...Orthopaedic Surgery - Arthroscopic Surgery - Joint Replacement - Sports Medicine - Fracture Care John R. Chance, M.D., David L. Fox, M.D., Jamie L. Lynch, M.D., Brian E. Schulze, M.D., Patrick M. Simon, M.D., Rex E. Wilcox, M.D. Diplomates, American Board of Orthopaedic Surgery Kelly A. Cooper, PA-C Total Knee Arthroplasty (Replacement) Post Operative Instructions IN THE HOSPITAL AFTER SURGERY: You will stay in the hospital for 2-3 days after having knee replacement surgery. During that time you will recover from your anesthesia and the surgery itself. Right after surgery you will spend 1-2 hours in a recovery room (PACU) before going into your room. You will likely wake up very tired and groggy. You will have a large dressing (bandage) over your incision and part of your leg. A small drainage tube may be in place during surgery to help drain fluids that collect in your knee joint after surgery. After being taken back to your room you will continue receiving fluids through your IV (a catheter or tube that is inserted into your vein to give the medical staff access for medications and fluids) until you are able to drink fluids on your own. You will slowly resume a normal diet. After knee replacement, some surgeons recommend using a continuous passive motion machine (CPM) while you are in bed. The CPM bends your knee for you. Over time, the rate and amount of bending will increase. If you are using this machine, always keep your leg in the CPM when you are in bed. It may help speed...
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...completed a fellowship in foot and ankle surgery in addition to her years of medical school and residency...
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...convulsions. Visualized a small essential tremor in bilateral hands. States has some weakness, tingling, and numbness in both lower extremities due to bilateral knee replacements. Denies signs or symptoms of difficulty speaking, or swallowing. States takes Narcotic pain medications for pain management. | Head and Neck:States intermittent migraines. Denies any neck pain. Denies any abnormal lumps or swelling in her neck or head area. Sinus surgery in 1991, without complications. | Eyes:Denies eye pain, excessive tearing or blurred vision of the eyes. Last eye exam was March, 2014 which included glaucoma testing, vision testing. No visible redness of eyes. Client states she is currently wearing progressive lens glasses. States when eyes are occasionally dry she uses artificial tears. | Ears:Denies earache or other ear pain. History of childhood chronic ear infections. No lengthy exposure to loud environmental noises. Denies any vertigo or ear medications. | Nose, Mouth, and Throat: States has had cold sores of the mouth in the past. Denies any nosebleeds. States has had gingivitis in the past and was treated by dentist. Allergies to multiple medications and bee stings. Last dental check-up, states was 1 year ago. States has had many root canals and tooth implants. Rinses with medicated mouth wash. States had sinus surgery in 1991, with no complications. | Skin, Hair and Nails:Skin dry and intact. No signs of skin disease. Denies any changes in...
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... The patient arrived to radiology on August 5, 2012. The patient was a 10 year old hispanic male whom presented to the hospital with pain in his right ankle. Prior to coming into the radiology department he had fallen on a play structure at his school. Immediately after his fall he was brought to the hospital by his parents. As a result the patient was x-rayed on August 5, 2012. An ankle complete series was performed which consisted of an AP, Oblique, and Lateral view. However, due to his age comparison films were also taken of his left ankle which consisted of only an ap and lateral. According to the radiology report from the images obtained the patient was said to have a non-ossifying fibroma in his right distal tibia metaphysis region. The recommendation following his visit from the radiologists was for the patient to be seen again for a followup in six months. On March 1, 2013 the patient returned to the department for his 6 month followup. Since the patient was being seen for a followup on this visit instead of for trauma like his initial visit, only three images were obtained. An AP, Oblique, and Lateral view of only his right ankle. According to the radiology reports from this visit the patient still was said to have a non ossifying fibroma on his right lower leg/ankle. A non-ossifying fibroma is a benign, non-aggressive tumor. It is non cancerous and is mainly composed of fibrous tissue. (Boston Children's Hospital, 2011) Non-ossifying fibromas...
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...and gunshot wounds and sports or recreational injuries. Traumas often result in bone and joint fractures and dislocations. (Scottsdale Healthcare Osborn, 2009, para. 2) • Arthritis treatments Treatment focused on relieving the pain associated with arthritis. Treatment types such as medicines, therapy, or surgery can be used alone or in combination together to ease the associated pain of arthritis. • Spine and Neck injuries Generalized neck pain, whiplash or cervical pain, disc herniation, weakness, and or numbness down the arms, and lower back or lumbar pain, are treated by orthopedic physicians specialized in spine and neck injury. • Upper extremity Treatment of muscle, ligaments, tendons, and bones in the shoulder, elbow, wrist, and hand are under physicians who have training in this specific part of the body. • Hand Physicians in this subspecialty have completed extensive training in the forearm, wrist, and hand. • Foot and ankle Foot care, diabetic foot care, arthritis, bunions, corns, ingrown toenails, heel pain are just the starting point for problems and injuries treated by physicians specializing in the foot and ankle. Reconstructive surgery is also included. • Sports medicine Treatment of injuries sustained...
