Podcast
Questions and Answers
Which type of knee arthroplasty is defined by the replacement of the opposing articular surfaces in both the medial and lateral compartments?
Which type of knee arthroplasty is defined by the replacement of the opposing articular surfaces in both the medial and lateral compartments?
What is a primary contraindication for undergoing knee arthroplasty?
What is a primary contraindication for undergoing knee arthroplasty?
During preoperative rehabilitation, which of the following should NOT be a focus of training?
During preoperative rehabilitation, which of the following should NOT be a focus of training?
Which type of knee arthroplasty is characterized by minimal joint constraint?
Which type of knee arthroplasty is characterized by minimal joint constraint?
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What is the main purpose of early postoperative care after knee arthroplasty?
What is the main purpose of early postoperative care after knee arthroplasty?
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Which of the following indications would lead to the consideration of knee arthroplasty?
Which of the following indications would lead to the consideration of knee arthroplasty?
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In knee arthroplasty classifications, what does tri-compartmental replacement involve?
In knee arthroplasty classifications, what does tri-compartmental replacement involve?
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What parameter is recorded during the preoperative visit as a baseline measurement?
What parameter is recorded during the preoperative visit as a baseline measurement?
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What is the primary purpose of performing quadriceps sets post-operatively?
What is the primary purpose of performing quadriceps sets post-operatively?
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What is the recommended knee flexion goal by the seventh postoperative day?
What is the recommended knee flexion goal by the seventh postoperative day?
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How should patients progress with knee flexion at home after surgery?
How should patients progress with knee flexion at home after surgery?
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What is a disadvantage of using a CPM machine during the early stages of recovery?
What is a disadvantage of using a CPM machine during the early stages of recovery?
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When is passive mobilization of the patella and scar advised to begin?
When is passive mobilization of the patella and scar advised to begin?
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What should be prioritized if patients have not reached the recommended knee flexion by day 7?
What should be prioritized if patients have not reached the recommended knee flexion by day 7?
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What initiates active assisted knee flexion post-operatively?
What initiates active assisted knee flexion post-operatively?
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What factor contributes to delayed unsupported weight bearing in the CPM group?
What factor contributes to delayed unsupported weight bearing in the CPM group?
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What is the recommended time frame to avoid twisting and turning after a total knee replacement?
What is the recommended time frame to avoid twisting and turning after a total knee replacement?
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What is the expected range of motion (ROM) for a cemented total knee replacement within 3-4 weeks post-operation?
What is the expected range of motion (ROM) for a cemented total knee replacement within 3-4 weeks post-operation?
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When should resistant exercises begin after a total knee replacement?
When should resistant exercises begin after a total knee replacement?
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What does the abbreviation TDWB stand for in the context of ambulation post knee surgery?
What does the abbreviation TDWB stand for in the context of ambulation post knee surgery?
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How many weeks is partial weight bearing with a walker recommended immediately postoperatively?
How many weeks is partial weight bearing with a walker recommended immediately postoperatively?
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What is the typical recovery range of normal function following a total knee replacement compared to a total hip replacement?
What is the typical recovery range of normal function following a total knee replacement compared to a total hip replacement?
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What might a patient with a newly replaced knee joint report as concerning symptoms after exercise?
What might a patient with a newly replaced knee joint report as concerning symptoms after exercise?
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After how many weeks should a patient generally transition to full weight bearing post total knee replacement?
After how many weeks should a patient generally transition to full weight bearing post total knee replacement?
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What should be done to address extensor lag in patients using a Continuous Passive Motion (CPM) device?
What should be done to address extensor lag in patients using a Continuous Passive Motion (CPM) device?
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Which of the following exercises is recommended to aid in rehabilitation after a prosthetic knee replacement?
Which of the following exercises is recommended to aid in rehabilitation after a prosthetic knee replacement?
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Why is loss of proprioception particularly pronounced after knee replacement surgeries?
Why is loss of proprioception particularly pronounced after knee replacement surgeries?
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For a cemented prosthesis, what is the initial recommended duration for using crutches or a walker?
For a cemented prosthesis, what is the initial recommended duration for using crutches or a walker?
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What is the correct approach to climbing stairs for an individual recovering from knee surgery?
What is the correct approach to climbing stairs for an individual recovering from knee surgery?
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Which type of exercise should be avoided during the rehabilitation process following a knee replacement?
Which type of exercise should be avoided during the rehabilitation process following a knee replacement?
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What advice is given regarding the use of a cane for patients with cement-less prosthesis?
What advice is given regarding the use of a cane for patients with cement-less prosthesis?
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What is the significance of gentle manual mobilization techniques such as Grade I or II Maitland mobilization?
What is the significance of gentle manual mobilization techniques such as Grade I or II Maitland mobilization?
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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 include severe joint pain, with or without deformity.
- Common secondary causes of knee arthroplasty include rheumatoid arthritis and osteoarthritis.
- Traumatic arthritis can also be a reason for arthroplasty.
- Contraindications include bone infection, severe osteoporosis, recent joint sepsis, and malignant tumors.
Knee Arthroplasty Classifications
- Uni-compartmental: replacement of the opposing articular surfaces of the femur and tibia of either the medial or lateral compartment; poor results
- Bi-compartmental: replacement of the opposing articular surfaces of the femur and tibia of both the medial and lateral compartments.
