what is a likely reason for this symptom?
If a patient experiences a hot and swollen knee joint after exercise just three days post knee replacement, what is a likely reason for this symptom?
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What is one primary reason for performing quadriceps sets after surgery?
What is one primary reason for performing quadriceps sets after surgery?
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What is the purpose of maintaining the knee in an extended position for 4 days without active exercise?
What is the purpose of maintaining the knee in an extended position for 4 days without active exercise?
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What is the recommended range of active knee flexion for a patient by the 7th postoperative day?
What is the recommended range of active knee flexion for a patient by the 7th postoperative day?
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Which of the following is NOT a stated disadvantage of using a CPM machine in the early stage?
Which of the following is NOT a stated disadvantage of using a CPM machine in the early stage?
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What should a patient aim for in their knee flexion range at home if it has not reached the target by day 7?
What should a patient aim for in their knee flexion range at home if it has not reached the target by day 7?
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What is a likely reason for delayed unsupported weight bearing in patients utilizing CPM?
What is a likely reason for delayed unsupported weight bearing in patients utilizing CPM?
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Which statement about active assisted knee flexion is correct?
Which statement about active assisted knee flexion is correct?
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Why might manipulation under anesthesia be indicated if a CPM machine is unavailable?
Why might manipulation under anesthesia be indicated if a CPM machine is unavailable?
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Study Notes
Knee Arthroplasty Rehabilitation
- Knee arthroplasty is the surgical construction of a new, artificial, painless, movable, and stable knee joint.
- Indications for surgery are severe painful joints, with or without deformity. Common causes include rheumatoid arthritis, osteoarthritis, and traumatic arthritis.
- Contraindications include bone infection, severe osteoporosis, recent joint sepsis, and malignant tumors.
Classifications of Knee Arthroplasty
- Uni-compartmental: Replacing the opposing articular surfaces of the femur and tibia on either the medial or lateral side; often not as successful.
- Bi-compartmental: Replacing the opposing articular surfaces of the femur and tibia on both the medial and lateral sides.
- Tri-compartmental: Same as bi-compartmental with resurfacing of the patellofemoral articulation.
Preoperative Rehabilitation
- The first purpose of the preoperative visit is to record baseline information.
- This includes: pain and swelling, functional abilities and range of motion (ROM), and muscle strength.
- The second purpose is to prepare the patient for the postoperative program.
- This includes practice with exercises used after surgery, such as isometric quadriceps exercises.
- Training with walking aids (walker or crutches) and CPM machines should also be done before surgery.
Early Postoperative Stage (Day One)
- Deep breathing and coughing exercises are crucial to prevent complications and pressure sores.
- Ankle pumps (10 times every 2 hours) promote circulation and minimize deep vein thrombosis (DVT).
- Gluteal sets, upper extremity exercises, and patella movement exercises will be part of daily routine.
- Quadriceps sets (10 times per hour) reduce joint effusion and pain and help achieve inner-range strength.
- SLR exercises should begin after the first two days.
Two Main Forms of Management (No CPM)
- The knee is maintained in an extended position for 4 days with a large compression bandage and splint.
- This prevents movement and reduces pain.
- No active exercise can be done until the bandage/splint is removed.
- Assisted weight bearing begins from day 2 without active knee exercises during this stage.
Post-Removal (After 4 Days)
- Passive mobilization of the patella and the scar is crucial to reduce pain and increase flexion.
- Active assisted knee flexion is vital, starting twice daily for 20 minutes or more.
- Patients are typically discharged 5-6 days post-operation, assuming no complications arise.
- By day 7 post-op, ideally 50-70 degrees of active knee flexion should be achieved.
CPM (Continuous Passive Motion)
- Used immediately after surgery for up to 4 days, with a 6-hour daily routine.
- Controls flexion range at 40 degrees during first 24 hours and gradually increases by 10 degrees per day to 80-90 degrees by day 7.
- Active knee flexion returns more quickly with CPM than without it.
- Weight-bearing with the splint is possible two days post-op, without the splint 1-2 days later.
- CPM can hasten quadriceps strength.
CPM and Disadvantages
- Increased bed time, loss of independence, and discomfort are some common disadvantages of CPM in the early stage.
- Increased incidence of common peroneal nerve palsy and quadriceps lag are also observed.
- Patients on CPM should wear a splint at night.
Fixed Flexion Deformity
- This can be a particular problem for the CPM group due to an imbalance between flexion and extension gains.
- Methods to solve this problem include passive flexion progression halt until the extensor lag reduces and manual mobilization techniques to increase extension.
Functional Rehabilitation (Start at Week 3)
- Closed chain exercises (e.g., sitting up, stepping up/down, step-ups, small arc cycling) are introduced.
Proprioception Training
- Loss of proprioception (sensation about the position of the limb in space) is a normal part of knee joint replacement, which is often accentuated by removing parts of the joint capsule, including the ACL.
Walking
- Crutches/walkers (6-12 weeks) are used to support patients depending on the prosthetic type (cemented vs. cement-free) for the first few weeks to months.
- Patients should walk rhythmically, smoothly, and gradually increase the step length and leg weight bearing. Avoid limping and leaning away from the operated knee.
Stairs
- Handrails are typically required initially to aid in balance support with ascending (up with the good knee). Ascending and descending stairs (up with the good/down with bad) is excellent strengthening and endurance training.
Driving and Activities
- Driving, twisting, turning, jumping, and running should be avoided for at least 3 months.
- Some doctors extend this restriction to 6 months.
Knee Replacement Guidelines and Precautions
- Activity, range of motion, isometric and active exercises, resisted exercises, and ambulation have specific guidelines which are determined by the prosthetic type, or cemented vs. cement-less.
Problem-Solving Exercises
- Patients with new knee replacement pain and increased swelling have potentially caused issues with infection, DVT, or incorrect movement into flexion. ICE, positioning, and other considerations should be attempted.
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Description
Test your knowledge on knee arthroplasty with this quiz. Covering important topics such as indications, rehabilitation practices, and postoperative care, this quiz will help reinforce your understanding of knee replacement procedures. Ideal for medical students and professionals in orthopedics.
