Rehabilitationi After Hip And Knee Joint Replacement

Front 1

The goal of joint-replacement surgery is to provide:

Back 1

long=lasting artificial joint that relieves pain and imporves function, while minimizing or avoiding surgical complications.

Front 2

Total-joint arthroplasty is indicated for:

Back 2

- advanced articular disease causing disabling pain when conservative management has failed

Front 3

The surgeon must consider the patient's:

Back 3

- level of pain
- degree of radiographic changes
- extent of functional limitations
- a risk-benefit analysis of the procedure

Front 4

Implants materials are:

Back 4

titanium,
cobalt alloys,
plastics,
ceramics

Front 5

The acetabular components is secured by ____ or by___

Back 5

1) polymethylmacrylate bone cement (press-fit)
2) screws, with or without surfaces that encounter bone ingrowth

Front 6

the ___ component is secured by cement or bone ingrowth.

Back 6

femoral

Front 7

The hip joint is _____ and ________ with a synthetic aceetabulum, femur, and typically, an ultra-high-molecular weight polyethylene liner.

Back 7

1) resect
2) replaced

Front 8

p[atient after THA and TKA are highly at risk of

Back 8

deep vein trombolysis and pulmonary emboli because of the local vessel damages and hyperviscosity caused by prolonged immobilization.

Front 9

THA and TKA patients are most at risk for deep vein trombolysis

Back 9

after 1 week to several week

Front 10

Trombolysis is difficult to diagnosed because of the overlapping symptoms of it and surgery, _____ is a valid diagnostic tool.

Back 10

repeated blood flows and lower-extremity venography

Front 11

Pulmonary emboli is also hard to disgnosed, _____ are valid diagnostic tools

Back 11

chest scan
perfusion lung scan
computed tomographic scan

Front 12

prophylaxis of deep vein trombolysis included:

Back 12

early mobilization, pneumatic compression devices and elastic compressive stockings
PHARMACOLO: heparin and warfarin

Front 13

the TKA contracture are hard to overome after

Back 13

3 months.

Front 14

enquality in leg length lasts

Back 14

several months after surgery.

Front 15

the differences between a significant true/real leg-length discrepancy:

Back 15

is uncommon compared to a functional leg-length discrepancies

Front 16

functional inequality is measured from the _____ to the _____ as opposed to true inequality.

Back 16

umbilicus to the medial malleolus

Front 17

Leg-length discrepancies are mostly due to

Back 17

muscle imbalance, muscle contractures

Front 18

the use of shoe lift is prohibited for a period of

Back 18

6 months

Front 19

if true leg-length discrepancies are found, a ___ is prescribed

Back 19

shoe-lift. Otherwise, gait retraining is the main focus.

Front 20

aseptic loosening is the most common cause of

Back 20

implant failure

Front 21

aseptic loosening is caused by the

Back 21

many sources of wear

Front 22

Management of wounds with drainage:

Back 22

- aggressive local wound care
- ROM precautions
- perioperative antibiotics until the wound is drained
- culture testing

Front 23

The most devastating nonfatal complication from joint replacement

Back 23

Infection

Front 24

Factors that increase the risk of infections (extra-operative)

Back 24

Diabetes, alcoholism, malnutrition, obesity, the use of immunosuppressant drugs, nonhealing ulcers of lower limbs, acute infection of the skin or urinary tract

Front 25

Intra-operative factor of increase risk of infection after joint replacement are:

Back 25

the duration of the operation,
repeat procedures,
a positive culture intraoperative,
postoperative hematomas and superficial infections.

Front 26

Stage 1 of infection symptoms are:

Back 26

more commonly: erythematous (redness), swelling and drainage
less commonly: increased count of white blood cells, fever, red blood cells sedimentation

Front 27

STage 1 is treated with

Back 27

superficial intravenous or oral antibiotics,
agressive local dressings and daily inspections

Front 28

acute, dramatic process or a more subtle indolent infection

Back 28

Stage 2

Front 29

Radiographs are not effective in differentiating:

Back 29

infection and mechanical loosening or tissue

Front 30

Aseptic fine needle aspiration negative results

Back 30

can not exclude the possibilities of infection.

Front 31

Late hematogenously spread infections

Back 31

Stage 3

Front 32

Stage 3 are commonly due to

Back 32

distant source infections

Front 33

Excission of the arthroplasty is necessary at which stages of infection:

Back 33

stage 2 and 3

Front 34

After excision of the artificial joint, the reimplantation occurs

Back 34

6 to 8 weeks after

Front 35

In the case of dental procedures or invasive procedures, it is guided to use prophylaxis or amoxicillin during the intervention _____ after the joint replacement

Back 35

3 years

Front 36

Heterotopic ossification is

Back 36

the bone deposition in soft tissue.

