W4 - Orthopaedics

Question 1

What is the difference between elective and trauma

Answer 1

Elective procedure is one that is planned in advance & dones y need to be performed immediately (joint replacements, lig reconstruction)

Trauma surgery is used to treat/manage traumatic injuries (open reduction internal fixation & external fixations)

Question 2

What is a joint replacement

Answer 2

When an arthritic or dysfunctional joint surface is replaced with a prosthesis

Question 3

Explain how a total hip replacement works

Answer 3

Performed under spinal anaesthetic
Incision made posters-laterally toexpose the joint
Surgeon dislocated the hip joint
Femoral head cut off, acetabulum is grinned down & reshaped
Acetabulum cup placed into socket then an insert placed inside the cup
Prosthetic femoral stem is placed into the shaft of the femur & prosthetic femoral head sits on top of the stem
Muscle & other soft tissue are repaired & skin is stitched up

Question 4

Name 2 types of hip replacement

Answer 4

Hemiarthroplasty
Hip resurfacing

Question 5

What is a hemiarthroplasty

Answer 5

Surgery that replaces half the hip joint (femoral head portion of the joint)

Question 6

What is a hip resurfacing

Answer 6

Replaces the surface of hip joint to preserve more bone
Head of femur isn’t removed but is reshaped allowing a metal cap over the top

Question 7

Explain the procedure of a total knee replacement

Answer 7

Soinal anaesthetic
Incision down from front of knee to expose kneecap
Kneecap moved to the side to assess knee joint
Distal femur & proximal tibia are cut away using guides which shape the bone to fit the prosthetic components
Distal end of femur is replaced with curved metal prosthetic & próx tibia replaced with flat prosthetic
Plastic spacer in between 2 components
Posterior aspect of the patella is also replaced

Question 8

Physio role in post op for a THR/TKR

Answer 8

Start mobilising on day 0
ROM/strengthening exercises
Hip precautions followed for 6/52
Swelling management
Pain management

Question 9

Complications of a THR/TKR

Answer 9

Post op infection
DVT - wells score
Malfunction of prosthesis
Nerve injury

Question 10

What is the aim of doing a total shoulder replacement

Answer 10

Restore mobility & reduce pain in a patients with late stage shoulder OA or after a severe shoulder fracture

Question 11

Name the 2 types of shoulder replacements

Answer 11

Traditional
Reverse

Question 12

Explain the procedure of a traditional shoulder replacement

Answer 12

GHJ accused anteriorly
Deltoid & pecs separated
Subscapularis cut to gain access to
Arthritic area removed
Implants inserted
Subscapularis repaired & Sicilians is closed

Question 13

Explain the procedure of a reverse shoulder replacement

Answer 13

Shoulder accessed anteriorly
Humerus prepared for new socket & glenoid prepared for ball shape prosthesis
Humeral stem inserted, humeral cup & glenisphere attached (cement or press fit)
Movement of joint checked
Muscles repaired & incision is closed

Question 14

Early post op physio for TSR

Answer 14

Sling 2/52
ROM exercises
Taught how to complete ADLs
Pain management

Question 15

Week 2-6 post op physio management for a TSR

Answer 15

Wean out the sling
Progress ROM ensuring good scapular rhythm
Start isometric rotator cuff exercises

Question 16

Week 6-12 post op physio management for a TSR

Answer 16

Same as week 2-6 but progres strength & functional exercises

Question 17

Up to 6 months post op physio management for TSR

Answer 17

Patient specific rehab depending on goals

Question 18

What tendons are used as grafts for an ACL reconstruction

Answer 18

Hamstring
Patella

Question 19

What is a patella tendon better to use then a hamstring tendon for a ACL reconstruction

Answer 19

Higher risk of hamstring injury post op

Question 20

What is the time period of rehab for return to sport post op for a ACL reconstruction

Answer 20

9-12 months

Question 21

Post op rehab for a ACL reconstruction

Answer 21

Initial phase = gait education, AROM & strengthening

Early = progression of ROM/strength (closed chain quads, early proprioception & cycling

Middle = progression strength & ROM, progress proprioception exercises & load acceptance, running in straight lines then multi directional

Late = start sport specific drills

Question 22

Explain the procedure for a rotator cuff repair

Answer 22

Surgeon starts with a pen EUA (exam under anaesthetic)
Joint/tendon will debrided, sometimes alongside a subacriminal decompression (remkval of bone spurs from underside of clavicle)
Rotator cuff tendon is reattached to the bone using anchor & sutures

Question 23

Post op physio management for a rotator cuff repair

Answer 23

3-6 months
Early = immobilisation for up to 6/52 in sling

Middle phase = AROM, scapular stability

Late phase = shoulder strengthening & proprioception as well as sport specific rehab

Question 24

Procedure of an Achilles repair

Answer 24

Posterior incision
Ruptured end of Achilles stitched together
Normally out in a bott in blantar flexion for 8-12/52
Initially likely to be toe touch weight bearing

Question 25

When is a discectomy/decompression used

Answer 25

Patient that have nerve root or spinal cord compression due to disc prolapse, bony spurs in intervertebral foramen or spinal canal stenosis

Question 26

What is a discectomy/decompression

Answer 26

Discectomy = Removing disc material that is extruding into the foramen/soinal canal Decompression = removal of osteophytes, laminectomy, removal of thickened ligaments, foraminotomy, facetecomy Central posterior incision made over the appropriate vertebrae, spinal muscles split down the middle & moved to wither side to gain access to spine

Question 27

Post op physio for a discectomy/decompression

Answer 27

Sitting restricted to 30 mins at a time for 1-2/52 Fentle ROM & isometric exercises given initially Walking encouraged from immediate post op Strength & mobilisation exercises progressed from 4-6/52 post op depending on symptoms

Question 28

When in a spinal fusion used

Answer 28

Nerve root compression, unstable spondylolisthesis, unstable fractures & scoliosis (very painful)

Question 29

What is a spinal fusion

Answer 29

Use of screws & ribs to fix vertebra in place

Question 30

Name 5 other common orthopaedic surgeries

Answer 30

Debridement Menisectomy Laboral repair Micro fractures Muscle/ligament/ tendon reconstructions

Question 31

What is ORIF

Answer 31

Used to fix broken bones that are displaced or unstable

Question 32

What is most commonly used in a ORIF

Answer 32

IM nails or plates / screws

Question 33

What does open reduction refer to as

Answer 33

Process of resetting the bones into the correct position

Question 34

What does internal fixation refer to as

Answer 34

Use of the implant to maintain this position so the bone can heal

Question 35

What are dynamic screws used for

Answer 35

Older osteoporosis patients Allows some movement of the femoral head in the direction of the screw

Question 36

What is a external fixation

Answer 36

Where Robles are screwed into the bone & exit the body to be attached to the stabilising structure Allows for weight bearing in LL fractures = promotes healing