Wright Medical Group

Sample Postoperative Care Protocols

What To Expect After Surgery

Postoperative Care*

The patient was placed in a well-padded plaster splint before leaving the operating room, and she remained splinted and non-weightbearing for 2 weeks.

2 WEEK POSTOP: At 2 weeks, postop, the sutures were removed. The patient was placed into a below-knee walker boot. We began physical therapy for motion but refrained from full weightbearing until the 6 week visit.

6 WEEK POSTOP: At 6 weeks, the walker boot was continued, and the patient began to weight-bear in the boot. She was progressed to full weight-bearing in the next 6 weeks.

12 WEEK POSTOP: At 12 weeks the patient was weaned into a normal shoe. She continued physical mtherapy under the direction of her therapist. Strength and motion were maximized, and swelling was reduced.

1 YEAR POSTOP FOLLOW-UP: At 1 year postoperative, the patient reported that she had no pain. She had a 10 degree motion arc and minimal to no swelling. She was off opiate pain medication. She was discharged to return in 1 year and with no restrictions (Figure 8A, 8B, 8C, 8D).

* Postoperative care is the responsibility of the medical professional.

Dr. Brage is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates

Postoperative Care*

The patient was placed into a well-padded plaster splint before leaving the operating room. The patient was ordered no weightbearing until seen in the office at 2 weeks postoperative. At 2 weeks postop, the sutures were removed. The patient was placed in a below-the-knee walker boot. Early motion was begun, but weightbearing was delayed for a full 6 weeks until the fracture was healed. At 6 weeks the fracture was deemed to be healing well. The implantalignment was good and appeared to be stable. The patient was allowed to begin a progressive return-to-function program over the next 6 weeks.

6 MONTHS POSTOPERATIVE: At 6 months postoperative, the patient was doing well tolerating weightbearing and walking without assistance devices. He was not taking pain medication. The implant appeared to be stable and in good alignment (Figure 10A, 10B). The tibial fracture was healed.

* Postoperative care is the responsibility of the medical professional.

Dr. Brage is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates

Postoperative Care*

The patient was placed in a well-padded splint before leaving the operating room. She remained splinted and non-weightbearing for 2 weeks.

2 Weeks Postop: At 2 weeks the splint and the sutures were removed. The patient was placed in a below-knee walker boot. Strict non-weightbearing was employed for another 4 weeks. The patient was allowed gentle, active range of motion.

6 Weeks Postop: At 6 weeks, the patient was allowed to begin weightbearing in the walker boot. A rigorous physical therapy program was initiated. The patient was progressed to full weightbearing in the boot over the next 6 weeks.

12 Weeks Postop: At 12 weeks postop, the patient was weaned into a shoe. She continued physical therapy to maximize range of motion. She was instructed to avoid activities that risked falling, vigorous twisting and repetitive impact on the ankle.

1 Year Postop: At 1 year postop, the patient was functioning well . The components were stable, and the medial malleolus fracture was healed. (Figure 11A, 11B).

3 Years Postop: At 3 years postoperative, the patient has some minimal pain to her ankle. She notes the ankle is quite stiff, but overall she feels that she is getting along just fine. She is satisfied with the current level of function. She is able to walk on flat ground and navigate stairs, and there is no interference with her activities of daily living. X-rays show the implants to be stable with good bony ingrowth, with no changes in alignment (Figure 12A, 12B).

* Postoperative care is the responsibility of the medical professional.

Dr. Brage is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates

Postoperative Care*

The patient was placed in a well-padded splint before leaving the operating room. She remained splinted and non-weightbearing for 2 weeks.

2 Weeks Postop: At 2 weeks the splint and the sutures were removed. The patient was placed in a below-knee walker boot. Strict non-weightbearing was employed for another 4 weeks. The patient was allowed gentle, active range of motion.

6 Weeks Postop: At 6 weeks, the patient was allowed to begin weightbearing in the walker boot. A rigorous physical therapy program was initiated. The patient was progressed to full weightbearing in the boot over the next 6 weeks.

12 Weeks Postop: At 12 weeks postop, the patient was weaned into a shoe. She continued physical therapy to maximize range of motion. She was instructed to avoid activities that risked falling, vigorous twisting and repetitive impact on the ankle.

1 Year Postop: At 1 year postop, the patient was functioning well . The components were stable, and the medial malleolus fracture was healed. (Figure 11A, 11B).

3 Years Postop: At 3 years postoperative, the patient has some minimal pain to her ankle. She notes the ankle is quite stiff, but overall she feels that she is getting along just fine. She is satisfied with the current level of function. She is able to walk on flat ground and navigate stairs, and there is no interference with her activities of daily living. X-rays show the implants to be stable with good bony ingrowth, with no changes in alignment (Figure 12A, 12B).

* Postoperative care is the responsibility of the medical professional.

