MSK IV Unit 5: Surgical Considerations

Comprehensive vocabulary flashcards covering post-operative screening, Achilles repair phases, ACL reconstruction healing and criteria, THA fixations/precautions, and lumbar surgical procedures.

Post-Op Systemic Red Flag Screen

A screen consisting of temperature, blood pressure, heart rate, respiratory rate, and $SpO_2$.

Signs of Post-Op Infection

Fever, redness, erythema, and discharge from the incision.

Signs and Symptoms of DVT

Pitting edema, erythema, increased skin temperature, and tenderness to superficial palpation.

Signs and Symptoms of Pulmonary Embolism (PE)

Dyspnea, tachypnea, and lateral chest pain that increases with deep breathing.

CRPS Post-Op Presentation

Allodynia, hyperalgesia, skin color changes (white to red to green), hypersensitivity to light touch or cold, skin temperature altering between hot and cold, and decreased ability to move the body part.

Open Primary Achilles Repair

A repair completed within a few days of injury involving a $10\,cm$ incision to visualize the tendon so ends can be sutured together.

Initial Achilles Repair Post-Op Positioning

A soft cast for $2\text{ weeks}$ then a hinge cam walking boot set in $20\text{ degrees PF}$.

Expected Return to Sport (Achilles Repair)

$8\text{-}12\text{ months}$ post-surgery.

Phase 2 Achilles Repair Rehab Goals (Weeks 6-12)

Regain full ankle ROM, increase calf strength, increase tolerance to activity, improve balance and proprioception, and normalize gait pattern.

Criteria to Progress to Phase 4 Achilles Rehab (Weeks 16-24)

No pain or swelling with jogging, normal gait, and the ability to perform $20\text{ SL heel raises}$.

Allograft ACL Reconstruction

Using cadaver tissue for reconstruction, typically used in older and less active patients.

Common ACL Autografts

Bone patellar tendon, hamstring, and quad tendon.

ACL Graft Revascularization Process

A necrotizing process for the first $2\text{-}3\text{ weeks}$ followed by revascularization, which weakens the graft again between weeks $6\text{-}8$.

ACL Graft Maturation Timeframe

Full maturation can take up to $18\text{ months}$, though it can withstand high-demand motions at $9\text{ months}$.

Criteria to Progress to Phase 2 ACL Rehab

Minimal swelling/effusion, normal patellar mobility, knee extension to $0\text{ degrees}$, knee flexion to $120\text{ degrees}$, and normal gait without crutches.

Cemented Fixation THA

Allows very early post-op weight bearing and shortens rehab; typically used for patients aged $60$ and up.

Cementless Fixation THA

Uses implants allowing osseous growth into a porous surface; used for patients under $60$ who are physically active.

Posterior THA Precautions

No hip flexion past $90\text{ degrees}$, no adduction, and no internal rotation ($IR$).

Lumbar Laminectomy

Removal of the lumbar levels lamina to decrease compression of nerve roots.

Lumbar Foraminotomy

A procedure that increases space in the intervertebral foramen to decrease pressure on a nerve root.

TLIF vs. PLIF

Transforaminal lumbar interbody fusion ($TLIF$) is a unilateral approach, while posterior lumbar interbody fusion ($PLIF$) is bilateral.

Lumbar Discectomy and Fusion Precautions

No bending, lifting, or twisting ($BLT$).

Essential Muscle Activation (Phase 1 Lumbar Rehab)

Multifidus and transversus abdominis ($TA$) activation.

Phase 2 Lumbar Rehab Lifting Restriction

No lifting more than $10\text{-}15\,lbs$.