Common orthopaedic procedures

Question 1

what is an elective procedure vs trauma

Answer 1

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

Question 2

what is a joint replacement surgery

Answer 2

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,

Question 3

total hip replacement (THR/THA)

Answer 3

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

Question 4

total hip replacement- what is replaced

Answer 4

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

Question 5

hemiarthroplasty and hip resurfacing

Answer 5

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

Question 6

total knee replacement-

Answer 6

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

Question 7

total knee replacement- what is replaced

Answer 7

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

Question 8

post op physio- knee and hip

Answer 8

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

Question 9

post-op physio- knee and hip

Answer 9

knee- quad control and ROM at the knee- flex ext, hip- glut med/min, affected strength wise due to insertions

Question 10

complications- infection

Answer 10

signs include pain, redness, heat, significant swelling and oozing from wound, person may have temperature and may complain of feeling unwell

Question 11

complications- deep vein thrombosis

Answer 11

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

Question 12

complications- malfunction of prosthesis

Answer 12

breakage, loosing or dislocation- particularly likely to occur in patients with trauma

Question 13

complications- nerve injury

Answer 13

weakness or changes in sensation- may have a little bit around scar which is normal

Question 14

total shoulder replacement- aims

Answer 14

aims to reduce pain and restore mobility in patients with late stage- OA or after severe fracture
traditional or reverse shoulder replacement

Question 15

total shoulder replacement- traditional

Answer 15

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

Question 16

total shoulder replacement- reverse

Answer 16

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

Question 17

post op physio TSR- early

Answer 17

sling for 2/52, ROM exercises as allowed, taught hoe to complete ADLs, pain management

Question 18

post op physio TSR- weeks 2-6

Answer 18

wean out of sling, progress ROM- ensure good scapula rhythm, start isometric RC exercises

Question 19

post op physio TSR- weeks 6-12, and 6 months

Answer 19

6-12- start to progress strength and functional exercises

6 months- patients specific rehab depending on goals

Question 20

ACL reconstruction

Answer 20

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

Question 21

ACL reconstruction procedure

Answer 21

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

Question 22

post op physio ACL reconstruction- initial and early phase

Answer 22

initial- gait education, AROM, strengthening

early- progression of ROM/strength- closed chain quads, early proprioception,

Question 23

post op physio ACL reconstruction- middle and late

Answer 23

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)

Question 24

rotator cuff repair- who?

Answer 24

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

Question 25

rotator cuff repair- surgery

Answer 25

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)

Question 26

post op rehab- RC rehab

Answer 26

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

Question 27

achilles repair- who

Answer 27

indicated in patients with ruptures can be treated conservatively or surgically (similar outcomes)

Question 28

achilles repair- procedure

Answer 28

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

Question 29

discectomy/ decompression- who?

Answer 29

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

Question 30

discectomy/ decompression- where

Answer 30

often performed in both cervical and lumbar spine

Question 31

discectomy

Answer 31

involves removing disc material that is extruding into the foramen or spinal canal

Question 32

decompression

Answer 32

can include removal of osteophytes, alinectomy, removal of thickened ligament, foraminotomy, facetomy

Question 33

discectomy/ decompression- procedure

Answer 33

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

Question 34

post op physio- disectomy/ decompression

Answer 34

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

Question 35

spinal fusion

Answer 35

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

Question 36

spinal fusion- physio

Answer 36

immediate post op physio aimed at regaining mobility, chest physio also required

Question 37

common orthopaedic surgeries

Answer 37

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

Question 38

open reduction internal fixation

Answer 38

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

Question 39

how long does the fixation remain in place

Answer 39

it remains in place unless metal work becomes problematic, at which point it may be removed

Question 40

dynamic hip screw

Answer 40

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

Question 41

what is external fixation

Answer 41

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

Question 42

how long can external fixation be in place for

Answer 42

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