A concise, clinical study guide covering definitions, physiological changes, common pathologies, osteopathic management, biopsychosocial factors, and post-operative recovery. Structured for rapid revision.
Conventionally defined as age ≥65 years. The WHO also recognises sub-groups: young-old (65–74), old (75–84), and oldest-old (≥85).
The number of years lived since birth. A fixed, calendar-based measure that does not reflect functional capacity.
A measure of physiological function and cellular health. May differ significantly from chronological age; more clinically relevant for treatment planning.
The period of life spent in good health, free from serious disease or disability. Distinct from lifespan; the goal of geriatric care is to maximise healthspan.
The gradual deterioration of functional characteristics in living organisms with age; occurs at cellular, tissue, and organ levels.
A clinical syndrome of decreased physiological reserve and resistance to stressors. Increases vulnerability to adverse outcomes. Assessed via Fried Frailty Criteria.
Concurrent use of ≥5 medications. Common in elderly; increases risk of adverse drug reactions, falls, and drug–drug interactions.
The presence of two or more chronic conditions simultaneously. The norm rather than the exception in geriatric patients.
Treat the whole person — physical, psychological, and social dimensions. Multimorbidity means no system can be treated in isolation.
Age-related structural changes (kyphosis, sarcopenia, joint degeneration) directly impair function. Restoring optimal structure supports function.
The body has inherent self-regulatory mechanisms. In elderly patients these are diminished — treatment supports rather than overrides them.
Treatment must be based on the above principles and adapted to the patient's current physiological state, not their chronological age alone.
| Technique | Rationale for Use | Considerations |
|---|---|---|
| Soft Tissue Techniques (STT) | Gentle; improves circulation, reduces muscle tension | Avoid over fragile skin or bruised areas |
| Muscle Energy Technique (MET) | Patient-active; low force; improves ROM | Ensure patient can generate force safely |
| Counterstrain / Strain-Counterstrain | Passive; very low force; well-tolerated | Positioning may be challenging |
| Myofascial Release (MFR) | Gentle sustained pressure; improves fascial mobility | Indirect techniques preferred |
| Craniosacral Therapy | Very gentle; suitable for frail patients | Evidence base limited; adjunct only |
| Lymphatic Pump Techniques | Reduces peripheral oedema; supports immunity | Avoid in active infection, malignancy, DVT |
| Articulatory Techniques | Gentle rhythmic joint mobilisation; improves ROM | Avoid in acute inflammation or instability |
| HVLA (High Velocity Low Amplitude) | May be used selectively | Use with extreme caution — see contraindications |
Osteopathic practitioners frequently encounter patients recovering from joint arthroplasty. Knowledge of post-operative precautions is essential for safe practice.
| Precaution | Rule | Rationale |
|---|---|---|
| Hip Flexion | Do NOT flex hip beyond 90° | Posterior capsule stress → dislocation risk |
| Hip Adduction | Do NOT cross midline (adduct) | Increases posterior dislocation risk |
| Internal Rotation | Do NOT internally rotate operated hip | Posterior capsule and short external rotators at risk |
| Sitting | Use raised toilet seat; avoid low chairs; hips above knees | Prevents hip flexion beyond 90° |
| Sleeping | Pillow between legs; avoid lying on operated side initially | Prevents adduction and internal rotation |
| Bending | Do not bend to pick up objects from floor | Hip flexion precaution |
| Weight Bearing | As per surgeon instruction (WBAT, PWB, NWB) | Depends on fixation type (cemented vs uncemented) |
| Driving | Typically 6–8 weeks post-op (right hip longer) | Reaction time and hip flexion considerations |
| OMT Caution | Avoid techniques that violate precautions; no HVLA to hip | Dislocation risk; implant integrity |
| Phase | Timeframe | Key Goals & Precautions |
|---|---|---|
| Immediate Post-Op | 0–2 weeks | Wound healing; DVT prophylaxis; pain management; WBAT with aid; ice and elevation; avoid prolonged dependency of limb |
| Early Rehabilitation | 2–6 weeks | Achieve ≥90° knee flexion; full extension (0°); quad strengthening; gait re-education; stair practice |
| Intermediate | 6–12 weeks | Progress ROM toward 120°+; progressive strengthening; balance training; reduce walking aid dependence |
| Late Rehabilitation | 3–6 months | Return to functional activities; low-impact exercise; swimming, cycling encouraged; avoid high-impact sports |
| TKA Specific Consideration | Detail |
|---|---|
| DVT Risk | High post-TKA; anticoagulation standard; watch for calf pain, swelling, warmth → refer urgently |
| Wound Inspection | Check for signs of infection: erythema, discharge, heat, fever → refer to surgeon |
| Swelling Management | Elevation, ice, compression; lymphatic techniques may assist after wound healed |
| Scar Tissue | Soft tissue work to scar (after healing) may improve ROM; avoid direct pressure on staples/sutures |
| OMT Approach | Treat lumbar, pelvis, hip, ankle to reduce compensatory strain; no HVLA to operated knee |
| Kneeling | Often uncomfortable long-term; not contraindicated but may be limited by patient tolerance |
| Driving | Right TKA: typically 4–6 weeks; left TKA: earlier if automatic vehicle |
Use this checklist to confirm your revision coverage before the exam.