Orthopedics

Knees

• Pain: Cryotherapy in acute recovery, balance pain and activity

• Positioning: Precautions to promote proper healing

• Performance: Functional, ADL focus

TKR Protocol

• Keep the knee in extension at rest (straight)

• Avoid twisting movements (forward)

BETTER TO KEEP THE KNEE STRAIGHT AS MUCH AS POSSIBLE SO THAT IT DOESN’T GET STIFF

Early movement and transfers for TKR

• Can typically get moving early, out of bed post-op day 1

• WBAT is common, but still check the physician’s orders

• Transfers (sit-stand) are of obvious concern

What do we worry about for a hip ORIF?

• Weight Bearing

What do we worry about for a hip arthroplasty?

• Weight Bearing

• Hip Precautions

Hip Precautions

• Anterior Hip Precautions

  • No extension, external rotation, and adduction (abduction wedge)

• Posterior Hip Precautions

  • No flexion (past 90 degrees) (use a raised toilet seat), internal rotation, and adduction (abduction wedge)

Spinal Precautions

• No Bending,

• No Lifting 

  • No lifting more than 8 lbs

  • Hold close to the body

  • Lift with legs, not your back

• No Twisting

Lower body dressing techniques for the spine

• Reacher

• Shoe horn

• Sock aid

• Dressing stick

• Supine dressing

Sleep positioning for the spine

• Supine with pillows under the knees

• Side-lying with pillows between the knees

Rotator Cuff Muscles

• S: Supraspinatus

• I: Infraspinatus

• T: Teres Minor

• S: Subscapularis

Soft-tissue ROM progression (Shoulders)

PROM —> AROM —→ Resistive

Shoulder Replacements

• After surgery we:

  • Immobilize & PROM — AAROM - AROM - Resistive

• Pendulum swings

Hemi & Total Shoulder Protocol

• Day 0: Immobilize & PROM

  • Sling

  • Pendulum swings from day 1

• 1 month: AAROM & AROM

  • If PROM ok, start AAROM (pulleys) and progress to AROM

  • Full ROM at 6 weeks

• 3 months: Resistive

  • Light shoulder strengthening

• ROM PROGRESSES SLOWLY

Reverse Shoulder Protocol

• Day 0: Immobilize & PROM

  • Sling

  • No pendulums without surgeon’s clearance

• 1 week: AAROM & Isometrics

• 2 weeks: AROM

• 1.5 months: Resistive

  • Light shoulder strengthening

• ROM progresses faster

Pre-prosthetic phase

• ADL retraining (hemi-dressing, AE)

• Wound and scar management

• Myosite testing

• Desensitization

• Limb shaping (figure 8 wrap, shrinker)

• Maintain ROM and strength

Basic Prosthetic Training

• Do everything but use the prosthetic

• Evaluate prosthetic

  • wear schedule

  • donning/doffing

  • limb hygiene

  • prosthetic knowledge

  • care of prosthesis

Intermediate Prosthetic Training

• Learn to use the prosthesis, but NOT with functional tasks

  • Control Training

    • practicing repeated controlled movements

  • Use Training

    • repeating graded tasks (pick up, put down cones)

Advanced Prosthetic Training

• Practicing functional use

• Functional training

  • Practicing ADL’s with prosthesis

LE Limb positioning

• After a lower extremity limb amputation, position the knee in extension to reduce the risk of a flexion contracture

TLSO Brace

• Make sure to wear a shirt underneath for skin integrity

• Wear whenever out of bed

Rotator Cuff Keyline

• Slow

• In

• The

• Shoulder

Shoulder Replacements

• Hemiarthroplasties & Arhtroplasty:

  • Use pendulum swings

  • ROM progresses slowly

• Reverse Arthroplasty:

  • Avoid pendulum swings

  • ROM progresses faster