Control Group Exercise

2001, Withrow, Huston et al. 2006). Quadriceps inserts on the proximal-anterior part of tibia and isolated contraction of the muscle will cause anterior translation of tibia in relation to femur, putting strain on the ACL and possibly rupture the ligament (Renström, Arms et al. 1986, DeMorat, Weinhold et al. 2004, Withrow, Huston et al. 2006). Furthermore, landing and cutting manoeuvres produce abduction, adduction and rotational torques about the hip and knee (Besier, Lloyd et al. 2001). Without an opposing force to these torques the loaded leg(s) will be forced into the valgus position with the femur adducted and internally rotated, the tibia externally rotated and the knee abducted further increasing strain on the ACL (Markolf, Burchfield et al. 1995). Ireland (2002) has characterized this the position of no return, unassumingly because it habitations the stabilizing muscles of the knee in a mechanical disadvantage disabling them from re-establishing a sound posture. I should notate that several studies have associated this position of no return to an increased risk of knee injury. Female athletes exhibit increased knee valgus 6 movement patterns during landing and cutting activities compared to male athletes (Chappell, Yu et al. 2002, Ford, Myer et al. 2003, Zeller, McCrory et al. 2003, Olsen,

As stated earlier, the patient admitting challenge was right total knee replacement related to history of osteoarthritis as evidenced by unrelieved pain. Osteoarthritis (OA) is a disease that “results from cartilage damage that triggers a metabolic response at the level of the chondrocytes” (Lewis, Dirksen, Heitkemper, Barry, Goldsworthy & Goodridge, 2011, p. 1881). As it progress, it causes the cartilage to become “dull, yellow, and granular” instead of being “smooth, white, translucent” (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1881).As a result, it eventually becomes softer, less elastic, and less capable to resist wear during heavy use. Moreover, as the “central cartilage becomes thinner, cartilage and bony growth increases at the joint margins … that results to uneven distribution of stress across the joint” that contributes to a decrease in motion. (Lewis et al., 2011; Gulanick & Myers, 2014, p. 1882). According to this patient, OA has been giving her pain for about two years that lead her to the decision of having the knee replacement.

Physical therapy is a huge part of the recovery process. Almost immediately following surgery, a physical therapist will come in and do an evaluation on the patient and then either the PT or a physical therapist assistant will help the patient start off with an exercise program. In the first few weeks following surgery, the main goals for the patient are learning to walk with their walker or crutches and gentle massage to the foot area. The patient can start a few exercises including keeping the knee and hip joints strong and moving with strengthening and range of motion exercises. During weeks two through six, other exercises are introduced including range of motion exercises for the ankle. Calf and ankle stretches, towel crunches, and ankle range of motions with a babst board are all beneficial and appropriate during this stage of treatment. After week six and x-rays are taken to confirm the ankle has healed, strengthening and weight bearing exercises can slowly be introduced to strengthen and reeducate the ankle back into a normal walking program and gait pattern. Swelling, popping, and decreased strength can be expected for at least the first year following the

As a new graduate working on the Medical/Surgical floor the use of a Continuous Passive Motion Machines (CPM) in post total knee arthroplasty (TKA) patients was essential. Seasoned nurses drilled onto graduate nurses that the patient had to wear the CPM for a minimum of eight hours per day. As a new nurse, I did not question the why, nor did I ask if there was data supporting the importance of using CPM machines.

People undergo total knee replacement when arthritis or injury erodes the joint's natural cushioning to the point where it's hard to walk even short distances without severe pain.

After 27 physical therapy visits post surgeries in a period of 6 months the patient reported no perceived disability to work after 52 weeks. Although, some functional disability was experienced when it came to general activities and sports between 4 to 13 percent based on the QuickDASH. Pain levels reported by the VAS remained considerable low. The subject reported pain level between 0-4 on a 10 scale; pain decreased to zero by week 10.

The isometric strength of the quadriceps was significantly different side to side (INV QUAD = 2.72 ± 0.77, UNINV QUAD = 3.07 ± 0.78, quad LSI = 89% ± 14%). The hip drop of the two limbs were weakly related to one another (r= 0.237, p = 0.026), the involved limb demonstrated more hip drop than the uninvolved (INV HIP ADD =14.55 ± 5.05, UNINV HIP ADD = 11.00 ± 5.31). Quadriceps strength symmetry and normalized max knee extensor moment were inversely related to hip drop with a stronger relationship on the surgical limb (INV: QUAD MVIC r = -.341 p = .001, KNEE MOM: r = -.425 p < .001 (n=88), UNINV: QUAD MVIC r = -0.278 p = .009, KNEE MOM: r = -.294 p = .005).