Front 37

Heterotopic ossification occurs 80 percent of the time in hip replacement; however, it does not have ____ consequences

Back 37

functional

Front 38

The diagnosis of heterotopic bone is confirmed by:

Back 38

1) elevated alkaline phosphatase
2) radiograph and bone scan

Front 39

Peripheral nerves injuries are ______ after joint replacement

Back 39

common

Front 40

The most commonly injured nerve is the

Back 40

sciatic nerve particularly its peroneal division.

Front 41

The mechanism of nerve injuries are:

Back 41

compression forces, trauma, traction and ischemia

Front 42

Femoral nerves injuries are ____ common

Back 42

less

Front 43

Sciatic nerve injuries will have the following symptoms:

Back 43

painful and weakness in the tibial region

Front 44

the prognosis of nerve injury is _____for mild early deficits

Back 44

good

Front 45

If motor function was recored early, the complete recovery of nerve injury is more

Back 45

probable

Front 46

the more common persistent complaint of peripheral nerve injury in recovery is

Back 46

dysesthetic pain

Front 47

IN a TKA, what impact rehabilitation:

Back 47

- type of fixation
- type and extent of bone cuts and soft tissue balancing
-patellar resurfacing was necessary or not
-extent of preoperative misalignment

Front 48

In a TKA, __________ can begin immediately.

Back 48

full weight-bearing

Front 49

A properly implanted prothesis will last more than:

Back 49

20 years

Front 50

computer assisted total-knee replacement has greatly improved the quality of

Back 50

soft tissue balancing in surgery, the pain and functional outcomes.

Front 51

minimally invasive surgery of the THA and TKA

Back 51

greater client satisfaction, less pain ,shorter hospital stays.

Front 52

The second most common cause to THA reoperation

Back 52

Dislocation (can be as high as 10 percent)

Front 53

Dislocation usually occur within:

Back 53

the early post-operative phase, 4 to 6 weeks.

Front 54

Posterior dislocation occurs from:

Back 54

flexion, adduction, internal rotation of the hip

Front 55

anterior dislocation occurs from:

Back 55

extension and external rotation.

Front 56

The most likely dislocation depends on the surgical approach, i.e. after a posteriolateral approach, the most common is _______, and after a anterior or lateral approach, both anterior and posterior dislocation occurs equally.

Back 56

posterior dislocation

Front 57

The surgical approach is not a _____ oh hip dislocation.

Back 57

factor

Front 58

TRUE or FALSE, clinical expertise can influence the rate of hip dislocation post-op.

Back 58

TRUE

Front 59

The clinician can reduce the risk of hip dislocation through:

Back 59

prescription of ROM precautions,
the use of adaptive devices,
patient education

Front 60

The ROM precautions for lateral surgical approach are avoid:

Back 60

flexion more than 90 degrees,
adduction past midline,
and internal rotation past neutral

Front 61

the ROM precautions for anterior surgerical approach are avoidance of

Back 61

extension and external rotation

Front 62

The ROM precautions must be maintain:

Back 62

6 weeks in uncomplicated patients,and 12 weeks in at risk patients

Front 63

Positioning to avoid hip dislocation post-surgery includes:

Back 63

- an abductor splint for the first few days
- the use of an pillow between the legs for the first 4-6 weeks

Front 64

Symptoms of acute dislocation are:

Back 64

complains of immediate pain and following weight bearing and reduced ability to use the legs, hearing a pop

Front 65

In the case of dislocation, closed reduction is achieved within the _____ because delays will cause swelling and muscle shortening.

Back 65

first hours

Front 66

high risk patients management to avoid dislocations included:

Back 66

a six weeks period of immobilization with the use of a cast or splint that stops rom ( like a hip sppica, hip abductor, hip-knee-ankle-foot orthosis)

Front 67

the goal of bracing or casting in preventing joint dislocations is to

Back 67

allow the soft tissue and capsular adhesions to develop.

Front 68

In the case of Tight hamstring muscles, the clinician can use a

Back 68

knee immobilizer.

Front 69

Obese patients have ____ serous drainage from underlying fat necrosis.

Back 69

persistent

Front 70

Persistent wound drainage post-op is a ______ _______ for deep wound infection.

Back 70

risk factor

Front 71

Wounds that drains for more than ____ are suspicious for infections.

Back 71

4 days

Front 72

THA (total hip arthroplasty) aprroaces are:

Back 72

-anterior
-anterolateral
-direct lateral
-posterolateral

Front 73

the downside of antero-lateral and direct-lateral surgeries are:

Back 73

a more prolonged weakness of the abductor muscles caused by the partial detachment of the glutei during surgery.

Front 74

Posterolateral surgery disadvantage is the:

Back 74

higher risk of dislocations

Front 75

IN THA, if a trochanteric osteotomy is performed:

Back 75

no abduction against resistance is allowed until the osteotomy has healed.

Front 76

The surgeon must watch for ______ after THA:

Back 76

pelvic pain

Front 77

if acetabular bone grafting is performed :

Back 77

restricted weight-bearing is prescribed.