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A 69-year-old female presents to her orthopaedic surgeon's office with pain and swelling in her left knee. She has been experiencing pain on the medial side for the past 2 years; however, she has been independent in all activities of daily living (ADLs) and has been able to exercise regularly until the last 3 months. Her primary complaint was pain with descending stairs. Visual examination showed overall effusion and palpable warmth with greater valgus deformity of the left knee than the right. Passive range of motion of the left knee was 5° to 125° with pain in the last 10° of flexion. X-rays showed tricompartmental arthritis with approximation of the medial femoral condyle and tibial plateau on the anteroposterior view. Merchant view showed a loss of joint space with lateral shift of the patella out of the patellar groove. Her relevant medical history includes: hypertension, hiatal hernia, and non-insulin–dependent diabetes mellitus. Surgical history includes two previous left knee arthroscopies (5 and 20 years ago) and hysterectomy 12 years ago. Daily preoperative medications are pantoprazole (Protonix), valsartan/hydrochlorothiazide (Diovan HCT), and ibuprofen (two to four 200 mg tablets, as needed). The patient has been retired for 4 years and maintained an active lifestyle. Prior to this recent 3-month onset of increased knee pain, she played golf, exercised regularly at a gym, and participated in a variety of volunteer activities 5 days per week. After discussion of the x-ray findings with the orthopaedic surgeon, she was scheduled for a total knee arthroplasty (TKA). The patient received educational materials regarding the surgery and the predicted hospital course. She also attended a preoperative education class prior to surgery. The patient is a widow and lives alone; however, she has two adult children living nearby who will be able to assist her after hospital discharge. She was admitted to the hospital and had a left TKA with no complications. According to the ordered TKA protocol, physical therapy is ordered to begin postoperative day 1 (POD 1).

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What are the most appropriate physical therapy outcome measures for gait and balance?

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What are the most appropriate physical therapy interventions?

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What are the possible complications that may limit the effectiveness of physical therapy?

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Identify referrals to other medical team members.

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  • RAPID RECOVERY PROTOCOLS: Protocols or clinical pathways designed to decrease length of stay and accelerate patient recovery postoperatively; typically include a combination of preoperative education materials, surgical technique, multimodal pain management, and focused rehabilitation interventions
  • TOTAL KNEE ARTHROPLASTY (TKA): Resurfacing of the articulating surfaces of the knee joint; comprised of four components including a distal femoral component, tibial plateau tray, patellar button, and polyethylene liner
  • VENOUS THROMBOSIS: Development of a blood clot in a vein

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  1. Define osteoarthritis (OA) and its pharmacologic management.

  2. Understand the indications for TKA.

  3. List the complications of immobility.

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