MSK ORTHOPAEDIC Flashcards
(13 cards)
What is a total hip replacement
Incision under general anaesthetic.
Incision made posters laterally of the hip joint, and the hip is dislocated.
Femoral head is shaved off and re shaped to fit a prosthetic
Acetabulum cup is reshaped to fit a concave prosthetic in.
Movement is checked to assure the joint is running smoothly and not grinding or getting stuck
Incision is closed
What is a hemiarthroplasty or hip resurfacing
A hemiarthroplasticity is only half a hip replacement involving the replacement of the femoral head with a porsthetic.
Whereas a hip resurfacing is where they re shaped the femoral head to fit into the acetabulum bette to allow for a metal cap to be placed on it.
Total knee replacement
General anaesthetic.
Incision made down the anterior knee.
Surrounding muscles and tendons are cut, and patella is moved out of the way.
Distal femoral head is shaved down and re shaped for a curved post hectic to be placed on and proximal head of tibia is reshaped to allow for a flat prosthetic to be put on.
A plastic spacer is placed in between the joints to flow the movement in the knee.
A dummy joint is used before finishing to check movement of the knee are correct and the sizing of the prosthetics are correct.
Muscles are re attached and fixed up and incision is closed.
Post Op for hip and knee replacements
Immediate mobilisation
Strength training in the joint
Pain and swelling medication for patient comfort
Risk can include possible post op infection, DVT and a malfunction with the prosthetics.
What is a total shoulder replacement and a reverse shoulder replacement
They are both accessed the shoulder anteriorly, where an incision is made and subscapularis is cut to expose the joint. Any arthritic areas are removed and implants are inserted for stability of the joint. In a total shoulder replacement, the glenoid is fitted with a new socket and the humeral head is fitted with a new ball to fit the normal mechanics of a s shoulder joint.
Whereas in a reverse shoulder replacement, the humeral head is fitted with a flat prosthetic and the glenoid is fitted with a glenoid sphere (concave) to play the role of the socket in ball .
Post op physio for shoulder replacements
Rehab can take up to 6 months.
Sling and immobilisation for 2 weeks.
Then concentrate on ADLs for patient to get some functional movement back
Then strengthening and conditioning for the shoulder to increase ROM and strength
Patient rehab specific to patient goals
ACL reconstruction
Use hamstring or patella tendon as a graft. With patella tendon they tend to use a 1/3 of the patella with some bone to add some stability to the reconstruction.
Rehab can be 9-12 months to sports
Rotator cuff repair
Incision made.
Rotator cuff tendon is debriefed and any clavicle bone spurs are removed. Saturn’s and anchors are put in place to stabilise the cuff and allow it to heal.
Rehab can be 3-6 months, 6 weeks in sling and immobile.
Strengthen and ROM of joint focused upon.
Patient specific goals and rehab in the late stages
Achilles repair
Diagnosed by a positive Thompson test.
Incision made posterior ankle on the Achilles tendon. Foot is placed in a plantar position and tendon is reattached.
Patient is in a boot for 6 weeks in a plantar position to allow for the tendon to heal and reattach itself.
Gradually wean out of boot and lengthen the tendon as foot comes more into a plantar grade position where patient can then begin to walk again.
Discectomy and spinal decompression
A spinal disectomy involves removing disc herniation from constricting the central canal.
A spinal decompression involves removing material out the way blocking the central canal, for example, bone spurs, thickened ligaments, osteocytes, could be a result of degeneration of bones and osteoporosis.
Spinal fusion
Can be elective or trauma depending on severity of the central canal being blocked and any nerves affected.
Can be in cases of scoliosis, spondylolisthesis.
Involves stabilising and restructuring the spine using metal rods and plates.
Can be an extremely painful procedure as you have to dissect the entire length of the spine to straighten it.
Mobilisation is focused upon in rehab however should be gentle and patient eased into it.
Open reduction internal fixation
Used to facilitate fixation of bone and joint fractures. Adds compression which can facilitate repair quicker.
A dynamic hip screw is an example used to fixate in a hip replacement, specifically in elderly patients who may suffer with osteoporosis.
External fixation
Used in more severe fractures
Where metal rods are inserted through a bone to stabilise and then exit out through the body and attach onto an external stable structure. Mobilisation should begin with the fixation still in place and fixation can be in place for weeks or months.
