should perform between physical therapy sessions. Given these examination findings, what are the key areas she should focus on? 4. The patient reports her desire to return to the following leisure activities when she has fully recovered: walking (this is her main mode of transportation to and from work), cycling, and hiking. What recommendations would you make regarding the frequency of these activities and the longevity of her arthroplasty device? Discussion 1. Her recent wrist fracture may limit her ability to use an assistive device effectively if she cannot bear weight on the wrist. Examination reveals full wrist extension, a loss of 15º of wrist flexion; she reports no pain with active movement, only “stiffness” and did not require substantial weight loading on the upper extremities with the use of a walker or crutches. If this was problematic, the physical therapist could consider modifying her assistive device with a platform attachment to allow independence in ambulation. In addition, it is important to assess the strength and joint mobility of her prior TKA as her functional mobility will rely heavily on adequate function of this knee, especially in the early phases of recovery when her newly operated knee is less functional. 2. She is planning to discharge directly home as she did with her last knee replacement. Positive factors for this discharge plan include a preoperative RAPT score of 10/12 (which indicates likely discharge to the home setting), her independent ambulation status prior to admission, and her overall prior level of function. Her greatest limitation is the need to climb stairs in her home to get to the bedroom and full bathroom, Resources ● American Academy of Orthopaedic Surgeons (AAOS) http://www.aaos.org This site contains information for clinicians and patients related to a variety of orthopedic conditions including arthritis and joint replacement. ● American College of Rheumatology (ACR) http://www.rheumatology.org This site contains patient information, publications, and resources relevant to the field of rheumatology and cover various types of arthritis. ● American Physical Therapy Association (APTA) http://www.apta.org This site contains very relevant information for physical therapists, including links to the PTNow.org site, which contains a summary of relevant research on total knee arthroplasty, and the Choosing Wisely initiative mentioned in the course. Aggarwal, V. K., Goyal, N., Deirmengian, G., Rangavajulla, A., Parvizi, J., & Austin, M.S. (2007). Revision total knee arthroplasty in the young patient: Is there trouble on the horizon? Best Practice & Research Clinical Rheumatology, 26, 637-647. Aglietti, P., Lup, D., Cuomo, P., Baldini, A., & De Luca, L. (2007). Total knee arthroplasty using a pie-crusting technique for valgus deformity. Clinical Orthopaedics and Related Research, 464, 73-77. Ajuied, A., Wong, F., Smith, C., Norris, M., Earnshaw, P., Back, D., & Davies, A. (2014). Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: A systematic review and meta-analysis. American Journal of Sports Medicine, 42 (9), 2242-2252. doi:10.1177/0363546513508376 AlBuhairan, B., Hind, D., & Hutchinson, A. (2008). Antibiotic prophylaxis for wound infections in total joint arthroplasty: A systemic review. Journal of Bone and Joint Surgery (British), 90 (7), 915-919. References Alden, K. J., Duncan, W. H., Trousdale, R. T., Pagnano, M. W., & Haidukewych, G. J. (2010). Intraoperative fracture during primary total knee arthroplasty. Clinical Orthopaedics Related Research, 468, 90-95. American Academy of Hip and Knee Surgeons. (2016). Surgical options for knee arthritis . Retrieved from http://www.aahks.org/care-for-hips-and-knees/surgical-options-for-knee- athritis/ American Academy of Orthopaedic Surgeons (AAOS). (2011). Home safety checklist. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=A00123 American Academy of Orthopaedic Surgeons (AAOS). (2014). 2.5 million Americans living with an artificial hip, 4.7 million with an artificial knee. Retrieved from http://newsroom.aaos.org/ media-resources/Press-releases/25-million-americans-living-with-an-artificial-hip-47-million-with- an-artificial-knee.htm American Academy of Orthopaedic Surgeons (AAOS). (2015). Total knee replacement. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=A00389 American Physical Therapy Association (APTA). (2015). Choosing wisely: The right care at the right time. Retrieved from https://integrity.apta.org/ChoosingWisely/ American Physical Therapy Association (APTA). (2016). Comprehensive care for joint replacement model (CJR). Retrieved from http://www.apta.org/cjr Anglin, C., Fu, C., Hodgson, A. J., Helmy, N., Greidanus, N. V., & Masri, B. A. (2009). Finding and defining the ideal patellar resection plane in total knee arthroplasty. Journal of Biomechanics, 42 (14), 2307-2312.
