OCS Surgical & Post-Operative Care 2 — Questions and Answers
Question 1: Following a total knee arthroplasty (TKA), which ROM milestone should a patient typically achieve by discharge from acute care?
- 0-90° flexion (Correct answer)
- 0-60° flexion
- 0-120° flexion
- 0-45° flexion
Correct answer: 0-90° flexion
A 0-90° arc of motion is the standard discharge goal after TKA, allowing functional sit-to-stand transfers.
Question 2: A patient 3 days post-ACL reconstruction reports calf pain, warmth, and swelling. What is the most appropriate immediate action?
- Notify the surgeon and screen for DVT (Correct answer)
- Apply ice and elevate the limb
- Begin gentle calf stretching
- Progress weight-bearing as tolerated
Correct answer: Notify the surgeon and screen for DVT
Calf pain, warmth, and swelling post-operatively are classic DVT warning signs requiring immediate surgical notification and further vascular screening.
Question 3: Which surgical approach for total hip arthroplasty (THA) generally requires posterior hip precautions to prevent dislocation?
- Posterior approach (Correct answer)
- Anterior approach
- Lateral approach
- Anterolateral approach
Correct answer: Posterior approach
The posterior approach violates the posterior capsule and external rotators, necessitating precautions against hip flexion >90°, adduction, and internal rotation.
Question 4: After arthroscopic rotator cuff repair of a large tear, what is the typical duration of immobilization in a sling before initiating passive ROM?
- 4-6 weeks (Correct answer)
- 1-2 weeks
- 8-12 weeks
- 0-1 week
Correct answer: 4-6 weeks
Large rotator cuff repairs require 4-6 weeks of immobilization to allow tissue healing before initiating passive motion, as premature movement risks re-tear.
Question 5: A patient 2 weeks post-lumbar spinal fusion presents with increasing pain, fever of 101.5°F, and elevated WBC. What should the physical therapist suspect?
- Surgical site infection or discitis (Correct answer)
- Normal post-operative inflammatory response
- Heterotopic ossification
- Adjacent segment disease
Correct answer: Surgical site infection or discitis
Fever, elevated WBC, and worsening pain 2 weeks post-spinal surgery are cardinal signs of surgical site infection or discitis requiring urgent medical evaluation.
Question 6: Which precaution is most critical for a patient in the first 6 weeks after anterior cruciate ligament (ACL) reconstruction using a patellar tendon autograft?
- Avoiding combined knee flexion with tibial internal rotation and valgus stress (Correct answer)
- Maintaining knee in full extension at all times
- Avoiding any weight-bearing through the extremity
- Preventing knee flexion beyond 45°
Correct answer: Avoiding combined knee flexion with tibial internal rotation and valgus stress
The graft is in a vulnerable 'ligamentization' phase; combined tibial internal rotation with valgus stress recreates the injury mechanism and risks graft failure.
Question 7: When is continuous passive motion (CPM) most commonly indicated following orthopedic surgery?
- Immediately post-TKA to maintain joint mobility and reduce stiffness (Correct answer)
- Following lumbar fusion to prevent epidural fibrosis
- After shoulder labral repair to restore external rotation
- Post-ACL reconstruction to accelerate graft maturation
Correct answer: Immediately post-TKA to maintain joint mobility and reduce stiffness
CPM is most commonly applied after TKA to prevent arthrofibrosis, maintain joint nutrition, and promote early cartilage healing.
OCS Surgical & Post-Operative Care 2
Following a total knee arthroplasty (TKA), which ROM milestone should a patient typically achieve by discharge from acute care?