- Tri-compartmental: similar to bi-compartmental but also resurfaces the patellofemoral joint.
Preoperative Rehabilitation
- The initial visit records baseline information.
- Measurements include pain, swelling, functional abilities, range of motion (ROM), and muscle strength.
- Patients practice exercises after surgery, like isometric quadriceps contractions.
- Training on crutches or walkers is included in the preparation process.
- CPM (continuous passive motion) machine use is also practiced before surgery.
Early Postoperative Stage
- Deep breathing and coughing helps with pressure sores.
- Ankle pumps every two hours encourage circulation and prevent deep vein thrombosis (DVT).
- Upper extremity exercises are also important.
- Patella movement exercises should be performed.
- Quadriceps sets (10 repetitions) are repeated hourly.
- Avoiding pain and encouraging range of motion helps achieve inner range strength.
- Using a sliding leg lifter to avoid high pressure points could be an option.
- Postoperative day two includes resuming the SLR (straight leg raise) after the first two post-op days.
No CPM Management
- For 4 days, the knee is kept in an extended position using a compression bandage and splint.
- This prevents joint movement and reduces pain.
- Active exercises are not allowed until the immobilization is stopped.
- Assisted weight bearing starts on day two.
Post-Immobilization (After 4 Days)
- Passive mobilization of the patella and surrounding scar tissue reduces pain.
- Active assisted knee flexion begins twice daily for at least 20 minutes.
- Patients are discharged after 5-6 days without any complications.
- Full 50-70° of active knee flexion is expected by day 7.
Knee Flexion Return
- Home-based exercises increase knee flexion by at least 10 degrees daily.
- If 50-70° isn't reached by day 7, CPM is used to maximize flexion for 6 hours daily.
- The knee should reach 80-90° within 14 days.
- Manipulation under anesthesia might be a treatment option if a CPM machine isn't available.
- Water therapy, if available, might also be helpful.
CPM Usage
- CPM machines should be used immediately after surgery (surgical recovery room) up to four days, for 6 hours a day.
- Knee flexion ranges are increased by 10 degrees each day until 80-90 degrees is achieved by day seven.
- Active knee flexion recovery is quicker than in the non-CPM group.
- Walking aids (sturdy splints) can be used two days after surgery for weight bearing.
- Unsupported weight bearing is often delayed by 1-2 days in the CPM group compared to controls, due to quadriceps lag.
- CPM usage is not advised for uncomplicated total knee replacements.
CPM Disadvantages
- Longer time in bed.
- Loss of independence.
- Discomfort.
- Possible incidence of common peroneal nerve palsy.
- Greater quadriceps lag (and possible splints) for patients using CPM machines.
Extensor Lag or Fixed Flexion Deformity
- A particular problem for the CPM group, occurs due to an imbalance between flexion and extension gains.
- Could cause difficulties with lifting the foot.
- Solutions include:
- Passive flexion to stop until extensor lag is reduced.
- Gentle manual mobilization techniques.
- Increasing the extension range.
- Avoiding forceful mobilization.
- Quadriceps exercises focusing on inner ranges.
- Correct stretching of the posterior hamstrings and knees.
Functional Rehabilitation
- Begins in the third week after surgery.
- Closed chain exercises (e.g., sitting to standing from varying heights and step-ups) are integrated.
- Small-arc cycling involves the use of a bicycle.
- Proprioception training: is important to restore the body's awareness of its knee position and movement.
Walking
- Crutches or walkers are used for 6 weeks or more after cemented replacements.
- Crutches or walkers are used for 12 weeks after cementless replacements.
- Walk rhythmically, smoothly, and avoid hurrying.
- Gradually increase the step length and speed.
- Gradually put more weight on the affected leg.
- Use a single crutch or cane on the opposite side.
- Avoid limping and leaning away from the operated knee.
Stairs
- A handrail helps with support.
- Use the 'good' leg to go up and the 'bad' leg to go down the stairs.
- As strength increases, climbing stairs foot-over-foot is possible.
Driving and Other Activities
- Knee joint proprioception, and quadriceps strength and range of motion are necessary for driving.
- Driving should not be attempted until at least 6 weeks after surgery.
- Avoid twisting, turning, jumping, and running for at least 3 months after total knee replacement; some surgeons extend this to 6 months.
Activity Guidelines for Cemented and Cemented-less Prosthesis
- Ranges for flexion and extension are detailed for both types of systems through various weeks after surgery.
- Types of exercises are broken down by type and time. Resisted exercise are introduced later.
Ambulation Guidelines for Cemented and Cemented-less Prosthesis
- Details on when partial, then full weight-bearing becomes acceptable, along with various walking aid requirements.
Problem-Solving Exercises (Example)
- A patient with a 3-day-old knee replacement is in pain, with increased swelling post exercise.
- Possible Causes: infection or DVT (deep vein thrombosis).
- Solution: measure the patient's temperature, check the calf for signs of DVT (swelling, pain, discomfort), and, if necessary, elevate the leg and apply ice.
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Description
Test your knowledge on knee arthroplasty with this quiz covering types, indications, rehabilitation, and postoperative care. Understand classifications and the importance of various exercises in recovery. Perfect for students and professionals in medical fields.
