8.24 TKA, Misc

Question 1

unicompartmental TKA: yay or nay?

Answer 1

• not much reason to just salvage one side

- most recent evidence doesn’t support as much

Question 2

TKA: most surgeons use this technology to ensure the best fit

Answer 2

• real-time fluoroscopy

- computer topography

Question 3

Why would the entire top of the tibia not be removed for a TKA?

Answer 3

if they’re saving the cruciate ligaments

Question 4

Function of a plastic spacer in a TKA

Answer 4

• helps with stability

- some stability is lost with removal of the ligaments

Question 5

TKA procedure

Answer 5

• entire top removed (may or may not save cruciates)
• almost always take off back of patella
• plastic spacer put in

Question 6

TKA bandage: what to consider

Answer 6

• long strip

- must think about strikethrough

Question 7

When can infections happen after surgery?

Answer 7

can happen quickly after surgery or years after

Question 8

Why can infections happen years after?

Answer 8

• always some inflammatory responses going on around the prosthesis
• systemic infections tend to go to the surgical site

Question 9

What would show up on the objective eval that would be cause for concern?

Answer 9

• fever
• warmth/redness that’s more than normal
• streaking
• increased girth
• increased drainage
• increased pain
• weak/tired

Question 10

What do they do for an infection in a total joint?

Answer 10

• long-term IV antibiotics to try to try to salvage the joint and prosthetic
• Irrigation and debridement: open up and rinse out

Question 11

If a bad enough infection and osteomyelitis has set in, what happens?

Answer 11

• prosthetic has to be removed

- fill the void with antibiotic beads

Question 12

What are antibiotic beads?

Answer 12

• way to deliver concentrated antibiotics

- leach out into the joint and blood supply to hopefully get rid of the infection

Question 13

How long will a pt have antibiotic beads in the void?

Answer 13

can be like this for months - until the infection clears

Question 14

Can the pt walk with antibiotic beads?

Answer 14

may be WBAT or not

Question 15

What happens if the infection is so bad that there’s not enough bone to put another prosthesis back?

Answer 15

may require amputation

Question 16

What will happen if you as a PT don’t get ROM back after a total joing?

Answer 16

The pt may have to have a manipulation under anesthesia

Question 17

What are some of the surgical complications following total joint replacement?

Answer 17

• infection
• deficits in ROM
• fat emboli
• stroke
• severed/pinched nerve
• nicking of an artery
• ileus

Question 18

TKA and strokes

Answer 18

Often get TKA and a stroke that affects the opposite side

Question 19

Normal sensory loss

Answer 19

over the incision site is normal

Question 20

Severed or pinched nerve: sign

Answer 20

• new loss of sensation/motor distally

- may be attributed to swelling in the area

Question 21

Why might a pinched or severed nerve not be caught early?

Answer 21

may be attributed to nerve block

Question 22

s/s of a nicked artery

Answer 22

• complaints that don’t seem the same as any other TKA (i.e. strange sensations or pain in foot or calf)
• cold, gray, white - skin doesn’t look the same

CHECK PEDAL PULSE!

Question 23

Catching a nicked artery

Answer 23

• nursing or PT should be checking up on this

- usually not caught quickly enough - can’t salvage the leg

Question 24

What is an ileus?

Answer 24

peristalsis is halted in the gut

Question 25

Who is at risk for an ileus?

Answer 25

- any surgical pt that doesn't get mobilized quickly enough | - have been given meds to slow everything down so surgery can be done

Question 26

s/s of an ileus

Answer 26

- distention - no bowel sounds - cranky pants - "coffee ground" emesis

Question 27

reverse peristalsis

Answer 27

vomiting

Question 28

treatment for an ileus

Answer 28

- NG tube to suck everything out - mobilize them - slowly build them back to their normal diet

Question 29

Why would a laxative not be helpful for a pt with an ileus?

Answer 29

- they aren't full of stuff - food is just not getting processed into their intestines - laxatives only blow out the end (colon)