Surgery

Caring Staff help Dorothy McGee at Encore Rehabilitation

Dorothy McGee ClantonRevised

Fall 2017 saw Dorothy McGee fall, break a hip, have surgery and receive inpatient rehabilitation. When it was time for her to go home after surgery, Dorothy and her family selected Encore Rehabilitation –Clanton for her care because it was close to her home. Now they have more than just convenience to them keep coming to Encore. Dorothy’s daughter Brenda shares, “We continue with Encore because of the care and the skill the staff provides. From the time we enter the front door, it is obvious how the staff cares about their patients. This includes everybody-receptionist, front desk, and therapists.”

Thank you, Dorothy and family, for choosing Encore Rehabilitation-Clanton. Happy National Physical Therapy Month!

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After knee surgery, Misty Tucker is feeling better!

Misty Tucker Vernon

“I had surgery on my left knee. I had two screws and a pin put in a device to keep the knee from popping out-of-place,” relates Misty Tucker. After eight weeks of physical therapy with Encore Rehabilitation – Vernon, she is doing much better. “The friendly staff helped me with the stiffness in my leg. The staff take the time to get you where you need to be after surgery.”

Thank you, Misty! Happy National Physical  Therapy Month!

Physical Therapy: A Good First Choice Before Surgery for Meniscal Tears and Knee Osteoarthritis

“Mild meniscal tears and moderate knee osteoarthritis send some people under the knife, when all they really need is physical therapy.

recent study in the New England Journal of Medicine found no significant difference between individuals who received surgery and those who received physical therapy alone, thus avoiding the unnecessarily invasive procedure and related costs.

Dr Edward Laskowski, codirector of the Mayo Clinic Sports Medicine Center, told Men’s Journal that physical therapy might prove equally effective for other knee injuries, including MCL, PCL, and cartilage tears (Try Physical Therapy Before Surgery – April 29, 2013).

“If you have good range of motion, physical therapy may very well settle down the symptoms over time,” Laskowski said.

Learn about physical therapist treatment of meniscal tears and osteoarthritis of the knee.”

Related Resources:

This article was found at http://www.moveforwardpt.com/DidYouKnow/Detail.aspx?cid=687aa921-ed48-46dd-9b2f-17febb9423ed.

Having a Total Knee Replacement? Here are a few FAQs to consider.

Total Knee Replacement

These are some of the frequently asked questions regarding total knee replacement (TKR):

How long does a TKR last?

A common reply to this question is that total joint replacement lasts 15-20 years. A more accurate way to think about longevity is via the annual failure rates. Most current data suggests that both hip and knee replacements have an annual failure rate between 0.5-1.0%. This means that if you have your total joint replaced today, you have a 90-95% chance that your joint will last 10 years, and a 80-85% that it will last 20 years. With improvements in technology, these numbers may improve.

What types of implants are there?

The orthopaedic implant industry has developed a number of innovative technologies in an effort to improve the outcomes of TJA. In recent years, these technologies have been marketed directly to patients, which has increased the awareness as well as confusion on what these different designs mean. The most important message is that while a certain manufacturer may claim that their design is better, almost all of the available registry data (large collections of data from countries that track TJA) show that there is no clear advantage to any of these designs when it comes to improving outcomes. Here are specific implant design terms:

  • Gender specific: This refers to a modified implant design that accounts for average anatomic differences between men’s and women’s knees. Most manufacturers have incorporated similar modifications in their newer designs, which allow for more sizing options so that the prosthesis can be more accurately fit to the patient’s native anatomy and recreate the natural function of the knee.
  • Rotating platform: This refers to a plastic bearing that independently rotates on a metal tray on which it is seated. More often, the plastic bearing locks into the metal tray – referred to as a “fixed bearing.” Some theoretical advantages to the rotating platform concept when it was initially designed was that it could reduce the wear of the plastic bearing, reduce the rate of loosening of the metal parts, and better replicate how a patient’s knee works (kinematics). Most current data shows that after 5-10 years in use, there does not appear to be any difference between rotating platform and fixed bearing designs in any of these outcomes.

