Rehabilitation Case Study Shang Shian Hsieh 80785

CASE STUDY - Total knee arthroplasty/replacement 

 
Patient:
71-year-old female admitted for an elective right total knee
arthroplasty/replacement (TKR)
 
 

1.   What are the short-term and long-term goals for this

patient and how can the therapist plan the post-discharge
rehabilitation program?
The short-term goal of knee replacement is to relieve pain, improve quality of life,
and maintain or improve knee function.

The long-goal of total knee replacement is to return patients to a high level of function
without knee pain.

Recommended:

 Swimming
 Water aerobics
 Cross-country skiing or Nordic Track
 Cycling or stationary bike
 Golf
 Dancing
 Sedentary occupations (desk work)

Permitted:

 Hiking
 Gentle doubles tennis
 Gentle downhill skiing
 Light labor (jobs that involve driving walking or standing but not heavy
lifting)
Not recommended:

 Jogging or running
 Impact exercises
 Sports that require twisting/pivoting (aggressive tennis, basketball,
racquetball)
 Contact sports
 Heavy labor

 The first signs of clinical improvement compared with preoperative

status generally occur between 6 and 12 weeks postoperatively with full
recovery occurring between one and two years postoperatively.

Postoperative care potentially includes pain management utilizing the

acute pain services, postoperative knee radiography, complete blood test
(particularly hemoglobin) and electrolytes on day one; and ongoing
thromboprophylaxis and antimicrobial prophylaxis.

Interventions that attempt to preserve knee motion include the use of

pillows under the operative foot while in bed to maintain extension and
to avoid flexion contracture. Active and passive exercises to achieve
maximal flexion should be instituted early with appropriate use of
analgesia to minimize pain. Realistic expectations on flexion range should
be based on preoperative flexion and average flexion of total knee
replacements around the world being around 115 degrees 

2.   What is osteoarthritis?
 Osteoarthritis occurs when the cartilage that cushions the ends of bones in your
joints gradually deteriorates. Cartilage is a firm, slippery tissue that enables nearly
frictionless joint motion. Eventually, if the cartilage wears down completely, bone
will rub on bone.
3.   What are the clinical features of osteoarthritis?
 Pain, tenderness, limitation of movement, bony swelling, joint deformity, Instability
4.   What can be considered conservative management for
knee joint osteoarthritis?

The main overarching aim of conservative treatment is to provide symptomatic relief

of the disease and slow its progression to avoid or forestall end-stage surgical
options.
The various conservative treatment options include exercise, weight loss,
pharmacological agents and orthotics.
5.   Give examples of different types of total knee prosthesis
 Fixed-Bearing Knee Implants, Mobile-Bearing Knee Implants, Medial Pivot Implants,
Posterior Cruciate Ligament (PCL)-Retaining or Substituting Implants,
6.   What are the post-operative complications of total knee
replacement?
 Outline
Aseptic loosening.
Joint instability.
Subacute and chronic periprosthetic infection.
Patellofemoral disorders.
Periprosthetic fracture.
Polyethylene wear.
Osteolysis.
Arthrofibrosis.

References:
Total knee arthroplasty, Gregory M Martin, MDIan Harris, AM, MBBS, MMed(Clin
Epi), MSc(HDS), PhD, Sep 16, 2022.
Clinical manifestations and diagnosis of osteoarthritis, Michael Doherty, MA, MD,
FRCP, FHEAAbhishek Abhishek, MBBS, MD, FRCP, PhD, Aug 31, 2022
Overview of the management of osteoarthritis, Leticia Alle Deveza, MD, PhD, Apr 15,
2022
European Alliance of Associations for Rheumatology
Types of Total Knee Implants, Joint Replacement Patient Advocacy
and Online Community,
Complications of total knee arthroplasty, Gregory M Martin, MDIan Harris, AM,
MBBS, MMed(Clin Epi), MSc(HDS), PhD, Mar 29, 2022