Surgeries

Question 1

3 types of surgery

Answer 1

> elective
traumatic
emergency - non-traumatic

Question 2

Total hip replacement - procedure

Answer 2

> Spinal anaesthetic
Incision is made postero-laterally (may lead to glute med/min tendon weakness)
hip is dislocated to gain access
acetabulum is reshaped to fit cup prosthesis + insert within cup
femoral head is removed + prosthetic is fitted which insert into femoral shaft (porous metal is used to encourage bony in growth)
Muscles + soft tissues = repaired
closed up

Question 3

Alternatives to total hip replacement

Answer 3

> hemiarthroplasty
- replacing half the hip joint (usually femoral head)
Resurfacing
- only surfaces of hip are replaced (femoral head is reshaped to allow metal cap to fit over it)

Question 4

Total Knee Replacement - procedure

Answer 4

> Spinal anaesthetic
Incision down front of knee - expose knee cap (moved to side to gain access)
Distal femur + proximal tibia are cut to fit shape of prosthesis + plastic spacer between to act like meniscus
posterior patella may also be replaced

Question 5

Physio post knee/hip replacement

Answer 5

> Usually full weight bearing on day 0
RoM + strength exercises (hip - glute med/min, knee = quads especially)
- crutch/weight-bearing education/training
Swelling + pain management

Some hospitals may have hip precautions for 6 weeks

• don’t flex past 90 degrees
• don’t adduct past midline
• don’t twist

Question 6

Complications with replacement

Answer 6

> Infection (pain/redness/swelling/heat/oozing - may not be distinguishable from post-op inflammation)
> DVT: Wells score will calculate risk of clot
          : pain/tenderness over veins 
          : warm/swollen/red skin
> Malfunction of prosthesis
- usually post trauma 
- pain/decreased RoM
> Nerve injury 
- weakness and changes in sensation

Question 7

ACL reconstruction

Answer 7

> Hamstring (weakens hamstrings initially)
Patella graft (risk of patella tendinopathy + anterior knee pain)

>  Initial Rehab 
- Gait re-education
- AROM
- Strength 
> Early
- RoM 
- Strength
- Proprios
> Mid
- Strength/RoM/Proprio = continued
- load acceptance
- Running 
> Late 
- goal/sport specific

Question 8

Achilles tear

Answer 8

> Surgery or conservative (similar outcomes)
Thompson test for diagnosis
boot in plantarflexion for 8-12 weeks (initially TTWB)