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  • Post Surgical Rehabilitation

    Post Surgical Rehabilitation

    ACL Repair, Total Knee/Hip Replacements, Rotator Cuff Repair, Meniscal Repair, Neck/Back Surgery, ORIF

ACL Repair

The recovery process for the ACL is usually broken down into different phases of rehabilitation. Each phase has its own objectives, however is intertwined with other phases since the goals are as progressive as the recovery itself. The rehabilitation process is at the pace of the patient. Timelines are sometimes given to help give an idea of where one can be during rehabilitation. Timelines are not used to discourage or encourage those who aren't ready to advance their recovery process. Such acts may cause serious injury or re-injury of the ACL.

Knee Replacement

The length of post-operative hospitalization is 5 days on average depending on the health status of the patient and the amount of support available outside the hospital setting. Protected weight bearing on crutches or a walker is required until specified by the surgeon because of weakness in the quadriceps muscle.

To increase the likelihood of a good outcome after surgery, multiple weeks of physical therapy is necessary. In these weeks, the therapist will help the patient return to normal activities, as well as prevent blood clots, improve circulation, increase range of motion, and eventually strengthen the surrounding muscles through specific exercises. Whether techniques such as neuromuscular electrical stimulation are effective at promoting gains in knee muscle strength after surgery is unclear. Often range of motion (to the limits of the prosthesis) is recovered over the first two weeks (the earlier the better). Over time, patients are able to increase the amount of weight bearing on the operated leg, and eventually are able to tolerate full weight bearing with the guidance of the physical therapist. After about ten months, the patient should be able to return to normal daily activities, although the operated leg may be significantly weaker than the non-operated leg.

For post-operative knee replacement patients, immobility is a factor precipitated by pain and other complications. Mobility is known as an important aspect of human biology that has many beneficial effects on the body system. It is well documented in literature that physical immobility affects every body system and contributes to functional complications of prolonged illness. In most medical-surgical hospital units that perform knee replacements, ambulation is a key aspect of nursing care that is promoted to patients. Early ambulation can decrease the risk of complications associated with immobilization such as pressure ulcers, deep vein thrombosis (DVT), impaired pulmonary function, and loss of functional mobility. Nurses’ promotion and execution of early ambulation on patients has found that it greatly reduces the complications listed above, as well as decreases length of stay and costs associated with further hospitalization. Nurses may also work with teams such as physical therapy and occupational therapy to accomplish ambulation goals and reduce complications.

It is important to explore multiple rehabilitation protocols used for recovery of total knee arthroplasty. Continuous passive motion (CPM) is a postoperative therapy approach that uses a machine to move the knee continuously through a specific range of motion, with the goal of preventing joint stiffness and improving recovery. There is no evidence that CPM therapy leads to a clinically significant improvement in range of motion, pain, knee function, or quality of life. CPM is inexpensive, convenient, and assists patients in therapeutic compliance. However, CPM should be used in conjunction with traditional physical therapy. In unusual cases where the person has a problem which prevents standard mobilization treatment, then CPM may be useful.

Sling therapy is a therapeutic modality used postoperative in order to decrease stiffness and improve range of motion following the procedure. In sling therapy, the patient's leg is placed in a standard tubular bandage that is suspended from a cross brace fixed to the bed while lying on their back . Unlike CPM, the use of sling therapy allows the patient to perform active knee flexion and extension with their leg suspended, minimizing gravity's resistance. By actively mobilizing the joint using their own muscular strength instead of outside forces like in CPM, studies show that there are clinically relevant benefits. The use of this modality is convenient and easy to set up in a hospital setting along with being less expensive than the CPM machine. This treatment should be incorporated with traditional physical therapy in the postoperative acute setting.

Cryotherapy, also known as 'cold therapy' is sometimes recommended after surgery for pain relief and to limit swelling of the knee. Cryotherapy involves the application of ice bags or cooled water to the skin of the knee joint. Cryotherapy may help in lowering pain, particularly after epidural analgesia, but is not considered to be an effective modality for patients with total knee arthroplasty surgery.

Rotator Cuff Repair

Rehabilitation after surgery consists of three stages. First, the arm is immobilized so that the muscle can heal. Second, when appropriate, a therapist assists with passive exercises to regain range of motion. Third, the arm is gradually exercised actively, with a goal of regaining and enhancing strength. The empty can and full can exercises are amongst the most effective at isolating and strengthening the supraspinatus.

Following arthroscopic rotator-cuff repair surgery, individuals need rehabilitation and physical therapy. Exercise decreases shoulder pain, strengthens the joint, and improves range of motion. Therapists, in conjunction with the surgeon, design exercise regimens specific to the individual and their injury.

There is consensus amongst orthopaedic surgeons and physical therapists regarding rotator cuff repair rehabilitation protocols. The timing and duration of treatments and exercises are based on biologic and biomedical factors involving the rotator cuff. For approximately two to three weeks following surgery, an individual experiences shoulder pain and swelling; no major therapeutic measures are instituted in this window other than oral pain medicine and ice. Those at risk of failure should usually be more conservative with rehabilitations.

That is followed by the "proliferative" and "maturation and remodeling" phases of healing, which ensues for the following six to ten weeks. The effect of active or passive motion during any of the phases is unclear, due to conflicting information and a shortage of clinical evidence. Gentle physical therapy guided motion is instituted at this phase, only to prevent stiffness of the shoulder; the rotator cuff remains fragile. At three months after surgery, physical therapy intervention changes substantially to focus on scapular mobilization and stretching of the glenohumeral joint. Once full passive motion is regained (at usually about four to four and a half months after surgery) strengthening exercises are the focus. The strengthening focuses on the rotator cuff and the upper back/scapular stabilizers. Typically at about six months after surgery, most have made a majority of their expected gains.

Meniscal Repair

After a successful surgery for treating the destroyed part of the meniscus, patients must follow a rehabilitation program to have the best result. The rehabilitation following a meniscus surgery depends on whether the entire meniscus was removed or repaired.

If the destroyed part of the meniscus was removed, patients can usually start walking using a crutch a day or two after surgery. Although each case is different, patients return to their normal activities on average after a few weeks (2 or 3). Still, a completely normal walk will resume gradually, and it's not unusual to take 2–3 months for the recovery to reach a level where a patient will walk totally smoothly. Many meniscectomy patients don't ever feel a 100% functional recovery, but even years after the procedure they sometimes feel tugging or tension in a part of their knee. There is little medical follow-up after meniscectomy and official medical documentation tends to ignore the imperfections and side-effects of this procedure.

If the meniscus was repaired, the rehabilitation program that follows is a lot more intensive. After the surgery, a hinged knee brace is sometimes placed on the patient. This brace allows controlled movement of the knee. The patient is encouraged to walk using crutches from the first day, and most of the times can put partial weight on the knee.

Improving symptoms, restoring function, and preventing further injuries are the main goals when rehabilitating. By the end of rehabilitation, normal range of motion, function of muscles and coordination of the body are restored. Personalized rehabilitation programs are designed considering the patient's surgery type, location repaired (medial or lateral), simultaneous knee injuries, type of meniscal tear, age of patient, condition of the knee, loss of strength and ROM, and the expectations and motivations of the patient.

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