Common orthopaedic procedures Flashcards
what is an elective procedure vs trauma
one that is planned in advance and does not need to be performed immediately e.g. joint replacement, ligament reconstruction
trauma is a surgery used to treat/ manage traumatic injuries e.g. open reduction internal fixation (ORIF), external fixation
what is a joint replacement surgery
orthopaedic surgery procedure in which an arthritic or dysfunctional joint surface is replaced with a prosthesis. most commonly replaced joints are hips and knees (160000 per year), can be shoulders, ankles, finger joint,
total hip replacement (THR/THA)
mostly performed under a spinal anaesthetic (blocks sensation from waist down), incision made postero-laterally to expose the joint, surgeon then dislocates the hip joint, femoral head cut off, and special tool used to grind down acetabulum and reshape it
total hip replacement- what is replaced
acetabular cup placed into socket, then an insert/linear placed inside the cup, the prosthetic femoral stem is placed into the shaft of the femur, and the prosthetic femoral head sits on top of the stem, muscle and other tissues are repaired, skin incision is stitched
hemiarthroplasty and hip resurfacing
surgical procedure that involves replacing half the hip joint, replaces only the femoral head portion of the joint
hip resurfacing- replaces the surfaces of the hip joint- preserves more bone than THR, the head of the femur is not removed, but is reshaped toa llo a metal cap to be cemented on
total knee replacement-
normal under a general anesthetic, incision made down the front of the knee to expose knee cap, kneecap is moved to the side to allow access to the knee joint, distal femur and proximal tibia are cut away, using guides which shape the bone to fit the prosthetic components
total knee replacement- what is replaced
the distal end of the femur is replaced with a curved metal prosthesis, and the proximal tibia is replaced with a flat prosthesis, plastic spacer in between 2 components, sometimes the posterior aspect of the patella is also replaced
post op physio- knee and hip
they are usually FWB after surgery, start mobilisation day 0, ROM/ strength exercises, usually stay for 3/52, hip precautions sometimes follow for 6/52- less common, not allowed to flex 90°, cannot adduct past midline, swelling management, pain management- cryotherapy or ice, teach them how to use crutches and weight bear
post-op physio- knee and hip
knee- quad control and ROM at the knee- flex ext, hip- glut med/min, affected strength wise due to insertions
complications- infection
signs include pain, redness, heat, significant swelling and oozing from wound, person may have temperature and may complain of feeling unwell
complications- deep vein thrombosis
wells score- determines risk of DVT- blood clot in leg both upper (less commonly picked up) and lower
causes pain and swelling in leg, walm leg skin, severe tenderness, and can lead to pulmonary embolism
complications- malfunction of prosthesis
breakage, loosing or dislocation- particularly likely to occur in patients with trauma
complications- nerve injury
weakness or changes in sensation- may have a little bit around scar which is normal
total shoulder replacement- aims
aims to reduce pain and restore mobility in patients with late stage- OA or after severe fracture
traditional or reverse shoulder replacement
total shoulder replacement- traditional
GHJ assessed anteriorly, deltoid and pecs are separated to access the shoulder joint, subscapularis cut to gain access, arthritic areas removed implants inserted, subscapularis repair and incisions, commonly used with patients whose RC are not damaged, head of humerus replaced with ball, glenoid replaced with socket
total shoulder replacement- reverse
shoulder assessed anteriorly, humerus pre prepared for new socket (humeral cap) and glenoid prepared for ball shaped prosthesis, humeral stem inserted, humeral cap and glenosphere attacked- may be attached with cement or may be press fit, movement of joint checked, muscles repaired; incisions closed
post op physio TSR- early
sling for 2/52, ROM exercises as allowed, taught hoe to complete ADLs, pain management
post op physio TSR- weeks 2-6
wean out of sling, progress ROM- ensure good scapula rhythm, start isometric RC exercises
post op physio TSR- weeks 6-12, and 6 months
6-12- start to progress strength and functional exercises
6 months- patients specific rehab depending on goals
ACL reconstruction
undergone in patients who have ruptured their ACL, hamstrings or patella tendon used as graft (autograft), similar outcome, hamstrings higher risk of hamstring injury post op, smaller wound, high strength of grat, PT- increase risk of tendinopathy/ anterior knee pain, 9-12 month rehab for return to sport post op
ACL reconstruction procedure
completed with tiny insertions- one for camera and fluid, one or 2 more are made either side of kneecap to gives access to knee, and one more posteriorly to stable graft
removed damaged ACL, retrofit cutter used to create tunnel through femur and through tibia into knee joint anchor points, hamstring tendon- stabilized with screw
post op physio ACL reconstruction- initial and early phase
initial- gait education, AROM, strengthening
early- progression of ROM/strength- closed chain quads, early proprioception,
post op physio ACL reconstruction- middle and late
middle- continue to progress strength and ROM, progress proprioceptive exercises, load acceptance, running- straight lines, then progress to multidirectional
late- start sport specific drills (normally from 6/12 onwards depending on patient progress)
rotator cuff repair- who?