Will my surgeon use a computer, robot, or custom cutting guide in my surgery?

There are many studies attempting to evaluate these emerging technologies and their influence of the success of surgeries. Each of these technologies has a specific goal that has fueled its development (i.e. more accuracy in implant placement, more efficient or faster surgery, etc.). To date, there appears to be both pros and cons to each of these technologies, but more research is required to determine what advantage, if any, these may offer. The best approach is to discuss this topic with your surgeon. You may want to know if they use one of these technologies, why they have chosen to do so, and what their experience has been in using it.

Will I need general anesthesia?

While general anesthesia is a safe option, both hip and knee replacements can be performed under regional anesthesia. Choices for regional anesthesia include spinal anesthesia, epidural anesthesia, or one of a variety of peripheral nerve blocks. Many surgeons and anesthesiologists prefer regional anesthesia because data shows it can reduce complications and improve your recovery experience with less pain, less nausea, less narcotic medicine required, etc.

How long will I stay in the hospital?

You will likely stay in the hospital for 1-3 days depending on your rehabilitation protocol and how fast you progress with physical therapy. This is highly dependent upon your condition before surgery, your age, and medical problems which can hinder your rehabilitation.

When can I walk after surgery?

Most surgeons and hospitals today emphasize getting you out of bed quickly. Most people are walking with the assistance of a walker on the day after surgery, and using a cane or nothing at all by 2-3 weeks.

When can I shower?

Many surgeons use waterproof dressings that allow for showering as early as the day after surgery. If your surgeon uses a standard dressing, you won’t be allowed to shower for 5-7 days, and usually no soaking for 3-4 weeks to allow the incision to fully heal.

Is TKR very painful?

Pain following total knee replacement has come a long way over the last 10-15 years with increased use of regional nerve blocks, spinal blocks, and various other modalities used for pain control. Total hip replacement is generally considered to be less painful than total knee replacement. Early range of motion and rapid rehabilitation protocols are also designed to reduce early stiffness and pain, making the procedure in general much less painful than in years past. You may have relatively mild pain following the procedure, or you may have a more difficult time than others. Everyone is unique and handles and perceives pain differently.

How long does it take to recover?

It can take up to 3 months for you to return to most activities, and likely 6 months to one year to fully recover to maximal strength and endurance following a TKR. This depends on your condition before surgery, additional medical problems, and your expectations.

Will I need physical therapy, and if so, for how long?

Most people who have undergone TKR require outpatient physical therapy following surgery. A skilled therapist can accelerate the rehabilitation as well as make the process more efficient with the use of dedicated machines and therapeutic modalities. Depending on your condition before surgery, physical therapy is beneficial for up to 3 months and rarely longer. The amount of therapy needed depends upon your condition before surgery, motivation, and general health.

When can I drive?

Most surgeons allow patients to drive at 4 to 6 weeks after surgery, and sometimes sooner if the operative leg is the left leg. There is some literature that states that your reaction time will not be back to normal prior to 6 weeks. You should not drive while on narcotics.

When can I return to work?

Returning to work is highly dependent on your general health, activity level and demands of your job. If you have a sedentary job, such as computer work, you can expect to return to work by 6-8 weeks. If you have a more demanding job that requires lifting, walking, or travel, you may need up to 3 months for full recovery

What restrictions will I have after surgery?

Restrictions following TKR are generally few and should be discussed with your surgeon. Following TKR, you will have some difficulty kneeling on the operative knee, which you will become less aware of with time, but will always have a general perception that the knee is artificial and doesn’t really feel like a normal knee. Most patients are able to return to usual activities and work but may have some difficulty performing heavy labor such as construction or farming. Most sporting activities are fine with the exception of running or jumping. Traveling should be not be affected by a joint replacement after the first 4-6 weeks when most surgeons advise against prolonged seated travel or flying due to increased risk of blood clot.

Are there complications to TKR?

