Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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27.1 Postoperative Management
of Orthopaedic Surgeries
Table of Contents

HIP

Abstract:

The range of surgical options available for individuals with hip pathology has continued to expand. Although total hip arthroplasty is a well-established technique for late-stage degenerative joint disease, arthroscopy and periacetabular osteotomy procedures are becoming more popular in the treatment of non-arthritic hip pain when conservative treatment is not successful. As surgical procedures for hip pathology advance, related rehabilitation protocols must evolve in parallel. This monograph will review pathological conditions of the hip joint, corresponding surgical options, and related postoperative rehabilitation concepts. Case studies will be provided to demonstrate application of postoperative rehabilitation protocols in specific clinical situations.

Keywords:​

acetabular labrum, femoral acetabular impingement, rehabilitation

References:

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KNEE

Abstract:

The reader will be introduced to the principles of rehabilitation and rules for progression for major surgical conditions of the knee. Readers will review the most appropriate self-report and performance-based measures for each population included. They will find detailed sections that combine surgical procedures and the implications of those procedures on rehabilitation guidelines. They will differentiate between surgery-modified rehabilitation and rehabilitation-modified surgery in the areas of meniscal, cartilage, ligamentous, and patellofemoral injures. Each section covers the scope of the injury or disease, indications for surgical or nonsurgical management and specific considerations and progressive guidelines for rehabilitation. Postsurgical complications are addressed as are the accompanying modifications needed in therapy. Three patient case scenarios are included to assist the reader in putting it all together and reviewing a full patient care process. The first case is 72-year-old female 1 week postoperatively following a right cemented posterior cruciate ligament sparing total knee arthroplasty. The second case describes a 57-year-old male fitness instructor with a ruptured patellar tendon that was repaired with tension band reinforcement. The last case is a preoperative case of a 19-year-old collegiate field hockey player who sustained a right anterior cruciate ligament injury and peripheral medial meniscus tear. This is a resource a clinician will go back to time and time again as infrequent and challenging patient conditions present themselves in the clinical setting.

Keywords:​

cartilage, osteoarthritis, ligament injury, knee rehabilitation, knee outcomes

References:

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ANKLE AND FOOT

Abstract:

Patients sustaining injuries to the foot and ankle frequently have long-term complications such as posttraumatic arthritis, decreased range of motion, and limitations with activities of daily living. These patients can be challenging to manage, therefore, the purpose of this monograph is to describe typical outcomes, treatments, and precautions for patients sustaining fractures to the calcaneus, Lisfranc fracture/dislocations, and Achilles tendon ruptures. Two cases are provided. These cases will include the examination, intervention, and outcomes for the following diagnoses: Achilles Tendon Surgical Repair and Calcaneal Open Reduction Internal Fixation.

Keywords:​

calcaneus fracture, Lisfranc fracture/dislocation, Achilles tendon rupture

References:

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CERVICAL AND LUMBAR SPINE

Abstract:

This monograph discusses physical therapy management for patients undergoing lumbar or cervical surgery. Indications for surgery are presented to assist clinicians to make informed decisions of when to refer patients for surgical consultation. Different surgical procedures for the lumbar and cervical spine are described. Short- and long-term outcomes for each procedure are offered. Variables are considered to assist in developing a patient-centered preoperative and postoperative plan of care. These variables include preoperative patient education, red flag screening following surgery, evidence-based outcome tools, and physical therapy interventions including cognitive and behavioral therapy, graded activity/exposure, muscle coordination/strengthening exercises, and neurodynamic mobilizations. Two case studies are presented to highlight how patients undergoing spinal surgery may be managed within the physical therapy patient-client management model. Each case highlights strong clinical reasoning and proper care. The first case involves a 46-year-old female referred to physical therapy 6 weeks following a lumbar microdiscectomy procedure. She presents with elevated fear-avoidance behaviors and hopes to return to recreational running and light weight lifting. The second case involves a 44-year-old male referred to physical therapy 6 weeks following an anterior cervical decompression and fusion procedure with residual arm weakness. He would like to return to full work activities as a high school vice principal, recreational tennis, and playing baseball with his children.

Keywords:​

rehabilitation, cervical surgery, lumbar surgery

References:

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SHOULDER

Abstract:

The first part of this monograph describes normal arthrokinematics, pathology, and its effect on biomechanics at each joint of the shoulder complex. Diagnostic considerations and nonoperative management are also described for each joint. The second part of the monograph discusses operative techniques for osseous, labral, and musculotendinous procedures at the shoulder complex as well as rehabilitation considerations and outcomes following each procedure. Three cases are presented at the end of the monograph. Their clinical presentations, operative management, and postoperative rehabilitation are described. The first case is a 20-year-old division I collegiate football player who required a Bankart and SLAP repair following an anterior dislocation. The second case is a 66-year-old male physician who required a surgical repair of his rotator cuff after falling on ice. The third case is an 82-year-old female who sustained a proximal humeral fracture requiring a reverse total shoulder arthroplasty.

Keywords:​

arthrokinematics, pathomechanics, surgical management

References:

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ELBOW

Abstract:

This monograph discusses postoperative management of elbow disorders. The surgical procedures, postoperative guidelines, treatment progression, and expected outcomes are presented based on current evidence. Elbow anatomy, biomechanics, and tissue healing are used to guide interventions, precautions, and treatment progression. The monograph also addresses identifying and managing the most common complications for the postoperative elbow. Two case studies are presented. Each case highlights surgical intervention, rehabilitation guidelines, and clinical reasoning. The first case describes a 30-year-old male who presents following biceps tendon repair. The second case describes a 60-year-old female who underwent a radial head replacement.

Keywords:​

elbow, postsurgical, rehabilitation

References:

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Postoperative Management

This course covers postoperative management for injuries and pathology of the hip, knee, ankle/foot, cervical/lumbar spine, shoulder, and elbow.

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