Joint Surgery And Postoperative Management

By Carolyn Kisner PT, MS and Lynn Allen Colby PT, MS on November 18th 2008

Many joint surgeries are available to treat early- and late-stage joint disease of the hip and some fractures that compromise the vascular supply to the head of the femur. As a result of advances in arthroscopy of the hip over the past decade, small to medium-size full-thickness lesions of the articular cartilage of the acetabulum and head of the femur, as well as other joint pathologies such as acetabular labral tears and capsular laxity, now can be managed arthroscopically One such procedure, microfracture, involves creating small fractures of subchondral bone in the area of the chondral lesion to stimulate growth of fibrocartilage to replace the damaged hyaline cartilage.

Surgical procedures to manage late-stage deterioration of the hip joint include osteotomy (which is actually an extra-articular procedure) and arthroplasty, specifically resurfacing arthroplasty (surface replacement), hemiarthroplasty, and total joint replacement arthroplasty. Arthrodesis and resection arthroplasty of the hip are considered salvage procedures after failure of arthroplasty and when revision arthroplasty is contraindicated or not feasible.

The goals of joint surgery and postoperative management are to provide a patient with (1) a pain-free hip, (2) a stable joint for lower extremity weight bearing and functional ambulation, and (3) adequate ROM and strength of the lower extremity for functional activities.

It is important for the therapist to have a basic understanding of the more common surgical procedures for management of joint disease and deformity and a thorough knowledge of appropriate therapeutic exercise interventions and their progression for an effective, safe postoperative rehabilitation program. An overview of two of the more common procedures, total hip arthroplasty and hemiarthroplasty, and guidelines for postoperative management are described in the following sections.

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Filed Under: Physical Therapy, tribes001
Tags: acetabular labra, arthroscopy, fibrocartilage, hemiarthroplasty, microfracture, osteotomy

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