TKA
Name three possible indications for a TKA
Severe joint pain
Destruction of articular cartilage- arthritis
Varus or Valgum deformity
Instability
loss of motion
Previous surgical failure
This exercise may be used after a TSA for range of motion. It is performed by stabilizing the nonsurgical arm on a table height surface and allowing the surgical arm to hang. Later progression could include movement of the hips to create circular movement in the arm.
Codman's Pendulums
Describe how the arthroplasty components of a rTSA differ from normal human anatomy
Humeral component is placed in the glenoid area and the glenoid component is placed into the proximal humerus
The SPADI assess disability in this joint
Shoulder
Shoulder Pain and Disability Index
Name the muscles of the rotator cuff
Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor
These are the three components replaced in a tri-compartmental TKA
Active internal rotation is prohibited for six weeks after TSA for the protection of this muscle
A massive rotator cuff tears are a common indication for an rTSA. A massive tear is this large.
5 cm or larger
Over the lateral aspect of the patient's greater tubercle
The capsular pattern of the shoulder
External Rotation < ABduction < Internal Rotation
The average lifespan of a total knee replacement
10 to 20 years
Maximum protection phase after a TSA prohibits these movements
Hyperextension, horizontal abduction past neutral, and combination of extension, adduction and internal rotation
Name two indications for a rTSA
Inoperable rotator cuff tear, failure of a previous rotator cuff repair, aseptic necrosis of the humeral head, repetitive shoulder dislocations in elderly patients
A higher score on the Lysholm Knee Rating Scale indicates this
Greater functional ability
The patellar tendon provides an insertion point for these muscles
Rectus Femoris, Vastus Lateralis, Vastus Medialis, Vastus Intermedialis
This procedure may be required if seventy degrees of knee flexion is not achieved by four weeks post TKA
The position a patient is immobilized in after surgery is determined by this
The direction of instability prior to surgery
Anterior or Anteroinferior: In sling or splint at the side
Posterior or Posteroinferior: "handshake" position
If the subscapularis was cut during an rTSA then this motion is prohibited
Internal Rotation
A positive drop arm test indicates this.
A full thickness rotator cuff tear
Describe the screw home mechanism during weight bearing
The femur will rotate medially on the tibia
Joint cement, the most common type of fixation for knee replacement, is a contraindication for this modality
Ultrasound
True or False: Patients with osteoarthritis have better range of motion results than those with rheumatoid arthritis following a total shoulder arthroplasty.
This statement is true. On average patients with OA are capable of 105 to 161 degrees of flexion following a TSA, while patients with RA on average range from 75 to 105 degrees. This likely because patient's with RA have higher incidences of rotator cuff deficiency. A well functioning rotator cuff mechanism is generally agreed to the basis for significant postoperative gains.
These muscles must function in order for a patient to qualify for a rTSA
The Deltoids
A therapist in the clinic has used a sharpie to mark a patient's tibial tuberosity and the corners of the patella following a TKA. They are preparing to measure this.
They are preparing to measure the patient's Q angle. Abnormal patellar tracking is a possible complication of TKA.
The ACL is routinely removed during a TKA. Name the origin and insertion of this ligament.
The ACL runs superior and posteriorly from anterior tibia just medial to medial meniscus to attach posteriorly to the lateral condyle of the femur