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Notes on Joint Anatomy, Preoperative Considerations, and Postoperative Care from Transcript

Anatomy and Function of Synovial Joints

  • Joints between bones that are movable and freely movable include knees, wrists, and ankles.
  • These joints are separated by a synovial space and contain synovial fluid, which lubricates and reduces friction while helping with joint alignment and function.
  • The synovial membrane and fluid play a key role in joint health; damage or disease can affect joint function.
  • Inflammatory or deforming conditions (e.g., rheumatoid disease, osteoarthritis) can deform joints and may lead to consideration of surgical intervention if nonoperative measures fail.

Preoperative Evaluation and History

  • Before any joint surgery, obtain a thorough history and assess pain location, functional impact, and prior joint deformities or conditions.
  • Pain location and its pattern help guide planning for treatment or surgery.
  • Evaluate overall health status and readiness for major surgery, including comorbidities that could affect recovery.

Weight Management and Surgical Candidacy

  • If a patient has knee pathology requiring surgery (e.g., total knee replacement) and is obese, weight loss is often advised before proceeding.
  • Rationale:
    • Excess weight increases mechanical load and wear on a prosthetic joint.
    • Postoperative recovery can be harder, and weight gain after surgery may worsen outcomes or lead to recurrence of problems.
  • Consequences of not losing weight:
    • Even after arthroplasty, weight-related stress can contribute to prosthetic issues and limited function.
  • Therefore, weight reduction is often part of the preoperative plan and candidacy assessment.

Inflammation and Infection as Contraindications

  • Active inflammation or infection around the joint area is a contraindication to immediate surgery.
  • These conditions must be treated and cleared before scheduling a procedure to minimize complications.

Postoperative Rehabilitation and Physical Therapy

  • Postoperative care includes extensive physical therapy to adapt to the prosthetic joint (e.g., knee replacement).
  • Goals of therapy:
    • Restore range of motion and strength.
    • Re-educate the body to use the prosthetic joint effectively.
    • Prevent complications such as falls or improper joint alignment.
  • PT is intense and requires patient endurance and participation.
  • Risk of falls or injury exists if the patient is not properly trained, especially with a new prosthetic knee.

Bleeding Risk, Anticoagulation, and INR Considerations

  • INR (International Normalized Ratio) relates to blood thinning; a high INR means blood is thinner and bleeds more easily.
  • A high INR increases bleeding risk during and after surgery and must be managed around the perioperative period.
  • Any patient with a prosthetic joint who experiences bleeding risk should be counseled about how this affects the prosthesis and overall recovery.

Dental Prophylaxis and Prosthetic Joint Infection Prevention

  • Patients with prosthetic joints (e.g., after knee replacement) should inform their dentist about their joint replacement.
  • Prophylactic antibiotics may be recommended before dental procedures to reduce the risk of prosthetic joint infection.
  • Timing varies and is determined by the dentist in coordination with the surgeon; common guidelines mentioned include a window around procedures such as:
    • 3 days before
    • 5 days before
    • 7 days before
  • The exact timing depends on the patient’s condition and the provider’s protocol; at minimum, antibiotics should be given per clinician guidance to reduce infection risk.

Preoperative and Postoperative Range of Motion and Exercises

  • Postoperative knee management includes gradual stretching and controlled range-of-motion exercises.
  • The caregiver or therapist may document safe range limits (e.g., an angle or degree limit) for initial stretching.
  • Start with small, progressive movements; avoid aggressive, rapid stretching.
  • While the operated leg is being rehabilitated, the non-operated leg should be exercised as well to prevent stiffness and muscle atrophy in the good leg.

Elective vs Emergency Nature of Surgery and Surrounding Anatomy

  • Joint replacement procedures (like knee or hip surgery) are typically elective unless performed due to acute trauma.
  • The surgical site (hip region) is highly vascular and lies near multiple vital structures; careful monitoring of nearby organs is necessary.
  • Important nearby structures include:
    • Intestines and bladder in the pelvic region
    • Female reproductive organs (e.g., cervix) in the pelvis
  • Given the proximity to these structures, surgeons monitor to ensure that nothing in surgery impairs surrounding organs.

Neuro Checks, Blood Flow, and Postoperative Monitoring

  • After surgery, perform neuro checks to assess sensation and motor function of the limb.
  • The blood supply to the lower extremity must be preserved and monitored to prevent ischemia.
  • Understanding vascular anatomy helps explain why the surgical field is carefully managed.

Positioning, Alignment, and Prosthesis Safety

  • Postoperative instructions emphasize keeping the leg straight and avoiding crossing the legs to protect the prosthetic joint.
  • Crossing the operated leg can push the prosthesis out of alignment or dislodge it.
  • When in bed or during transfers, avoid bending the leg excessively or performing movements that could destabilize the prosthesis.
  • Do not lift or pull blankets in a way that causes the leg to flex or rotate abnormally.

Practical Implications and Patient Education

  • Clear communication among surgeons, dentists, physical therapists, and patients is essential to optimize outcomes and minimize complications.
  • Patients should understand the reasons for weight management, infection prevention, and strict postoperative positioning.
  • Healthcare teams should tailor antibiotic prophylaxis, rehabilitation pacing, and activity restrictions to each patient’s clinical status and surgeon recommendations.

Summary of Key Practical Points

  • Joints in the knee are synovial joints with lubrication provided by synovial fluid; inflammation or deformity may require surgery.
  • Preoperative planning includes evaluating pain, function, weight status, infection risk, and overall health.
  • Obesity can disqualify or complicate joint replacement; weight loss is often required before surgery.
  • Active inflammatory or infectious conditions must be treated prior to surgery.
  • Postoperative rehab is intensive and aims to restore function while preventing dislocation and falls.
  • Monitor bleeding risk via INR and coordinate dental prophylaxis to prevent prosthetic joint infection.
  • Postoperative ROM exercises should be gradual; maintain movement of the non-operated leg to prevent stiffness.
  • Elective vs emergency status depends on trauma; pelvic anatomy around hip surgery necessitates careful monitoring due to vascularity and nearby organs.
  • Neuro checks and strict limb positioning are crucial to protect the prosthesis and promote healing.