  • TKR is primarily a pain relieving procedure; however, it may not relieve all pain, and there is a possibility of residual stiffness and swelling.
  • Although complications are relatively rare (1-2% of patients), patients may experience a complication in the postoperative period. These include very serious and possibly life threatening complications such as heart attack, stroke, pulmonary embolism and kidney failure.
  • Stiffness or loss of motion can also occur.
  • Infection (1%) is one of the most debilitating complications and often requires prolonged antibiotics with several additional surgeries to rid the infection.
  • A blood clot in the leg is also a relatively common complication requiring some type of blood thinner following surgery to reduce the incidence.
  • The implants can also fail over time due to wear or loosening of the components, but this generally occurs many years after surgery.

Should I continue to see my surgeon after I’m healed?

It is important to follow up with your surgeon after your joint replacement. In most cases, joint replacements last for many years. You need to meet with your treating doctor after surgery to ensure that your replacement is continuing to function well. In some cases, the replaced parts can start to wear out or loosen. The frequency of required follow up visits is dependent on many factors including the age of the patient, the demand levels placed on the joint, and the type of replacement. Your physician will consider all these factors and tailor a follow-up schedule to meet your needs. In general seeing your surgeon every 3-5 years is recommended.

Will I need to take antibiotics prior to seeing  a dentist or having other invasive procedures?

The American Academy of Orthopedic Surgery (AAOS) and American Dental Association (ADA) have generally recommended short-term antibiotics prior to dental procedures (1 dose 1 hour prior to dental procedure) for patients who have had joint replacements. This recommendation continues for up to 2 years after your joint replacement.

Two or more years after the replacement, continued use of antibiotics prior to dental procedures is based on the discretion of the treating surgeon and the patient. Your surgeon will consider many factors including whether or not you are at increased risk of infection due to immune suppression (i.e. diabetic, transplant patients, and rheumatoid arthritis).

The use of prophylactic antibiotics prior to dental cleanings and other invasive procedures remains controversial. Most orthopaedic surgeons now recommend lifetime suppression. Patients should discuss whether or not they need antibiotics prior to dental or other invasive procedures with their treating orthopedic surgeon.

Will my implant set off metal detectors at airports and courthouses?

Usually patients with joint replacements will set off metal detectors. It is reasonable for you to inform the TSA screening agent at the airport that you have had a joint replacement; however, you will still require screening and will need to follow the directions of the screening agent. Learn more about airport security.

There are millions of individuals with joint replacements, and screening protocols recognize that people who have had joint replacements may set off detectors. You do not need to carry specific documentation to prove that you have a joint replacement. Metal detector screenings follow universal protocols that allow for people with joint replacements to proceed after confirmation that no threat exists.

Article from: http://www.aahks.org/care-for-hips-and-knees/do-i-need-a-joint-replacement/total-knee-replacement/

What is a Torn Rotator Cuff and what to expect after Surgery.

“The rotator cuff is a group of four tendons and the related muscles that stabilize the shoulder joint and allow you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles, tendons, ligaments, and the joint capsule. The rotator cuff helps keep the ball of the arm bone seated into the socket of the shoulder blade.

Surgery to repair a torn rotator cuff tendon usually involves:

  • Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder where the rotator cuff moves (debridement).
  • Making more room for the rotator cuff tendon so it is not pinched or irritated. If needed, this includes shaving bone or removing bone spurs from the point of the shoulder blade (subacromial smoothing).
  • Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).

In open shoulder surgery, a surgeon makes an incision [2 in. (5 cm) to 3 in. (7.6 cm)] in the shoulder to open it and view the shoulder directly while repairing it. A smaller incision can be done with a mini-open procedure that allows the surgeon to reach the affected tendon by splitting the deltoid muscle. This method may reduce your chances of problems from a deltoid injury.

Open-shoulder surgery often requires a short stay in the hospital.

General anesthesia or a nerve block may be used for these types of surgical repair.

Rotator cuff tears can sometimes be repaired with arthroscopic surgery.

Surgery to repair a torn rotator cuff tendon usually involves:

Discomfort after surgery may decrease with taking pain medicines prescribed by your doctor.

