Surgical Interventions and Postoperative Management Chapter 12

Indications for Surgical Intervention Incapacitating pain at rest or with activity Marked limitation of motion Gross instability of a joint or bony segment Joint deformity or abnormal alignment Significant structural degeneration Chronic joint swelling Failed nonsurgical or previous surgical management Significant loss of function leading to disability as the result of any of the preceding factors Box 12.1 contains Indications for Surgery for Musculoskeletal Disorders of the Extremities and Spine.

Considerations for Preoperative Management Preoperative Examination and Evaluation Pain Range of motion and joint integrity Integrity of the skin Muscle performance (strength and endurance) Posture Gait analysis Functional status Guidelines for Preoperative and Postoperative Management Box 12.2 contains Benefits of Preoperative Contact with a Patient.

Preoperative Patient Education Methods and Rationale Components Overview of the plan of care Postoperative precautions Bed mobility and transfers Initial postoperative exercises Gait training Wound care Guidelines for Preoperative and Postoperative Management

Considerations for Postoperative Management Postoperative Examination and Evaluation Phases of Postoperative Rehabilitation Maximum protection phase Moderate protection phase Minimum protection/return to function phase Time-Based and Criterion-Based Progression Putting Postoperative Rehabilitation into Perspective Guidelines for Preoperative and Postoperative Management Box 12.3 contains Factors That Influence the Components, Progression, and Outcomes of a Postoperative Rehabilitation Program. Box 12.4 outlines Inspection of the Surgical Incision. Box 12.5 contains Management Guidelines: Postoperative Rehabilitation.

Potential Postoperative Complications and Risk Reduction Pulmonary Complications Deep Vein Thrombosis Subluxation or Dislocation after Joint Surgery Restricted Motion From Adhesions and Scar Tissue Formation Failure, Displacement, or Loosening of Internal Fixation Guidelines for Preoperative and Postoperative Management Box 12.6 contains Potential Postoperative Complications.

Deep Vein Thrombosis and Pulmonary Embolism: A Closer Look Risk Factors for DVT Deep Vein Thrombosis: Signs and Symptoms Pulmonary Embolism: Signs and Symptoms Reducing the Risk of Deep Vein Thrombosis Management of Deep Vein Thrombosis Acute care management Post-hospitalization precautions Guidelines for Preoperative and Postoperative Management Box 12.7 contains Risk Factors for Deep Vein Thrombosis and Thrombophlebitis. Box 12.8 contains Management Guidelines: Deep Vein Thrombosis and Thrombophlebitis.

Overview of Common Orthopedic Surgeries and Postoperative Management Surgical Approaches Open procedures Arthroscopic procedures Arthroscopically assisted procedures Use of Tissue Grafts Types of grafts Autograft Allograft Synthetic grafts Table 12.1 contains General Methods and Examples of Musculoskeletal Surgeries. Box 12.9 contains Risks with Use of Autografts and Allografts.

Repair, Reattachment, Reconstruction, Stabilization, or Transfer of Soft Tissues Muscle Repair Tendon Repair Ligament Repair or Reconstruction Capsule Stabilization and Reconstruction Capsulorrhaphy (capsular shift) Capsulolabral reconstruction Electrothermally assisted capsulorrhaphy Tendon Transfer or Realignment Overview of Common Orthopedic Surgeries and Postoperative Management

Release, Lengthening, or Decompression of Soft Tissue Procedures Myotomy Tenotomy Fasiotomy Postoperative Management Overview of Common Orthopedic Surgeries and Postoperative Management

Joint Procedures Arthroscopic Debridement and Lavage Synovectomy Articular Cartilage Procedures Abrasion arthroplasty, subchondral drilling, and microfracture Chondrocyte transplantation Osteochondral autograft or allograft implantation Overview of Common Orthopedic Surgeries and Postoperative Management

Joint Procedures (cont'd) Arthroplasty Excision arthroplasty Excision arthroplasty with implant Interposition arthroplasty Joint replacement arthroplasty Arthrodesis Overview of Common Orthopedic Surgeries and Postoperative Management Box 12.10 contains Materials, Designs, and Methods of Fixation for Joint Replacement Arthroplasty. Box 12.11 contains Contraindications to Total Joint Arthroplasty. Table 12.2 outlines Optimal Positions for Arthrodesis.

Extra-Articular Bony Procedures Open Reduction and Internal Fixation of Fractures Osteotomy High tibial, lateral wedge osteotomy Medial wedge osteotomy Intertrochanteric osteotomy Periacetabular osteotomy Overview of Common Orthopedic Surgeries and Postoperative Management

Independent Learning Activities Critical Thinking and Discussion