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...arthroplasty is the replacement of the hip joint with a prosthesis, and is one of the most common reconstructive operations (Huo et al 2008). Hip arthroplasty may be performed when irreversible damage has occurred to the joint; this damage often causes pain, dysfunction and reduced quality of life. The pre-operative nursing considerations begin with patient education. This should begin at the time the decision is made to have the surgical procedure performed. It is important that the patient understand the preoperative requirements, the surgical procedure, postoperative care and the necessary home/activity modification. The patient should be instructed in self-preparation, including mental and emotion readiness and having a positive attitude about the surgical outcome. There is a great deal of evidence that a patient’s psychological state before the surgery impacts on their recovery afterwards. Studies have shown that patients who report lower levels of general or mental health before surgery have worse physical health outcomes, such as pain levels, after surgery (Long et al, 2005). Like all surgeries, the patient will be assed for their ability to tolerate the procedure and anesthesia. Of particular concern is their cardiovascular and respiratory status, and the presence of any comorbidities. The patient should also be evaluated for the presence of any infection, as it could spread to the hip prosthesis. The teaching of postoperative exercise before surgery allows the patient...
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...raise the risk of DVT are: • An injury that damages veins • Obesity, which puts pressure on the veins in the pelvis and legs • Heredity • A catheter put in a vein for any reason • Hormonal changes such as birth control pills or hormone therapy • Smoking • Long periods of sitting such as on a plane trip of more than four hours Certain diseases such as heredity disorders, inflammatory bowel syndrome, cancer and heart disease can increase the risk of developing DVT, especially if you have one other risk. Surgery is a major risk for developing DVT, especially if you have had joint replacement surgery in the lower legs. Pregnancy also increases the risk of DVT for up to six weeks after delivery as does bed rest and having a caesarian section. There are symptoms for DVT, but only about 50 percent of the people who develop DVT have symptoms. The most common symptoms are: • Swelling of the ankle or foot that is often only on one side • Cramps in the calf that has DVT • Pain in the ankle or foot for no apparent reason • A warm spot on the surface of your skin • The skin over the vein turns red, blue or pale Since symptoms are rare, many people only realize they have DVT when they require emergency care for a pulmonary embolism. This means the clot has come loose and traveled to the lung blocking a major artery. This is a very serious condition. There are several treatment options that our specialist may recommend for keeping a clot from becoming larger. Treatment is also intended...
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...Heart Valve Surgery Once a valve problem has been diagnosed and surgery scheduled, you’ll have some things to do. Some preparations will help make your surgery go smoothly. Some will help you get set up for your return home from the hospital. And others will help you feel more at ease. Your doctor will talk with you about the risks. Write down all your questions in advance so you don’t forget to ask them. The Week Before Surgery Steps you take before your surgery can help make both the surgery and recovery go smoothly. Follow your doctor’s instructions. • Ask your doctor about scheduling any dental work you might need. Dental work could let bacteria into your bloodstream, which can cause infection on a new valve. • Give your doctor a list of every medication you take, including supplements and over-the-counter products. Your doctor may have you stop taking some of them or start taking others before surgery. • If you smoke, quit right away. You will do better during and after surgery. • Arrange for an adult family member or friend to drive you home from the hospital. Have a helper available for your first week or two at home. • Prepare and freeze food or arrange to have food brought in while you recover. • Make adjustments around your home to simplify movements, such as reducing the need to climb stairs. The Day Before Surgery • You may be asked to wash with special soap the night before surgery. The morning of surgery, don’t use deodorant, lotion, or perfume. • Don’t...
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...nails long, thickened, yellowish color. End of toe nails are chipped, capillary refill of 1.5 seconds. Skin/Extremities: Warm to touch, dry, color is normal for patient’s ethnicity. Skin turgor elastic, and rapidly returns to original shape. Patient has scattered bruising on top of both thighs and up and down arms bilaterally. Fluid filled blisters and open sores scattered on both lower legs and feet bilaterally. Scabs scattered on lower legs and feet bilaterally, 70% yellowish drainage from open sores bilateral on lower legs. Both legs have evidence of varicose veins. Left lower leg has evidence of cellulitis. Capillary refill of 2 seconds, upper extremities no edema present. Lower extremities have evidence of edema, left ankle 2+ edema, right ankle 1+ edema. Both lower legs covered with telfa to open areas and blisters, legs wrapped with kerlix and secured with surgilast, iodine...
