1. Therapeutic Exercise I Chapter 12
Surgical Interventions
and Postoperative Management

2. Non-operative options
Rest
Protection/Splinting
Use of assisted device
Medication

3. Non-operative options
Therapeutic Exercises
Manual Therapy
Functional Training
Use of Physical Agents/Electrotherapy

4. Guidelines for Pre-Operative and Post-Operative Management
Ideally rehabilitation starts pre-surgery, through the recovery of surgery and after…with a well devised self-management program (HEP)
Although surgery can correct or reduce adverse effects/impairments, a well designed post-operative program is essential to achieve optimal functional outcomes

5. Pre-Operative Examination and Evaluation
Should contain the following information for realistic goals and relevant functional activities to be accomplished following surgery and with the implementation of Physical Rehabilitation….which are the same components following the evaluation after surgery and throughout the rehabilitation process

6. Pre-Operative Examination and Evaluation Continued:
--Pain-use of pain scale (visual analog scale or a scale specific on functional activities)
--ROM and Joint Integrity
--Integrity of the skin
--Muscle Performance
--Posture
--Gait Analysis
--Functional Status

7. Components of Preoperative Patient Education
Overview of the POC
Post-operative precautions
Bed mobility/transfers
Initial post-operative exercises
Gait training
Wound care

8. Post-Operative Examination and Evaluation
A well devised POC should be constructed by the supervising PT composed of: therapeutic exercises, functional modalities, functional training, and ongoing patient education
Ongoing exam/evaluation will help design an individuals program/HEP

9. Phases of Post-Operative Rehabilitation:
Maximal protection phase
Moderate protection phase
Minimal Protection/return to function phase
Note: Time-Based and Criterion-Based Progression…each time frame will vary pending tissues involved and type of procedure, along with the patients response

10. Putting Post-Operative Rehabilitation into Perspective
Due to limited therapy sessions by the insurance companies or patient’s ability for payment/attend PT sessions…all phases will not necessarily be under the care of the therapist, therefore it is imperative to educate the patient to ensure safe and effective self-management of their program, and is important to periodically monitor and modify the program as needed

11. Potential Post-Operative Complications
Pulmonary
Deep Vein Thrombosis (DVT)
Subluxation or dislocation after joint surgery
Restricted motion from adhesions and scar tissue formation
Failure, displacement, or loosening of internal fixation

12. Surgical Approaches Open Arthroscopic
Arthroscopically Assisted Procedure

13. Use of Tissue Grafts
Autograft-(autogenous or autologus graft) is when the patient uses their own harvested tissue
Allograft- is when a fresh or cryopreserved tissue is used by a source other than the patient ie: cadaver
Synthetic grafts- is when materials such as Gore-Tex and Dacron is offered as an alternative to human tissue (however, not a successful rate)

14. Types of Tissue Grafts:
Hamstring Auto Graft Allograft
Synthetic Gore-Tex
Synthetic Dacron

15. Types of Repairs, Reattachments, Reconstruction, Stabilization or Transfers of Soft Tissue
Muscle repair
Tendon repair
Ligament repair
Capsule stabilization and reconstruction
Tendon transfer or re-alignment
Release, lengthening, or decompression

16. Joint Procedures Synovectomy Articular Cartilage Procedures
Arthroplasty (Minimally invasive versus traditional arthroplasty)
Arthrodesis
Extra-Articular Bony Procedures

17. Examples of Traditional Arthroplasty:
Shoulder

18. Alternative Arthroplasty:

19. Remember!!!!! Always communicate with your supervising PT
Be aware of abnormal signs and repot them to your supervising PT
As a PTA you are to assist the entire process, including preparations for discharge
Always educate the patient and ensure safe performance of any activity asked of them-supply with HEP only if the patient fully understands what is being asked of them

20. Remember!!!! Communication is both verbal and non-verbal
It is your responsibility to communicate with all health care personnel that are involved in the patients care
Be timely, accurate, and concise with your documentation
Always use good body mechanics for your and your patient and ensure a safe environment to work in