Joint Surgery Postoperative Management:
range of surgical options for management of arthritis of the knee is available when joint pain and synovitis cannot be controlled with conservative therapy and appropriate medical management or when destruction of articular surfaces, deformity, or restriction of motion have progressed to the point that functional abilities are significantly impaired. Joint Surgery Postoperative Management
The surgical procedure selected depends on the patient signs and symptoms, activity level and age, type of diseases, severity of articular damage or joint deformity, and involvement of other joints. Arthroscopic debridement and lavage are used to remove loose bodies that may be causing swelling and intermittent locking of the knee. A number of procedures to repair damaged articular cartilage have been developed. Abrasion arthroplasty, a procedure designed to smooth worn articular surfaces and stimulate growth of replacement cartilage has met with only limited success. Most recently developed procedures used to repair small, localized articular cartilage defects of the knee, such as micro fracture osteochondral autograft transplantation and autologous chondrocyte implantation, appear to hold promise. Joint Surgery Postoperative Management
Synovectomy was the procedure of choice in the past for ayoung patient with unremetting joint effusion, synovial proliferation and the pain as a result of RA or juvenile RA butt with minimal destruction of articular surfaces however it is now used infrequently osteotomy of the distal femur or proximal tibia redistributes weight bearing forces between the tibia and femur in an attempt to reduce joint pain during weight bearing activities and delay the need for arthroplasty of the knee. In the past, high tibial osteotomy was considered a surgical option of the active patient younger than age 50 to 55 years without active systemic disease and significant limitation of motion or joint deformity. However, because arthroplasty is now performed in younger patients than was the case a decade or two ago osteotomy is an infrequently selected surgical option.
When erosion of articular surfaces becomes severe and pain is unremitting, total knee arthroplasty is the surgical procedure of choice to reduce pain, correct deformity, and improve functional movement. only in highly selective situations is arthrodesis of the knee used as a salvage procedure to provide a patient with a stable and pain free knee.
Regardless of the type of the surgery selected, the goals of surgery and postoperative management are to
- Reduce pain
- Correct deformity or instability
- Restore lower extremity function.
Carefully progressed postoperative rehabilitation is essential for optimum functional outcomes.
A cautiously progressed and closely monitored rehabilitation program after articular cartilage repair procedures is critical for a successful outcome. The components and progression of a rehabilitation program, including exercise, ambulation and functional activities, must be guarded to protect the repair or graft and prevent further articular damage while applying controlled stresses to stimulate the healing process.
The progression of postoperative exercises and functional activities after micro fracture, osteochondral autologous transplantation and autologous chondrocytes implantation has many common elements, yet they vary to some degree. Detailed postoperative protocols, as well as comprehensive clinical practice guidelines for each of the procedures have been published in the literature. In addition to the type of repair employed the rehabilitation progression is based on the size depth and location of the articular defect the need of concomitant surgical procedures and patient related factors such as age body mass index health history and preoperative activity level. Joint Surgery Postoperative Management
The goals during rehabilitation after articular cartilage repair are similar to those found for most knee rehabilitation program. Protected weight bearing over and extended period of time and early motions are essential after articular cartilage repair to promote maturation and maintain the health of the repaired and implanted cartilage. Special consideration for exercise and weight bearing associated with the various articular cartilage procedures. Joint Surgery Postoperative Management