|
|
TKR protocol & CPM
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
TKR protocol & CPM - October 3, 2006 5:47:00 PM
|
|
|
joshua5
Posts: 52
Joined: April 19, 2004
Status: offline
|
as i understand it, functional outcomes state there's not much difference in CPM vs. no CPM.
can anyone give me a typical protocol for a traditional TKR CPM.
84 year old male 8 days post op and transfering and ambulating 300' on tile idependently with a rolling walker. incision looks good. sitting arom to 90 degres flexion. extension arom is wnl. strength is typical for his stage post op. supine heel slide to 60-70 degrees of flexion. incision looks good. periodic knee pain especially first thing in the a.m. until arom is done. thanks for any replys. the more i learn, the more i don't know.
|
|
|
|
|
Re: TKR protocol & CPM - October 4, 2006 2:00:00 AM
|
|
|
pt4pt
Posts: 13
Joined: September 22, 2006
Status: offline
|
actually i`ve seen many patients post TKR
what i`ve noticed that AROM reach maximally 90-95 and passively 100 and that will be funcional for them throughout the life
but what we as PT need to concentrate more is achieving FULL extension
i hope u got my point
|
|
|
|
|
Re: TKR protocol & CPM - October 4, 2006 8:08:00 AM
|
|
|
Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Im not sure that the CPM protocols are anything but arbitrary numbers in most cases. I actually thoroughly enjoy this population, both pre and post op, as I see a lot of them. I always shoot for the maximal flexion, which, for most TKA's is 120-125, and FULL extension. The folks who have problems post TKA lack full extension, have very poor quad function and poor flexion as well. Early and often ROM as far as is possible, immediate post op seems by my accounts to be the most important factor in determining trouble down the road. This is most often most comfortable if it is truly passive, so I teach the pre-ops how to relax their quads during edge of bed flexion ROM.
Let me know if you have other insights, and whether or not I even remotely answered your question!
Steve
_____________________________
Steve Hill PT
|
|
|
|
|
Re: TKR protocol & CPM - October 4, 2006 4:25:00 PM
|
|
|
joshua5
Posts: 52
Joined: April 19, 2004
Status: offline
|
pt4pt,
thanks for the reply. i was wondering if you had any experience with a CPM protocol for a TKR?
Shill,
insightful. thank you. i think you answered my question. unfortunately, i'm not able to see my patients pre-op as they're not in my facility. really appreciate the help!!
|
|
|
|
|
Re: TKR protocol & CPM - October 5, 2006 4:10:00 PM
|
|
|
Jon Newman
Posts: 1711
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
At our hospital we use a CPM post-op through discharge. Patients are placed on CPM for 1 hour three times a day. They start at 0-40 degrees and progress as tolerated.
I advocate against the automatic use of CPMs for a number of reasons which can largely be captured by; increased use of staff (PT, CNA/Nursing, housekeeping), cost (CPM supplies/repair), and patient suffering without obvious (or any) long term benefit.
I feel that PT is quite valuable and rarely has to be aggressive. I would rank patient motivation (may be influenced by PT), pre-morbid status and surgical success as primary determinants of outcome.
Things I'd like to know: Pre-morbid range of motion while awake and under anesthesia and post-op ROM under anesthesia.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: TKR protocol & CPM - October 5, 2006 4:49:00 PM
|
|
|
joshua5
Posts: 52
Joined: April 19, 2004
Status: offline
|
Jon,
thanks so much for the info. i really like, and agree with your second paragraph as well as the first sentence of the third.
as far as this specific patient goes, i wouldn't be able to give you an exact pre-morbid rom or post op under anesthesia. extension rom is equal bilat which is about 3 or 4 degrees from zero as i've been told. have not measured this recently as i haven't been the one to work with him.
he has done very well and will have a home evaluation on monday. thanks for the help guys!
|
|
|
|
|
Re: TKR protocol & CPM - October 6, 2006 5:59:00 AM
|
|
|
Jon Newman
Posts: 1711
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Hi Steve,
I am interested in how you teach relaxation of the quads.
Are your anesthesiologists using femoral nerve blocks for post-op pain management? If so, I'd like to read about your experiences with that.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: TKR protocol & CPM - October 6, 2006 7:08:00 AM
|
|
|
Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
Hey Jon
Its just a matter of "see how squishy your muscle is right now? Try to keep it that way while I let gravity take your foot down."(in sitting at edge of table. That works surprisingly well. In the immediate post ops, it still works, if I can get them to trust me.
Sometimes the femoral nerve blocks are done, and with varying degrees of wearing off prior to PT. Im not on the inpatient floor much anymore, (1-2x per year), but one of the surgeons told me that PT wasnt notified about the block, and quad function hadnt yet returned, and we had a fall. Thankfully, no injury, but a fall none the less. This shows the need for the PT's to not only know ahead of time, but to check as well.
I can tell you from my own experience that I have had a nerve block once myself, interscalene, and I had little to no post operative pain. It is quite a strange phenomenon though. I can elaborate if you wish.
Steve
_____________________________
Steve Hill PT
|
|
|
|
|
Re: TKR protocol & CPM - October 6, 2006 7:34:00 AM
|
|
|
Jon Newman
Posts: 1711
Joined: April 24, 2004
From: Amherst, WI
Status: offline
|
Please elaborate. I'd be interested.
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
|
|
|
|
|
Re: TKR protocol & CPM - October 6, 2006 7:59:00 AM
|
|
|
Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
I was about to have a shoulder arthroscopic evaluation and repair of whatever they found, so I "went to sleep" (had general anesthesia too), and awoke thinking my hand was resting comfortably on my tummy. I took a look, and no hand was there. No arm, nothing. This was a little unnerving (pun intended), but I wasnt too concerned. Then, out of the corner of my eye, was this thing flopping at my side. Ah ha. There's my arm! Couldnt feel it or move it, but it was attached. So, I grabbed it, and put it back where it belonged.
I assume that this is the neural memory some speak of. My brain thought my arm was someplace it wasnt, as my nerve was not providing current feedback, and the last message it provided was "Hey, Im right here", then silence.
It took about 10+ hours for the block to wear off, all the while I was complaining more about my sore throat from the apparently jittery person who intubated me.
As an aside, I would really like to see these interscalene blocks done on those suspected of having adhesive capsulitis, and then have them come to PT. There would be no pain, and then we could see what truly creates their inability to move, whether it is indeed a capsular issue, or whether it is something else. I suspect we would find both situations, but I doubt this would ever happen, at least not until the block only costs a few bucks.
_____________________________
Steve Hill PT
|
|
|
|
|
Re: TKR protocol & CPM - October 6, 2006 5:41:00 PM
|
|
|
PTupdate.com
Posts: 1478
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
Jumping in a little late, but remember this article:
USE OF CONTINUOUS PASSIVE MOTION AFTER TOTAL KNEE ARTHROPLASTY The Journal of Arthroplasty, Vol. 16, No. 3, April 2001
Which basically indicated that CPM may assist in early discharge, decreased DVT, decreased pain, but may not be worth the cost and effort involved with the program.
It had some flaws in the manner of it's research, but not the first one I have read that indicated it speeds things up at first, but in the long run, no major difference
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.078
|
Printable Version