After 27 physical therapy visits post surgeries in a period of 6 months the patient reported no perceived disability with work after 52 weeks. Although, some functional disability was experienced when it came to general activities and sports between 4 to 13 percent based on the QuickDASH. Pain levels reported by the VAS remained considerable low. The subject reported pain level between 0-4 on a 10 scale; pain decreased to zero by week 10.

This study included 28 patients who underwent ACL surgery performed by the same 2 surgeons and standard rehab protocol was done in the same physical therapy clinic, with all the same exercises and progressions. The Battery Test uses exercise analysis to grade the participants. The exercises include measurement of isokinetic strength, single hop for distance, triple hop, side hop, and a jump-landing assessment. There were also patient surveys that asses their feelings about the overall health of their knee. The participants completed this testing 6 months after surgery, which is the average RTP time frame for basic ACL rehab protocol. Out of all 28 patients, only 2 individuals passed this test and can be considered safe for RTP. This information is extremely important for anyone who has the authority to grant RTP to any athlete. Allowing patients back to play too soon is extremely dangerous and can cause further injury. Using this specific test to determine RTP decisions is a great technique to utilize in athletic

Hi I'm Dr Bill Brian orthopedic surgeon I'm Craig Crier physical therapist with John with their preserve were here in this section to talk to you about what happens during the second month of physical therapy after total knee replacement the second month and in fact in the first part of the second month your pain should significantly go down so should be able to be more functional anyway and then the second last is primarily related to progressively getting after your strengthening program. Finalizing any kind of range of motion deficits that you may have and really getting more functional. Talking about starting different kind of sport activities and things like that so maybe some preliminary activities working on balance and proplectic type

Results: The 10 year cumulative percent revision of a 1st revision knee replacement (i.e. the rate of 2nd revision) was 22.6%. There were 9,428 1st revisions of known primary procedures performed ≤5 years and 2,304 1st revisions of known primary procedures performed >5 years. The rate of 2nd revision was higher when the 1st revision was undertaken within five years of the primary procedure. The cumulative percent revision at seven years of the ≤5 year group was 20.1% compared to 10.1% for the >5 years.

Study Design & Methods: In this prospective cohort study 80 knees were operated with a posterior

et al. also state that immediate postoperative phase starts frome days 1-7 after surgery. The objective was to eliminate pain and swelling, achieve full active knee extension equal to the uninvolved side, restore the ability to control the leg while weight bearing, achieve at least 125˚ of knee flexion. From the main article, author also state that strengthening exercise such as running was allowed at 3-6 months with progressive squatting exercise. The study by Gereon Berschin. et al. also state that for lower extremity strength, the use of squat or squat position was mostly used this guarantees a synergistic activation of knee extensor and flexor groups, thus co-activating the hamstring. From the main article, the author state the knee joint condition at the preoperative and the latest follow-up period was evaluated based on side-to-side differences between the injured and uninjured leg. Test that used by examiners was Lachman test, pivot shift test, poeterior drawer test, manual valgus test, the lysholm knee scale and visual analogue scale (VAS) during follow-up time. This

3 outpatient clinics involved in the study. Each patient was classified with a knee dysfunction

Hip replacements are viable surgical options when damage occurs within the joint or bones affecting the ability to function. The most common causes of requiring a hip replacement include osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, avascular necrosis and childhood hip diseases (Foran & Fischer, 2015). Rooks et al. (2006) reported that “osteoarthritis is an increasingly prevalent chronic illness of aging Americans and the leading cause of disability in the US” (p. 700). Progression of symptoms relating to arthritis lead to a decrease in mobility, reduced functional status and deconditioning (Rooks et al., 2006). Arthritis or other conditions damaging the hip joint severely impact individual’s quality of life and independence in occupational performances. Overall, studies report a rise every year in hip replacements due to the aging population. Due to the increased need for this population, “long waits for surgery prolong the experience of pain and low functioning level, therefore possibly leading to an increase in disability" (Gill, McBurney, & Schulz, 2009, p. 388). Clients may face many physical and emotional changes about their arthritis while awaiting the opportunity to undergo a hip replacement.