indicated in patients with complete tears of RC tendons, or sometimes for partial tears who have failed conservative treatment, normally done arthroscopically, although can be open surgery
rotator cuff repair- surgery
surgeon will start with an examination under aesthetic- EUA, joint/tendon will be debrided, sometimes longside a subacromial decompression (removed bone spurs from the underside of clavicle), RC tendon will then be reattached to the bone using an anchor and sutures (different variations depending on surgery)
post op rehab- RC rehab
3-6 months, early phase- immobilised for up to 6/52 in sling, middle phase- AROM, scapula stability
late phase- shoulder stretching, proprioception, sport specific rehab
achilles repair- who
indicated in patients with ruptures can be treated conservatively or surgically (similar outcomes)
achilles repair- procedure
posterior incision made, ruptured end of achilles stretched together, normally put in boot, in PF for 8-12/52- slowly decrease until reach plantigrade, initially likely to be toe touch weight bearing, thompson test
discectomy/ decompression- who?
indicated in patients who have nerve roots of spinal cord compression- this could be because of disc prolapse, bony spurs in the intervertebral foramen or spinal cord stenosis. surgery is urgent in the case of cauda equina symptoms- pain, weakness altered sensation in LL, aim or surgery is to reduce compression to the nerve and/or spinal cord
discectomy/ decompression- where
often performed in both cervical and lumbar spine
discectomy
involves removing disc material that is extruding into the foramen or spinal canal
decompression
can include removal of osteophytes, alinectomy, removal of thickened ligament, foraminotomy, facetomy
discectomy/ decompression- procedure
central posterior incision made over the appropriate vertebrae, spinal muscles are split down the middle and moved to either side to gain access to spine
post op physio- disectomy/ decompression
sitting often restricted to 30 mins at a time for first 1-2/52, gentle ROM and isometric exercises given initially, walking encouraged from immediately post- op, strength and mobility exercises progressed from 4-6/52 post-op depending on symptoms
spinal fusion
can be elective or trauma surgery- indicated in some cases of nerve root compression, unstable spondylolisthesis, unstable fractures, scoliosis, surgeon uses screws and rods to fix vertebra in place- fusion, a scoliosis correction is a very painful surgery
spinal fusion- physio
immediate post op physio aimed at regaining mobility, chest physio also required
common orthopaedic surgeries
debridement- removal or damaged tissue, meniscectomy remove damaged area- prevent getting caught, labral repair, microfractures- if someone has osteochondral defect- drill small holes into area of bone where defect is- causes bleeding- causes blood clot and scar tissue taken the place of defect, muscle/ligament/tendon reconstructions
open reduction internal fixation
surgery used to fix broken bones that are displaced or unstable, different types of fixation- IM nail or plates/ screws are most common, open reduction refers to the process of resetting the bones into correct position, internal fixation is then the use of the implant to maintain the position allowing the bone to heal
how long does the fixation remain in place
it remains in place unless metal work becomes problematic, at which point it may be removed
dynamic hip screw
common in older osteoporotic patients, indicates in the case of fractured neck of femur, allows some movement of the femoral head in the direction of the screw- promotes remodelling and healing
what is external fixation
surgical treatment where the rods are screwed into the bone, and exit the body to be attached to a stabilizing structure externally. indicated in the case of severe open fractures, infected-non-unions, correction of malalignments, polytrauma, sometimes allows for weight bearing in LL fractures- promote healing
how long can external fixation be in place for
can remain in place for weeks or months, e.g. LL, Ilizarov frames are often in place for 9 months, rehab starts whilst ex-fix is till in place
