Surgical & Post-Operative Care Flashcards

During the first post-operative day after total knee arthroplasty, the physical therapist notes the patient's knee is significantly swollen and the drain output is bright red and greater than 200 mL/hour. The BEST action is:

Answer: Notify the nursing staff and surgeon immediately and defer therapy

Excessive bright red drain output exceeding 200 mL/hour suggests active post-operative hemorrhage, which is a medical emergency requiring immediate surgical notification.

Which clinical sign differentiates a periprosthetic joint infection (PJI) from aseptic loosening following total joint arthroplasty?

Answer: Elevated ESR, CRP, and synovial fluid WBC count above 1,700 cells/μL

Elevated inflammatory markers (ESR, CRP) and high synovial WBC (>1,700 cells/μL with >65% neutrophils) distinguish PJI from aseptic loosening, which presents with normal or mildly elevated labs.

A patient is 10 days post-operative from a lumbar microdiscectomy for L4-L5 disc herniation. She reports new-onset saddle anesthesia and difficulty initiating urination. The therapist should:

Answer: Immediately refer back to the surgeon as this may indicate cauda equina syndrome

New saddle anesthesia and bladder dysfunction after lumbar surgery are red flags for cauda equina syndrome, a surgical emergency requiring immediate re-evaluation.

Which graft type for ACL reconstruction is associated with the highest rate of donor-site morbidity (anterior knee pain and kneeling pain)?

Answer: Bone-patellar tendon-bone (BPTB) autograft

BPTB autograft harvest causes significant anterior knee pain and kneeling difficulties due to patellar tendon disruption and proximal tibial bone plug harvest site.

A patient 3 weeks after ulnar nerve transposition surgery reports persistent numbness in the ring and little fingers with Tinel's sign at the medial elbow. The appropriate interpretation is:

Answer: Axonal regeneration is occurring normally and symptoms may persist for several months

Nerve regeneration after transposition proceeds at approximately 1 mm/day, and persistent sensory symptoms with Tinel's sign at 3 weeks indicate ongoing but normal recovery.

Which functional outcome measure is MOST appropriate for tracking recovery after total knee arthroplasty across multiple time points?

Answer: Knee injury and Osteoarthritis Outcome Score (KOOS) or KOOS-JR

The KOOS and its short-form KOOS-JR were specifically developed and validated for TKA populations, measuring pain, symptoms, function in daily living, sports/recreation, and quality of life.

After a Latarjet procedure for recurrent anterior shoulder instability, why is coracoid transfer to the anterior glenoid rim effective?

Answer: It provides a bony buttress and the conjoined tendon acts as a dynamic sling preventing anterior humeral head translation

The coracoid graft extends the glenoid articular arc (bony buttress), while the transferred conjoined tendon creates a dynamic sling effect that resists anterior subluxation during abduction-external rotation.