however she reports performing stair climbing one step at a time due to her left knee pain independently on a daily basis prior to her admission to the hospital. 3. Preoperatively she reports a knee flexion contracture and is limited in extension range of motion. Regaining this motion will facilitate an improvement in her gait mechanics. Passive positioning with a towel roll under the distal portion of her lower leg while in bed will assist in gaining extension ROM. In addition, she can incorporate isometric quadriceps in this position, not only to facilitate further extension ROM but also to improve her quadriceps activation. Application of ice/ cryotherapy will assist in reducing her postoperative joint swelling, which will also facilitate knee extension ROM and quadriceps activation. 4. You should strongly encourage her to utilize walking as a regular form of exercise to maintain her lower extremity strength, cardiovascular and respiratory fitness, and bone health. Her desire to resume cycling may require some adjustments to her bike depending on her knee ROM. Stationary cycling can be used as a mechanism for gaining knee flexion ROM, and she is likely to be motivated to do this given her goal of returning to cycling as a leisure activity. Hiking is the one activity that she should embark on with caution. The uneven terrain and higher impact loads to the knee may contribute to early wear of the arthroplasty implant. Recommendations to consider hiking on easy trails and pursuing this at a lower frequency than walking and cycling may be the best combination to preserve her arthroplasty device.
● Arthritis Foundation http://www.arthritis.org
This site is primarily geared toward patients with resources to understand the various types and treatments of arthritis. ● Centers for Disease Control and Prevention (CDC) http://www.cdc.gov Data regarding numerous disorders and interventions, including aggregate data from national and state reports, and numerous resources for the clinician and patient. ● National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS) http://www.niams.nih.gov
This is another site with health resources for the patient and clinician and includes various clinical trials and research related to arthritis
Anglin, C., Ho, K. C., Briard, J. L., de Lambilly, C., Plaskos, C., Nodwell, E., & Stindel, E. (2008). In vivo patellar kinematics during total knee arthroplasty. Computer Aided Surgery, 13 (6), 377-391. Arirachakaran, A., Choowit, P., Putananon, C., Muangsiri, S., & Kongtharvonskul, J. (2015). Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. European Journal of Orthopaedic Surgery & Traumatology, 25 , 799-806. Ariza, G., Badia, M., Cuixart, A., Fernández-Martínez, J. J., & Trujillano, J. (2012). Quality of life after knee arthroplasty: Utility of the RAPT scale. Rehabilitation, 46 , 147-156. Artz, N., Elvers, K. T., Minns Lowe, C., Sackley, C., Jepson, P., & Beswick, A. D. (2015). Effectiveness of physiotherapy exercise following total knee replacement: Systematic review and meta-analysis. BMC Musculoskeletal Disorders, 16 , 15. doi:10.1186/s12891-015-0469-6 Bade, M. J., Kohrt, W. M., & Stevens-Lapsley, J. E. (2010). Outcomes before and after total knee arthroplasty compared to healthy adults. Journal of Orthopaedic and Sports Physical Therapy, 40 (9), 559-567. Bade, M. J., & Stevens-Lapsley, J. E. (2011). Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. Journal of Orthopaedic and Sports Physical Therapy, 41, 932-941. Baker, C. S., & McKeon, J. M. (2012). Does preoperative rehabilitation improve patient-based outcomes in persons who have undergone total knee arthroplasty? A systematic review. Physical Medicine and Rehabilitation, 4, 756-767. doi:10.1016/j.pmrj.2012.06.005 Baratta, J. L., Gandhi, K., & Viscusi, E. R. (2014). Perioperative pain management for total knee arthroplasty. Journal of Surgical Orthopaedic Advances, 23, 22-36. Barbieri, A., Vanhaecht, K., Van Herck, P., Sermeus, W., Faggiano, F., Marchisio, S., & Panella, M. (2009). Effects of clinical pathways in the joint replacement: A meta-analysis. BMC Medicine, 7, 32. Barsoum, W. K., Murray, T. G., Klika, A. K., Green, K., Miniaci, S. L., Wells, B. J., & Kattan, M. W. (2010). Predicting patient discharge disposition after total joint arthroplasty in the United States. Journal of Arthroplasty, 25, 885-892. Bartels, E. M., Lund, H., Hagen, K. B., Dagfinrud, H., Christensen, R., & Danneskiold-Samsøe, B. (2007). Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews, 4, CD005523. Benazzo, F., Rossi, S. M. P., & Ghiara, M. (2014). Partial knee arthroplasty: Patellofemoral arthroplasty and combined unicompartmental and patellofemoral arthroplasty implants
Book Code: PTNY3622B
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