Dr. Brage is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates

Postoperative Care*

Immediately postoperatively, the patient had a compression wrap protocol for the first 2.5 weeks. A wound care therapist, physical therapist, or physician’s assistant performed short stretch compression wraps (Hsu, et.al FAI 35(7): 719-724, 2014) every 2 to 3 days to minimize edema about the incision line and subsequent wound complications. Physical therapy commenced 2 weeks postop, working on passive range of motion.

Patient’s prosthesis was well fixed, and he had not undergone any significant supplementary procedures (osteotomy), therefore weightbearing stretch was begun at 4 weeks postoperative.

Standing in a CAM boot was implemented at 6 weeks postop with gradual increase in walking from a few steps to return to shoe at 10 weeks.

Regular activities were avoided until 4 months postop to allow the bone mass to increase to prevent stress fractures or subsidence about the prosthesis.

Patient Outcome: Patient is now walking in a shoe without pain. He appreciates the restored ankle motion and balance achieved through realignment at the ankle joint (FIGURE 6A, 6B, 6C). He feels fluid motion, which allows him to walk without difficulty (FIGURE 6D, and 6E).

* Postoperative care is the responsibility of the medical professional.

Dr. Haddad is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates

Postoperative Care*

Due to edema, before each of the surgical procedures, compression wrap therapy was instituted for one week (Hsu, et.al FAI 35(7): 719-724, 2014). Following each of the procedures, the same compression wrap protocol was instituted postoperatively for 2.5 weeks.

At 2.5 weeks after the first surgery (subtalar arthrodesis and ligament reconstruction), the sutures were removed and compression wrapping was discontinued; the extremity was then casted. The patient was transitioned to a weight bearing CAM boot at 6 weeks postop. At 3 months postoperative, alignment was assessed through gait and standing observation so that the surgeon could determine if supplementary osteotomies would be required at the second stage. CT scan was used to confirm subtalar arthrodesis, and then the secondstage surgery was performed.

Following the second surgery (total ankle replacement),physical therapy commenced 2 weeks postoperative, working on passive range of motion. Weightbearing stretch was begun at 4 weeks postoperative because patient had a well-fixed prosthesis without significant supplementary procedures, e.g. osteotomies.

Standing in a CAM boot was implemented at 6 weeks postop with gradual increase in walking from a few steps to return to shoe at 10 weeks.

Physical activities were avoided until 4 months postoperative in order for the bone mass to increase to prevent stress fractures or subsidence at the prosthesis.

Patient Outcome: At 1.5 years postoperative, patient was capable of walking in a shoe without pain. He reported feeling balanced and stable, and his swelling was down markedly (FIGURE 8A, 8B, 8C). His range of motion was markedly improved (FIGURE 8D, 8E). Interestingly, his opposite ankle, which appeared fairly normal on his initial assessment, had by that time developed a similar deformity (FIGURE 8C).

Radiographically, no component subsidence was noted, confirming good resting bone strength to support the prosthesis (FIGURE 9A, 9B, 9C). True ankle range of motion is shown in the flexion/extension radiographs (FIGURE 9D, 9E).

* Postoperative care is the responsibility of the medical professional.

Dr. Haddad is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates

Postoperative Care*

Because supplementary procedures such as arthrodesis were not required, patient underwent an accelerated postoperative protocol. The INBONE II Total Ankle fixation was strong and allowed not only early range of motion, but also earlier weightbearing.

Patient began compression wraps immediately postoperative, and at each session, passive range of motion PT was performed. At 3 weeks postoperative, she began weight bearing stretch.At 6 weeks postop, she was standing and taking 50 steps at a time in a CAM boot. She returned to a shoe by 9 weeks postoperative.

Patient Outcome: Patient reported that she was enjoying her total ankle prosthesis and was very happy with the decreased swelling (FIGURES 6A, 6B) and lack of pain with ambulation. Her heel is balanced (FIGURE 6B), and her range of motion improved markedly from the anterior abutment noted prior to surgery (FIGURES 6C, 6D).

Radiographically, the prosthesis is stable and well balanced (FIGURE 7A). In the sagittal plane, it can be observed that her prosthesis is resting on quality bone (FIGURE 7B), and the height of the talus was elevated from the prior flattened surface to achieve anatomic center of rotation. The broken talar screw from her previous surgery was left in place as it did not compromise component positioning.

* Postoperative care is the responsibility of the medical professional.

Dr. Haddad is a paid consultant for Wright Medical Group N.V.

Wright provided financial support for this case study.

These results are specific to this individual only. Individual results and activity levels after surgery vary and depend on many factors including age, weight, and prior activity levels. There are risks and recovery times associated with surgery, and there are certain individuals who should not undergo surgery.

This case study is a publication of Wright Medical Group N.V. or its affiliates