1. Surgical Interventions and Postoperative Management
Chapter 12

2. 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.

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

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

11. 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

12. 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 contains Materials, Designs, and Methods of Fixation for Joint Replacement Arthroplasty.
Box contains Contraindications to Total Joint Arthroplasty.
Table 12.2 outlines Optimal Positions for Arthrodesis.

13. 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

14. Independent Learning Activities
Critical Thinking and Discussion