Surgical Interventions and Postoperative Management

• Extra-articular Procedures

  ORIF and Osteotomy
• Arthrodesis Post op management

  ROM and strength at joint above and below maintained, weight bearing restricted
• Joint Replacement Arthroplasty Contraindications

  Active infection, chronic osteomyelitis, systemic infection, substantial loss of bone or malignant tumor, significant paralysis of muscles surrounding joint, neuropathic joint, inadequate patient motivation
• Joint Replacement Arthroplasty Implant Designs

  Unconstrained (no inherent stability), semiconstrained, fully constrained (inherent stability)
• Joint Replacement Arthroplasty Implant Materials

  Rigid (inert metal) or semirigid (plastic)
• Arthroplasty Procedures

  Excision Arthroplasty, Excision Arthroplasty with implant, interposition arthroplasty, joint replacement arthroplasty
• Articular cartilage procedures


  Abrasion arthroplasty, microfracture, chondrocyte transplantation, osteochondral graft
• Joint Procedures

  Arthroscopic Debridement and lavage, synovectomy
• Release, Lengthening, Decompression Procedures

  CPM and/or AAROM within day or two, strengthen antagonist of lengthened muscle
• Tendon Transfers Post-Op Management

  Muscle setting and protected motion
• Capsular Repair Post-Op Management

  Restore ROM, emphasis or active motions with protected range, dynamic joint stabilization
• Tendon Repair Post-Op Management after Several Weeks

  Controlled antigravity motions
• Tendon Repair Post-Op Management Immediately after surgery

  Muscle Setting, antagonist muscle work if able to
• Muscle Repair Post- Op Management Partial weight bearing

  Low-load, high rep progressed gradually,
• Muscle Repair Post-Op Management Immobilization removed

  AROM, emphasis on controlled motion within controlled motion
• Muscle Repair Post-Op Management Immediately after surgery

  Gradual muscle-setting Exercises
• Synthetic Graft

  Artificial graft; made
• Allograft


  Skin graft from someone else
• Autograft


  Skin graft from yourself
• DVT Impairments

  Dull ache or pain usually in calf, tenderness, warmth, and swelling
• Prevention of DVT

  Anticoagulant therapy, leg elevation, no prolonged sitting, initiate ambulation ASAP, ankle pumps, and compression
• DVT Risk Factors

  Immobilization, prolonged bed rest, sedentary lifestyle, prolonged standing, trauma to venous vessels, limb paralysis, active malignancy, history of DVT or PE, advanced age, obesity, CHF, oral contraceptives, pregnancy
• DVT Assessment

  Doppler study, Homan's sign, or Well's Clinical Prediction Rule
• Deep Vein Thrombosis (DVT) Clinical Features

  Limb pain and tenderness, swelling of calf or thigh, usually unilateral, distension of superficial veins, increase skin temp, and skin discoloration
• Potential Postoperative complications

  Pulmonary dysfunction, infection, DVT, pulmonary embolism, delayed healing, muscle deficits, internal fixation failure, delayed union of bone, rupture of incompletely healed soft tissue, Subluxation or dislocation, nerve entrapment, adhesion, periprosthetic infection
• Phases of Postoperative Rehab

  Maximum protection, moderate protection, and return to function phases
• Post Op rehab impairments

  Pain d/t disruption of tissue, swelling, circulatory and pulmonary complications, joint stiffness/ limitation d/t immobilization, muscle atrophy, loss of strength, weight-bearing limit, loss of strength of non-operated joints
• Inspection of Surgical Incision

  redness or necrosis, tenderness, edema, warmth, drainage, mobility, and scar healing
• Factors affecting postoperative rehab

  Tissue pathology, size and severity of lesion, surgical procedure, patient factors, pre-surgical impairments, history, lifestyle history, motivation, healing stage, tissue involved, immobilization and remobilization, adjacent structures, and surgeon's philosophy
• Preoperative Patient Education


  POC, precautions, bed mobility and transfers, initial exercises, gait training, wound care, pain management
• Preoperative Management exam and eval

  Pain, ROM and joint integrity, skin integrity, muscle performance, postural, gait analysis, functional status
• Indications for Surgery

  Incapacitating Pain, limit AROM or PROM, joint instability, joint degeneration, chronic swelling, failed conservative care, and loss of function