Post operative considerations Flashcards
Operations
Meniscal Repair
Meniscectomy
Knee Arthroplasty (TKA and UKA)
Patellofemoral Procedures
Meniscus Repair
Outer 1/3 has a good vascular supply
Limited WB progression over 8 weeks
Often prescribed fixed extension brace
No knee flexion >45 in WB for first 4 weeks
No knee flexion >90 in WB for first 8 weeks
Focus on OC quad strengthening
Meniscal Excision
Inner 2/3 has poor vascular supply
No precautions post-op
Rehab driven by presence of typical impairments
Recovery time 2-6 weeks
Need for further surgery most common in lateral compartment
Meniscal repair Goals Week 1-4
Regain functional ROM Prevent patellar restrictions Reestablish control of knee musculature Restore postural stability Improve strength and flexibility of hip and ankle Maintain CP fitness
Meniscal Repair Goals week 4-12
Discontinue bracing at 6-8 weeks Restore full ROM Improve LE flexibility, strength, endurance Establish NM control and balance Improve aerobic fitness
Meniscal Repair goals weeks 12-9 months
Reutrn to high level physical activity
Patient education
Advanced strengthening
Simulate fuctional activity movement patterns
Improve coordination, power, and proper alignment
Transition walking to running program ~6months
Meniscectomy Management immediate
Compression dressing
Cryotherapy
Elevation
WB as tolerated
Meniscectomy Management weeks 1-2
- Exercises to reduce atrophy, prevent contracture
- Gradual progression of WB and non-WB activity in pain free range
- Control inflammation and pain
- Establish independent abulation
- Restore ROM
Meniscectomy Management weeks 3-4
Restore full, pain free ROM Normal Gait pattern Resistance training Endurance activities Proprioceptive/balance activities NM Retraining
Meniscectomy Management weeks 4-8
Return to function tasks
Meniscal Transplant
Candidates: -Under 40 -Minimal OA -Not currently candidate for TKA -Wish to remain highly active Not applicable for: -Patients with malalignments -Advanced arthritic changes -Uncontrolled knee instability
Meniscal Transplant timeline
Surgeons expect full extension within first few weeks
Limited WB for 3-6 weeks progressing to FWB after 9 weeks
Osteotomy
Wedge of bone is taken out to realign joint
Pts <60 y/o
May delay need for arthroplasty for 10 years
Failure rate of 10%
-Cannot use cuff weights distal to osteotomy until after 4 weeks
-Full ROM encouraged immediately
Unilateral Knee Arthroplasty Considerations
DJD in one compartment
Max 10 degrees varus or 5 degrees valgus from mechanical axis
Flexion contractures <32
Unilateral Knee arthroplasty rehab
Immediate WBAT
Facilitate full extension and 90 degrees flexion 1st week
Facilitate quad activity
Patellar joint mobilization
Unilateral knee arthroplasty advantages
Greater bone preservation
More normal mechanics due to ligament sparing
Better ROM and proprioception
Cemented TKA
Allows for immediate WBAT
Implant is cemented into the bone
High rate of loosening
Uncemented TKA
WB restrictions immediate post op
Rely on rapid bone growth
High rate of loosening at the tibial interface
Hybrid TKA
Uncemented femoral component
Cemented tibial component
TKA Post op considerations
Monitor integrity of incision
Avoid SLR in sidelying to avoid excessive varus/valgus forces for:
2 weeks if cemented
4-6 weeks if uncemented
Joint mobilization techniques may not be appropriate depending on prosthetic components
Complications of TKA
Wound healing issues DVT <3% Pneumonia Myocardial infarction nerve or vascular issues joint instability Knee stiffness
Success variable of ACL operation
Preoperative fitness level Healing properties Status of knee joint at time of injury Time from injury to surgury Presences of concomitant injury that occurred at the same time as ACL injury
Current guidelines focus for ACL rehab
Immediate WB
Immediate ROM
Early return to function and sport
ACL rehab
Avoid strengthening of quads between 60-90 degrees of knee flexion due to greatest amount of anterior tibial translation here
