Knee Arthroplasty Basics Quiz

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Questions and Answers

What is the main purpose of knee arthroplasty?

  • To correct visual impairments in patients
  • To relieve pain and provide knee joint stability (correct)
  • To improve bone density
  • To enhance muscle strength around the joint

Which of the following conditions is NOT a contraindication for knee arthroplasty?

  • Severe osteoporosis
  • Traumatic arthritis (correct)
  • Recent joint sepsis
  • Bone infection

What classification of knee arthroplasty includes replacing both the femur and tibia in both compartments?

  • Cemented
  • Tri-compartmental
  • Bi-compartmental (correct)
  • Uni-compartmental

Which fixation method is characterized by not using cement?

<p>Cemented-less (C)</p> Signup and view all the answers

What should be practiced during the preoperative rehabilitation visit?

<p>Walking aids training (D)</p> Signup and view all the answers

Which of the following is NOT recommended during the early postoperative stage?

<p>Intensive resistance training (A)</p> Signup and view all the answers

What is the purpose of using a CPM machine before surgery?

<p>To prepare the patient for easier post-surgical rehabilitation (D)</p> Signup and view all the answers

Which type of knee arthroplasty involves resurfacing the patellofemoral articulation?

<p>Tri-compartmental (C)</p> Signup and view all the answers

What is the recommended approach if there is an extensor lag in patients using a continuous passive motion (CPM) device?

<p>Stop progression of passive flexion until extensor lag reduces. (A)</p> Signup and view all the answers

Which of the following exercises is appropriate for stretching the posterior aspect of a prosthetic knee replacement?

<p>Passive knee extension stretch. (D)</p> Signup and view all the answers

What type of exercises should functional rehabilitation begin with after week 3?

<p>Closed chain exercises. (B)</p> Signup and view all the answers

For a patient with a cemented prosthesis, what mobility aid is recommended initially?

<p>Crutches or a walker for 6 weeks. (A)</p> Signup and view all the answers

Which statement regarding stair climbing after knee surgery is accurate?

<p>Only one step at a time is recommended initially. (C)</p> Signup and view all the answers

What type of exercises should be avoided for patients experiencing an extensor lag?

<p>Forceful mobilization or PROM over 90°. (B)</p> Signup and view all the answers

What is a key strategy to mitigate the loss of proprioception after knee joint replacement?

<p>Engage in proprioception training. (A)</p> Signup and view all the answers

Which of the following best describes the proper walking technique post knee surgery?

<p>Adjust step length and speed gradually. (D)</p> Signup and view all the answers

What is the recommended duration to avoid twisting and turning after a knee replacement surgery?

<p>3 months (C)</p> Signup and view all the answers

What is the possible range of motion expected for a cemented knee replacement within 3-4 weeks?

<p>0-120° (D)</p> Signup and view all the answers

At what week is it advisable to begin ambulation with a cane after a cemented knee replacement?

<p>Week 3 (D)</p> Signup and view all the answers

What is the typical function percentage achieved with the best knee replacements compared to total hip replacements?

<p>80-85% for knees, 90-95% for hips (B)</p> Signup and view all the answers

Following a total knee replacement, when should isometric exercises start?

<p>Immediately postoperative (A)</p> Signup and view all the answers

What is the weight-bearing recommendation for a patient with a cemented knee replacement by the fourth week?

<p>Full weight bearing without assistive device (C)</p> Signup and view all the answers

What percentage of body weight should a patient with a cemented-less knee replacement aim to bear by week 6?

<p>50% (B)</p> Signup and view all the answers

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?

<p>Excessive exercise leading to inflammation (A)</p> Signup and view all the answers

What is one primary reason for performing quadriceps sets after surgery?

<p>To overcome muscle inhibition produced by pain (B)</p> Signup and view all the answers

What is the purpose of maintaining the knee in an extended position for 4 days without active exercise?

<p>To prevent movement and reduce pain (C)</p> Signup and view all the answers

What is the recommended range of active knee flexion for a patient by the 7th postoperative day?

<p>50-70 degrees (D)</p> Signup and view all the answers

Which of the following is NOT a stated disadvantage of using a CPM machine in the early stage?

<p>Increased risk of joint stiffness (C)</p> Signup and view all the answers

What should a patient aim for in their knee flexion range at home if it has not reached the target by day 7?

<p>Increase flexion range by 10 degrees per day (B)</p> Signup and view all the answers

What is a likely reason for delayed unsupported weight bearing in patients utilizing CPM?

<p>Greater quadriceps lag (C)</p> Signup and view all the answers

Which statement about active assisted knee flexion is correct?

<p>It should begin twice daily for at least 20 minutes (C)</p> Signup and view all the answers

Why might manipulation under anesthesia be indicated if a CPM machine is unavailable?

<p>To address insufficient knee flexion by day 7 (C)</p> Signup and view all the answers

Flashcards

Uni-compartmental knee replacement

Replacing only the surfaces of the medial or lateral compartment of the knee.

