Post Osteotomy Rehabilitation Physiotherapy Assesment & Managment

1. POST OSTEOTOMY
REHABILITATION
NIRAV
JEEL
PREPARED BY :-

2. Introduction
 An osteotomy is a surgical operation whereby a
bone is cut to shorten or lengthen it or to change its
alignment
 It is a surgical procedure which requires careful
planning during recovery period and is done under a
general anaesthetic.
 The purpose of osteotomy varies for different joints.

4. Indications
 To correct excessive angulation, bowing or rotation
of long bones.
 To correct mal-alignment of a joint due to mal-union
or deformity like coxa vara, genu valgum, and genu
varum etc.
 To relieve pain in arthritis, especially of the hip and
knee.

5. Contraindications
 Neuropathic Arthropathy
 Inflammatory Arthropathy
 Active infectious
 Severe osteopania
 Smoking
 Advanced arthritis/Ankylosis

6. TYPES OF OSTEOTOMY
 Chin
 Osteotomy of the Chin
 Elbow
 French Osteotomy
 Spine
 Spinal osteotomy
 Knee
 High tibial osteotomy
 Hip
 McMurry osteotomy, Pauwel's osteotomy,
Salter's osteotomy, Chiari's osteotomy,

7. Assesment
 Demographic Data
→ Name :-
→ Age :- Older Age are more common
affected
→ Gender :- Women affected more than
Male
→ Occupation:- House Wife
→ Address :-
→ BMI :- OverWeight

8.  Chief Complain :-
→ Difficulty in Walking
→ Difficulty in Ascending And
Descending the stair
 Provisional Diagnosis :- OA

9.  History
→ Present History :-
- It Can Be Obisity, OA
- Mal-Alignment of a Joint due to malunion or
deformity like genu valgum or genu varum
→ Past History :- NAD
→ Drug History :- NSAIDS
→ Surgical History :- Knee Osteotomy ( Lt Side)
→ Personal History :- NAD
→ Family History :- NAD
→ Medical History :- NAD

10.  ON Observation
→ Genaral Condition Of Patient :- Good
→ Body Built :- Endomorph
→ Swelling :- Present
→ Scar :- Present
→ Redness :- Present
→ Posture :- Poor Posture
→ Gait :- Antalgic Gait
→ External Aids :- Mobility Aid Present

11.  ON Palpation
→ Tenderness :- Present(Grade-2)
→ Temprature :- Localized Increse
→ Scar :- Present
→ Swelling :- Present
→ Spasm :- Absent
→ Oedema :- Absent
→ Crepitis :- Absent

12.  ON Examinaton
→ Vitals :- Normal
→ Pain Assesment :-
- Onset :- Gradual
- Type :- Dull-Ache
- Site :- Left Knee Joint
- Side :- Left Side
→ Aggravating Factor :- During
Activity(ascending stair)
→ Relieving Factor :- Rest, NSAIDS

13.  ON Examinaton
→ Motor Assesment :- ROM
- Knee :- Flexion & Extention More
Reduce
- Hip :- Slightly Reduce
- Ankle :- Slightly Reduce
→ MMT :- Knee Flexors And Extenors
Grade 3

14.  Investigation
→X-Ray :- Complete loss of joint space
Between Tibia and Femur
→MRI
Functional Outcome Measurement
→ Lower Extremitry Functional Scale
→ Knee Disability And osteoarthritis outcome
Score
 Final Diagnosis
→ Knee Osteotomy

15. X-Ray

16. Managment
 Post Osteotomy Rehabilitation
 0-4 Weeks
 4-8 Weeks
 8-12 Weeks
 4-6 Months

17.  0-4 weeks
 Physiotherapy rehabilitation with immediately
protecting knee from harmful forces
 decrease pain and swelling
 gradually improve range of motion and function of
knee.

18.  to wear a protective knee brace during
functional and weight bearing activities and also
wear the brace during sleep for up to 4 weeks
 To reduce initial swelling and pain,
 treatment using RICE will be given which
includes
 rest, ice, compression and elevation of
your knee.

19.  To improve range of motion
exercises include such as:
 Hip Joint Abduction & Flexion
 Knee Joint Flexion & Extension
 Stretching Exercise

20.  To improve strength of knee during the first 4
weeks after osteotomy, exercises include:
 Strengthening exercises for quadriceps
 Strengthening exercises for hamstrings
 Strengthening exercises for muscles in and
around hip and ankle
 SLR

22. 4-8 weeks
 Goals
 gradually progressing to full weight bearing and
regaining full range of movement of knee
 the continuation of improvements in the
strengthening and range of motion exercises from
previous weeks.

23.  Progression of weight bearing as tolerated
(full weight bearing without crutches by 8
weeks)
 Discontinue use of brace at 6-8 weeks
 Range of motion exercises
 Patellar mobilisations
 Stretching exercises for quadriceps,
hamstrings and calf

24.  Standing Terminal Knee Extensions
 Standing Hip Abduction & Flexion
 Bridging
 Heel Raises

25. Patella mobilisations

26. 8-12 weeks
 Continues of stretching and strengthening
exercises for muscles in and around knee
 Knee Mobilisation
 Walking programme (gait re-education)
 Proprioception (single leg balance exercise)
 Static bicycle

27. 8-12 weeks
 Squats – as able
 Forward Step Ups
 Forward Step Down
 Leg Press
 Hydrotherapy

28. Mobilisations of the knee joint

29. 4-6 Months
 Continues of strengthening and stretching
exercises from Previous Week
 Stability and strength training for the knee
 Agility training (changes in direction)
 Static bicycle
 Sport specific activities
 Function specific activities

30. Stability and strength training for the knee