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... |Uncertain/equivocal | | |+ |Present or Noted | | |++ |Present Significantly | | |+++ |Present in Excess | | |= |Equivalent to | | |3 |OK or satisfactory | | |A |Ankle Jerk/Reflex |Hitting the ankle with a patella hammer to | | | |test reflexes | |AAA |Abdominal Aortic Aneurysm |Swelling of the main artery in the abdomen | |AAL |Anterior Axillary Line |Imaginary line drawn from the front arm pit| | | |down the chest wall | |ABG |Arterial Blood Gas also "Sats" |Blood test to see how much oxygen there is | | | |in the blood (percentage ‘saturation’...
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...ankylosing spondylitis five years prior. Because of deterioration of patient’s left hip, a total hip replacement (THR) surgery is recommended by his rheumatologist. The patient has a past medical history of mild hypertension and anterior cruciate ligament repair to his right knee 12 years ago. Medications the patient is currently taking are Tenormin (Beta-blocker), Prednisone (Corticosteroid), and Ibuprofen (NSAID/ nonsteroidal anti-inflammatory drug). Physician’s referral consists of pre-surgery LE strengthening exercises, activities of daily living (ADL) training, and THR management education within 6 outpatient visits. Ankylosing spondylitis (AS) is a type of chronic inflammatory...
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...play collegiate level soccer, went in for a tackle during a match. As his leg planted into the turf, a player on the opposing team kicked him mid-shin. The impact of the force exerted onto his lower extremity resulted in an open tibia fibula fracture. As I stared at Nick's leg in shock, I realized that his life and future had drastically changed in a matter of seconds. What I did not foresee, was that his injury would also have a lasting effect on my life and future by opening my eyes to the field of orthopaedic surgery. Nick ended up undergoing an ORIF, with multiple revisions eventually regaining the majority of his mobility, a journey that would take two years. Through this time, I stayed in close contact with him. Intrigued by the details of his surgeries, a seed was planted that would eventually grow into the passion for orthopaedic surgery that I feel today....
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...medical care in collaboration with the tourism industry for patients needing surgical and other forms of specialized treatment. Medical or Health tourism has become a common form of vacationing, and covers a broad spectrum of medical services. It mixes leisure, fun and relaxation together with wellness and healthcare. The global health care industry is valued at $ 2.8 tn. The market for health tourism is estimated to be $67 bn, growing at a rate 20% per annum. It can be divided into three broad segments: 1. Surgeries like orthopedic surgery, heart by-pass surgery, cancer therapy, eye surgery, organ transplantation. 2. Plastic surgery or cosmetic surgery. 3. Health spas, weight loss exercise centers, hot springs and holistic treatment including wellness therapies. Different countries have become preferred destination in each of these segments for medical tourist. India is a preferred destination for heart, orthopedic, eye and neurosurgeries. Eye surgery kidney dialysis and organ transplantation are among the most common treatments sought by medical tourist in Thailand and according to the Health Ministry, in 2004 the country attracted 600,000 medical tourists, who generated 20 billion baht in revenue. As a result, Asia’s medical tourism industry could generate over US$4.4 billion a year by 2012, with India, Thailand, Singapore, Malaysia and South Korea the top destinations. Tourist arrivals from the United Arab Emirates (UAE) in Malaysia alone totalled 29,606...
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...Use of the Cusum technique for evaluation of a CT based navigation system for total knee replacement (TKR) Praemer et al30reported that in 1996, 245,000 total knee replacements (TKRs) were done in the United States. They estimated that the projected increase in TKRs in the United States will be 209,000 between 1996 and 2030. Most of the early failures of TKRs are related to technical flaws. Experimental and clinical data indicate that to achieve optimal midterm and long-term results of a TKR, good alignment in /the frontal plane of the lower limb is mandatory. In an experimental study, Hsu et al 14showed that a femoral component in 7° valgus, with the tibial component placed at 90° to the long axis of the tibia, was the best position for the total condylar knee and produced equal force distribution between the medial and lateral plateaus. For the Kinematic knee, the best position was 9° valgus for the femoral component with 2° varus of the tibial component. A clinical association between failure of TKR and malalignment seems likely. Ritter et al 32 reported that varus knees had a lower survival at 10 years than aligned or valgus knees. Jeffery et al,16 with the first design of the Denham prosthesis, reported that at 12 years the incidence of loosening was 3% when, on long-leg standing radio-graphs, the line joining the center of the femoral head to the center of the body of the talus passed through themiddle1⁄3of the knee prosthesis. The incidence of loosening was 24%...
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...Technical College Abstract Osteoarthritis is a very common degenerative condition that affects tens of millions of Americans with treatment options varying from pain medicine management to surgical joint replacement. Because osteoarthritis is a chronic incurable disease, therapies using pharmacological methods are not always preferable due to side effects stemming from long term medicine use. Resistance training treatment is a potentially effective form of treatment, using resistance exercises to strengthen musculature surrounding the joint to alleviate stress on the joint. Several studies show significant improvement in pain management and...
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