Bi-compartmental knee replacement

Replacing the surfaces of both the medial and lateral compartments of the knee.

Tri-compartmental knee replacement

Replacing both medial and lateral compartments of the knee, plus the patellofemoral joint.

Preoperative knee arthroplasty rehabilitation

The use of isometric quadriceps exercises, walking aids, and potentially a CPM machine.

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Early post-operative knee arthroplasty rehabilitation

Deep breathing, coughing, ankle pumps, gluteal sets, and upper extremity exercises.

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What is knee arthroplasty?

A surgical procedure to replace a damaged knee joint with an artificial one.

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What are some indications for knee arthroplasty?

Painful knee joint with or without deformity, due to conditions like rheumatoid arthritis, osteoarthritis, or traumatic arthritis.

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What are some contraindications for knee arthroplasty?

Bone infection, severe osteoporosis, recent joint sepsis, and malignant tumors.

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Extensor lag

A condition where the knee cannot fully extend due to an imbalance between the gain of flexion and extension, often seen after knee replacement.

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Continuous Passive Motion (CPM) Machine

A device that passively flexes and extends the knee joint to help improve range of motion after surgery.

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Isometric Exercises

Exercises that strengthen muscles by contracting them without significant movement.

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Hamstring and Posterior Knee Stretching

Stretching exercises that target the muscles on the back of the leg, especially those near the knee joint.

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Common Peroneal Nerve Palsy

A common complication after knee replacement that involves damage to the peroneal nerve, leading to weakness or paralysis of muscles in the foot and lower leg.

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Functional Rehabilitation

Exercises typically starting 3 weeks post-operation that involve movements in natural, functional ways.

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Proprioception

The ability to sense the position and movement of the body, which can be impaired after knee replacement surgery.

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Crutches or Walker

A type of walking aid used after knee replacement to help with stability and reduce weight-bearing on the operated leg.

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Why are quadriceps sets important?

Regularly performing quadriceps sets helps reduce joint swelling, combat pain-induced muscle stiffness, and strengthen the knee for subsequent exercises.

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What is the 'no CPM' approach for early knee post-surgery?

This strategy involves immobilizing the knee in a straightened position for 4 days using a compression bandage and splint. It aims to reduce pain and prevent movement, preparing for later rehabilitation exercises.

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What is the 'CPM' approach for early knee post-surgery?

This approach involves the immediate use of a continuous passive motion (CPM) machine for up to 4 days after surgery, gently moving the knee joint to promote healing and flexibility.

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How does the 'no CPM' approach affect knee flexion?

The 'no CPM' method usually leads to a slower return of knee flexion compared to the 'CPM' method.

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What is passive mobilization?

This involves moving the knee joint through its range of motion passively, without the patient actively participating, to ease pain and improve flexibility.

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What is active assisted knee flexion?

Active assisted knee flexion exercises involve the patient flexing their knee joint with assistance, like using a towel or resistance band, to regain strength and flexibility.

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How does weight bearing differ between the two methods?

Weight bearing with a splint can start on the second day after surgery in the 'CPM' approach, while unsupported weight bearing is typically a day or two later due to the possible need for additional quadriceps strengthening.

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What is the expected knee flexion range by day 7?

The patient should ideally reach a knee flexion range of 50-70 degrees by the seventh day after surgery. If this goal isn't reached, a continuous passive motion machine may be recommended to assist in achieving greater flexion.

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What are the key requirements for driving after knee replacement?

Driving requires strong inner range quadriceps, good knee joint proprioception and ROM.

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What activities should be avoided after a knee replacement?

Avoid twisting, turning, jumping, and running for at least 3 months after surgery. Some surgeons recommend up to 6 months.

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How does the function of a total knee replacement compare to a total hip replacement?

Total knee replacement provides about 80-85% of normal knee function. Total hip replacement is simpler, offering 90-95% of normal function.

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What is the expected range of motion goal for a knee replacement within the first few weeks?

Within 2 weeks, patients should achieve 0-90 degrees of knee flexion. Within 3-4 weeks, they should reach 0-120 degrees.

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When are different types of exercises begun after knee replacement?

Isometric exercises and active exercises are started immediately after surgery, resisted exercises start at week 2-3.

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Describe the typical ambulation progression after a cemented knee replacement.

Immediately post-op, patients begin weight bearing as tolerated with a walker. Transitioning to cane by week 3 and full weight bearing by week 4.

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Describe the typical ambulation progression after a cemented-less knee replacement.

Touch-down weight bearing with a walker immediately after surgery. Transition to weight bearing as tolerated with a walker by week 6, full weight bearing by week 12.

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What does a hot, painful knee joint with increased swelling 3 days after knee replacement suggest?

A hot, painful knee joint with increased swelling 3 days after knee replacement suggests a complication following exercise.

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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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