The arm will be protected in a sling for a defined period of time, especially when at risk of additional injury.

*Physical therapy after surgery is crucial to a successful recovery. A rehabilitation program may include the following:

  • As soon as you awake from anesthesia, you may start doing exercises that flex and extend the elbow, wrist, and hand.
  • The day after surgery, if your doctor allows, passive exercises that move your arm may be done about 3 times a day (a machine or physical therapist may help the joint through its range of motion).
  • Active exercise (you move your arm yourself) and stretches, with the assistance of a physical therapist, may start 6 to 8 weeks after surgery. This depends on how bad your tear was and how complex the surgical repair was.
  • Strengthening exercises, beginning with light weights and progressing to heavier weights, can start a few months after surgery.”

Source: 

William, B., & Timothy, B. (2011, November 11). Rotator Cuff Repair. Retrieved from                                                 http://www.webmd.com/a-to-z-guides/rotator-cuff-repair

Considering ACL Surgery?

ACL surgery Hayden Clinic Encore Rehab

Surgery for anterior cruciate ligament (ACL) injuries involves reconstructing or repairing the ACL.

  • ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Another choice is allograft tissue, which is taken from a deceased donor.
  • Repair surgery typically is used only in the case of an avulsion fracture (a separation of the ligament and a piece of the bone from the rest of the bone). In this case, the bone fragment connected to the ACL is reattached to the bone.

ACL surgery is usually done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery). In some cases, it is done by cutting a large incision in the knee (open surgery).

ACL surgeries are done by orthopedic surgeons.

Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because:

  • It is easy to see and work on the knee structures.
  • It uses smaller incisions than open surgery.
  • It can be done at the same time as diagnostic arthroscopy (using arthroscopy to find out about the injury or damage to the knee).
  • It may have fewer risks than open surgery.

Arthroscopic surgery is done under regional (such as spinal) anesthesia or generalanesthesia.

What happens

During arthroscopic ACL reconstruction, the surgeon makes several small incisions—usually two or three—around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows the doctor to see the knee structures more clearly.

The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room.

Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored.

The surgeon will also make another incision in the knee and take the graft (replacement tissue).

  • graft taken from the tendon at the front of the knee below the kneecap (patellar tendon) will include two small pieces of bone called “bone blocks” on the ends of the tissue. One piece of bone is taken from the kneecap and the other piece is taken from a part of the lower leg bone near the knee joint. This type of graft allows better healing because the tendon is still attached to its original bone, and the pieces of bone just need to heal into their new locations.
  • If the autograft comes from the hamstring, bone blocks are not taken. This type of graft may allow the knee to look more normal after it heals, because the tendon from the front of the knee is not used. It is also easier to add extra tissue from a deceased donor (allograft) to this type of graft.
  • The whole graft may also be taken from a deceased donor (allograft).

The graft is pulled through the two tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with hardware such as screws or staples and will close the incisions with stitches or tape. The knee is bandaged, and you are taken to the recovery room for 2 to 3 hours.

During ACL surgery, the surgeon may repair other injured parts of the knee as well, such as menisci, other knee ligamentscartilage, or broken bones.

What To Expect After Surgery

Arthroscopic surgery is often done on an outpatient basis, which means that you do not spend a night in the hospital. Other surgery may require staying in the hospital for a couple of days.

You will feel tired for several days. Your knee will be swollen, and you may have numbness around the cut (incision) on your knee. Your ankle and shin may be bruised or swollen. You can put ice on the area to reduce swelling. Most of this will go away in a few days, and you should soon start seeing improvement in your knee.

To care for your incision while it heals, you need to keep it clean and dry and watch for signs of infection.

Physical rehabilitation after ACL surgery may take several months to a year. The length of time until you can return to normal activities or sports is different for every person. It may range from 4 to 6 months.1

Source:

WebMD. “Anterior Cruciate Ligament (ACL) Surgery.” WebM. Healthwise, Incorporated., 5 Apr 2012. Web. 10 Apr 2014. .