Ask a PT

156 Posts
 
Posted - 09/11/2007 :  15:42:11  Show Profile  Reply with Quote
Our user asked: "I am a first year Doctor of Physical Therapy student at the University of Rhode Island. I stumbled on this website and figured I'd give it a shot. Myself and a couple classmates have been given a research project on Total Knee Replacements. We are required to come up with a strategy to treat a hypothetical situation. I couldn't find the exact answer on the web so hopefully you can help. In a preliminary visit with a patient that is thinking about receiving a TKR what would the PT evaluation include and what are some of the ROM and MMT considerations? Thanks so much for the help."

Ask a PT Response: "For an individual who has OA or DJD of the knee and is considering a TKA, a physical therapist would want to consider many variables.

S: First, a subjective interview would be conducted to determine how much pain the patient is experiencing and how it is affecting the quality of life. A psychosocial assessment will be conducted as well to determine what the patient's functional limitations are (ie. unable to ambulate greater than 20ft, unable to negotiate stairs, car transfers etc..). The PT can also examine the x-ray or review the x-ray report to get a better idea of how bad the knee actually is in regards to how much deterioration of the cartilage there is. PMH and past injuries should also be taken into consideration. Medications should be acknowledged as well.

O: The PT will examine the posture of the patient, how the knee looks and the patient's gait. Next ROM measurements can be taken and be compared to the non involved extremity. Manual muscle tests could also be performed to determine strength not only at the knees but at the ankles and hips as these muscules also assists with gait, transfers and other functional activities. You may want to also check PF mobility and utilize special tests to rule out other conditions which could be occuring at the knee. Palpation also allows the PT to know where the patient has tissue irritability and also assists in the PT differentiation process. Other issues to consider are flexibility (ie quads, hams, ITB/glut, hip flexors) and leg length discrepancy.

A: After your S & O. You will need to develop a problem list and determine if PT will be beneficial for the patient and give a prognosis as well. Time bound, functional and measurable goals should then be developed.

P: Your plan will describe what you would want to do (ie. Patient to be seen for ROM, stretching, strengthening, gait training, fucntional training, manual therapy, modalities, aquatic therapy and patient education 3 x wk for 4 wks).

For more info visit: http://www.cyberpt.com/totalkneereplace.asp - http://www.cyberpt.com/totalkneereplace.asp (Be sure to click on the Edheads link as it will take you to a virtual surgery which is very educational). If you or any of your fellow classmates have any questions or concenrs, please don't hesitate to contact us. Thanks for using CyberPT."