Rehabilitation guidelines following Excision of Bone Lesion
Much of the surgery carried out on the Sarcoma Unit at RNOHT is unusual.
We have therefore devised guidelines which outline the goals patients should
be aiming to achieve during their rehabilitation. These are guidelines and
every patient should be assessed and treated as an individual, therefore,
there may be variation in timing and outcome but the restrictions MUST
remain the same.
Patients who have been diagnosed with a tumour and then undergone
orthopaedic surgery are, if appropriate, referred for pre/post op chemotherapy
or radiotherapy. (Not all tumours are malignant and not all tumours are
chemotherapy/radiotherapy sensitive). These treatments will impact on their
rehabilitation. (Refer to the appendix for details)
Therapy rehabilitation
Excision of Bone Lesion
Excision of a benign or malignant lesion from a bone. This may require
additional fixation which can be done by bone graft, cement or metal fixation.
Indications:
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Malignant or benign lesion not usually including the joint
Possible complications:
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Wound healing/infection
Neuropraxia
Recurrence
Poor ROM requiring MUA
Expected outcome;
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Patient should usually regain full function of the affected limb
RC/SH/KS March 2014
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Review March 2016
Initial rehabilitation phase
Goals:
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Optimise tissue healing
Ensure adequate pain control
Patient to be independently mobile
Range of movement within post operative limitations achieved
Restrictions:
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Will be documented in post operative guidelines if applicable
Orthotic appliances:
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Only if surgical procedure requires or if required following assessment
by therapist
Pain relief:
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Adequate analgesia, resting positions
Patient education:
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Post operative restrictions, rehabilitation guidelines, how to donn and
doff any orthotic appliances
Physiotherapy rehabilitation:
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Static muscle strengthening and circulatory exercises commence from
day 1. Aim for range of movement within post operative restrictions
Mobilise with appropriate walking aid adhering to weight bearing status
Practice stairs as appropriate
Teach to donn and doff any orthotic appliances
Prior to hospital discharge patients may require a referral for outpatient
physiotherapy. If these patients are also going to receive
chemotherapy or radiotherapy then a transfer summary must be sent to
the centre that will be carrying out adjunctive therapy,
Occupational Therapy Intervention
Occupational Therapy is not routinely indicated, however, other members of
the MDT may make referrals for any specific OT related problems that the
patient may be experiencing.
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Review March 2016
Final rehabilitation phase
12 weeks and beyond
Goals:
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Return to function
Orthotic appliances:
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Should no longer be required
Patient education:
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Encourage return to normal function
Physiotherapy rehabilitation - lower limb:
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Gait re-education
Dynamic control/core stability
Proprioception/balance work
Return to full function
Upper limb:
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AROM with good dynamic scapula control
Scapula stability and core stability
Proprioception/balance work
Return to full function
RC/SH/KS March 2014
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Review March 2016
Appendix
Some chemotherapy and radiotherapy side effects and
implications for treatment:
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Bone marrow toxicity, ↓white cell count, ↓platelets, ↓Hb and ↓rate of
healing. White cell count will be at its lowest approximately 10 days
post chemotherapy and signs of wound infection should be watched
for. Hydrotherapy should not be undertaken at this point
Nausea, vomiting, diarrhoea, ↓appetite, lethargy and ↓exercise
tolerance. Physiotherapy will be particularly important during and
immediately after chemo and radiotherapy, as patients often lose ROM
and strength after a cycle. Community physiotherapy may need to be
arranged after discharge if the patient is too unwell to attend for
outpatient treatment. The occupational therapist may need to advise on
the practical implications of the symptoms such as meal and drink
preparation, laundry and hygiene. Relaxation techniques may also be
used to reduce nausea and vomiting in addition to reducing anxiety
levels associated with food and meal times.
Anxiety and depression – these can diminish people’s concentration,
ability to assimilate information and motivation to carry out activities.
The therapists, among other treatment, will identify goals which
increase a person’s sense of control.
Fatigue – needs to be addressed / acknowledged as it can affect a
person’s physical and cognitive ability to carry out normal activities.
The therapists will need to take this into consideration and tailor the
rehabilitation accordingly.
Anaemia which can lead to tiredness, lethargy and breathlessness
Radiotherapy only:
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Fibrosis of soft tissues – Can continue for up to 2 years and may lead
to contractures. Passive exercise is very important during and
immediately post radiotherapy to prevent loss of ROM
Demineralisation of bone – increases risk of fracture
Redness, soreness and sensitivity of the skin to heat – care of the skin
is important.
Heat modalities are contraindicated post DXT.
Application of lotions and manual treatments are contraindicated during
DXT, but can be used with caution post DXT. Electrical modalities e.g.
TNS and FES can be used with caution
RC/SH/KS March 2014
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Review March 2016