AustPAR - Post-Operative Physiotherapy

Acute Care

Post-Operative Physiotherapy

Post-operative Physiotherapy discussed on this page will include the immediate post-operative period, but many of the techniques described will be relevant for the entire pre-prosthetic period. Goals of this period are:

Prevent post-operative respiratory complications
Assist in wound management
Prevent complications associated with immobility and amputation surgery (pressure sores, contractures, deconditioning)
Restore mobility and independence (bed mobility, transfers, crutch / frame / wheelchair mobility)
Prepare the stump for wearing a prosthesis
Assist in pain management techniques
Assist in planning for discharge home or transfer to a rehabilitation setting

Ongoing education forms a large part of these goals.

1. Prevent Post-Operative Respiratory Complications

As well as the effects of an anaesthetic, patients often have pulmonary co-morbidities. Assess and treat as appropriate, including specific respiratory techniques, and early sit out of bed / mobilisation.

2. Assist in Wound Management

Physiotherapy includes:

Manufacture / fitting of rigid dressings (removeable / non-removeable), and monitoring the fit of the casts over time
Education of staff / patient on correct donning techniques for removeable rigid dressings, and / or shrinkers and stump bandages, and for signs of incorrect fit / donning
Monitoring for signs of wound breakdown / infection: temperature spikes that are not explained by infections elsewhere, odours, redness, wound discharges
Educate the patient:

Minimise risk of infection
Protection of the stump in transfers / mobilisation
Keep dressings dry & intact
Don't pick at the wound!
Don't poke objects under the dressings to scratch itches
Report any changes in pain / odour / temperature
Do not sit with the stump dangling (which potentially increases dependent oedema and tension on the wound)

3. Prevent Complications Associated with Immobility and Amputation Surgery

Potential complications include pressure areas, contractures, and deconditioning. Techniques to avoid these complications include:

Instruction / training in bed mobility, transfers, and mobilisation, as appropriate
Assist and encourage early sit out of bed
Prescription, and education of positioning programs:

Prone lying
Knee extension while lying, sitting out of bed
No pillows under the knee
Avoidance of prolonged flexion / abduction / external rotation

General and /or targeted strengthening / stretching programs
Cardiovascular program as able or appropriate

4. Restore Mobility and Independence

Please see our pages on Early Mobility

5. Prepare the Stump for Wearing a Prosthesis

The ideal stump is one that is well-healed, has good vascular supply, soft and mobile scars, minimal pain, minimal oedema, a length sufficient for biomechanical leverage but not too long to restrict choices for prosthetic components, and large surface areas for distribution of pressure. While the surgery plays a large part in creating the ideal stump, Physiotherapy is required to maximise chances of achieving this ideal.

Oedema reduction

Rigid dressings
Fitting and education on use of stump bandaging / shrinkers
Intermittent Pneumatic Compression Therapy
Positioning / elevation
Supply of equipment: legboards
Education: positioning & massage techniques
Measurement of changes over time

Scar management

Massage / transverse frictions, to mobilise scar tissue and prevent adherent / raised scars
Education on correct donning of shrinkers, bandages, silicon liners

Desensitisation

Massage
Rubbing, tapping, vibration
Encouraging normal touch: hands, towels, clothes and sheets

Range of motion

Thigh-length rigid dressings
Splints / backslabs for nights
Positioning programs and equipment
Strengthening and range of motion exercises
Stretching programs

6. Assist in Pain Management Techniques

Please see our pages on Pain Management

7. Assist in Planning for Discharge or Transfer to a Rehabilitation Setting

Active participation with the patient and multidisciplinary team, on negotiating / defining goals to enable discharge or transfer, and using the techniques described to work towards those goals. This may also include training in advanced mobility with crutches for accessing the home, such as car transfers, stairs, ramps, curbs, minimum required endurance.