10 - POSTOP MANAGEMENT OF HIP FRACTURES Flashcards
Surgeries of hip
SURGERIES OF HIP
- Arthroscopy
- Open procedures:
o Osteotomy
o Arthroplasty (THR)
o Stabilization post fracture
Principles of rehab:
- special questions
- general principal of rehab
Special questions
If post-surgical, ask:
- Pre surgery condition of hip leading to surgery
- Surgery type / date & understanding of precautions
- Pain meds & time of most recent dose
- Equipment: assistive device, raised toilet seat, pedometer, weights, TheraBand, reaches
- Screen for urinary incontinence
General principal of rehabilitation
- Respect individual differences
o Person, goals & activity level
o Consider structural variations before or after surgery
- Promote optimal motion
- Promote proper muscle activity during therapeutic exercise, functional activities & sporting skills
- Incorporate breathing to exercise performance
- Soft tissue mobilization of involved tissues & scar
- Understand patient expectations & fear avoidance behavior
- Look beyond injured or surgical site: low back, hip, knee, ankle, health of shoulders & hands to use assistive devices or perform exercises
- Consider MS diagnosis sooner than later
- Use standard measures:
o Performance: TUG, ROM, strength & balance
o Self-report: HOOS, Harris Hip Score, WOMAC, VAS & VNPR
Arthroscopy post op precautions & rehab:
- common conditions
- arthroscopic procedures
Rules
(intra or peri-articular lesions)
Common conditions
- FAI
- Labral tear
- Snapping hip
Arthroscopic procedures
- Labral resection / debridement
- Labral repair
- Chondroplasty
- Osteochondroplasty
- Microfracture
- Capsular modification
- Iliopsoas release or lengthening
Rules
- No driving until full WB & off narcotic pain medications
- Medications: pain, constipation, anticoagulation (avoid falling
Labral repair:
- procedures
- equipment varies
- bottom line
Image
Equipment varies
Some surgeons use, other do not:
- Bracing
- Rotational boots to prevent LR
- CPM
o Number of hours & days varies
o Consider position in bed versus setting on machine
Bottom line
- Communication is key
- Perform exam
- Consider precautions & evaluate if make sense for patient
- Communicate concerns to surgeon
Arthroscopy for FAI:
- phases of rehab
Phases of rehab
1) Minimal weight bearing (FF)
2) Partial to full weight bearing
3) Full weight bearing
4) Return to sport
Arthroscopy for FAI: phase 1:
- gait
- sitting
- sit to stand
- sleeping
- exercises
- other
Table
Arthroscopy for FAI:
Progress from phase 1 to 2
Progress from phase 1 to 2
- Adequate pain control
- Surgeon clearer patient to progress to full WB
Arthroscopy for FAI: phase 2
- description
- function
- gait
- sit to stand
- exercise
Phase 2
Partial to full WB
2 to 10 weeks depending on procedures
Table
Exercise
- Progress ROM & active exercise gradually
- Upright bike, lay add slight resistance
- Swimming, elliptical
- Abdominal strengthening: focused on recruitment of abs in all exercises + planks
- Gentle stretching of musculature of LE
- Heel raises
- Introduce balance & neuromuscular training
Arthroscopy for FAI: Progress from phases 2 to 3
Progress from phase 2 to 3
- No limitations or abnormal movement patterns with basic ADLs expect possibly stairs
- ROM necessary for function
- Walk with normal gait pattern-no assistive device
- Single leg stance with good control of trunk, pelvis & hip
Arthroscopy for FAI: phase 3
- full WB
- Step training foot over over
- exercises
- other
Table
Arthroscopy of FAI: progress from phase 3 to 4
Progress from phase 3 to 4
Many patients do not need to progress to phase 4
- No limitation or abnormal movement patterns during gait or stairs
- No abnormal movement patterns during patient preferred fitness or basic sport drills
- ROM necessary for sport or fitness
- Pass sport test
Arthroscopy for FAI: Return to sport test
Table
Arthroscopy for FAI: Phase 4:
- description
- goals
Phase 4
Return to sport
12-24 weeks
Work closely with coach
Goals:
- Maximize strength & endurance of LE
- Maximize agility, speed & power
- Progress sport specific activities to include rotational & diagonal movements
- Promote symmetry with drills
- Education in maintenance program (hip)
- Provide feedback to help with motivation & reduce fear
Osteotomy:
- types
- complications
OSTEOTOMY
Types
- Surgical hip dislocation
- Arthroscopy + limited open osteochondroplasty
- Peri-acetabular osteotomy (PAO)
- Femoral varus or valgus
Complications
Early
- Wound healing, hypersensitivity
- DVT
- Bladder control
- Paresthesia (numbness, prickly felling, tingling)
Later
- Hardware: may need to be removed, not done for 1y
- Plan for surgery on other hip: need to be strong enough to handle full WB demands while WB
protected on surgical hip
- Scar tissue
- Iliopsoas snapping hip or trochanteric bursitis
- Leg length discrepancy
- Other painful regions (LBP, knee pain, pain in other hip
Peri-acetabular osteotomy:
- 2 types
- rehabilitation PAO
PERI-ACETABULAR OSTEOTOMY
- Treat symptomatic hip dysplasia
2 types
- Rectus femoris detached
- Rectus femoris spared
Rectus femoris detached
- Rehabilitation similar to rectus sparing but phases longer because there is no active hip flexion for 6w
Both types
- Hip abductors preserved obturator nerve may be injured
- Painful procedure
- Screen for urinary incontinence
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