8.22 THA

Question 1

What are the types of THA procedures?

Answer 1

• anterior
• posteroateral
• posterior

Question 2

Where is the incision for anterior?

Answer 2

tiny incision in the inguinal space

• only cutting through skin and capsule
• everything else is retracted

Question 3

Benefit to anterior approach

Answer 3

• Capsule is gone, but you still have all the musculature to protect
• Only precaution is no extreme extension
• Usually day surgery

Question 4

What are the hip precautions for a posterior/posterolateral approach to THA?

Answer 4

• no adduction
• no IR
• no flexion past 90˚

Question 5

Real life instructions for hip precautions?

Answer 5

DON’T:

• cross legs
• pick things up off the floor
• turn toward affected side
• lean forward in seated

DO:
- robot legs to walk

Question 6

Why is it important to turn to the unaffected side?

Answer 6

Because they rotate around a fixated surgical site if they turn toward the injured side

Question 7

Does the anterior approach preserve the capsule?

Answer 7

no

Question 8

How long should hip precautions be followed generally?

Answer 8

3-6 months

Question 9

Who will often get a dislocation after THA?

Answer 9

• pt that’s walking well, feeling good

- accidentally breaks hip precautions

Question 10

What is the worst orthotic ever?

Answer 10

hip spica

Question 11

hip dislocations

Answer 11

• affected leg will appear shorter

- easier to dislocate after the first one

Question 12

What categories of therapy should be performed after THA?

Answer 12

• gait training
• Ther Ex
• education
• fall prevention if necessary
• stair training
• home eval questions

Question 13

Ther Ex: things to do with a THA pt?

Answer 13

• glute sets
• heel slides
• ankle pumps
• 4 way hip
• SAQ, LAQ
• walk

Question 14

What are ankle pumps important for?

Answer 14

blood flow - prevention of DT

Question 15

SCD

Answer 15

sequential compression devices

Question 16

lovenox

coumadin

Answer 16

blood thinners

Question 17

What to look for when someone is on blood thinners?

Answer 17

• stomach issues
• intestinal ulcers
• diverticulutis
• sponaneous bleeding

Question 18

Pt education (blood thinners)

Answer 18

• don’t eat leafy veggies

- vitamin K causes blood to thicken

Question 19

How would you know if a pt’s blood is too thin?

Answer 19

• spontaneous bruising with no reason
• hematuria
• blood in stool
• s/s of PE

Question 20

hematuria

Answer 20

peeing blood

Question 21

blood in stool: bright red

Answer 21

• at colon or small intestine

- could be external or hemmorhoids

Question 22

blood in stool: dark red/brown

Answer 22

• bleeding in stomach or intestines

- can come out in clots

Question 23

TED hose

Answer 23

thromboembolytic deterrent

Question 24

What should be done if a pt is wearing TED hose?

Answer 24

• check capillary refill
• ensure correct it
• look for wrinkles

Question 25

Why is it better for someone with a THA to use a walker until after 2-4 weeks?

Answer 25

• people SEE a walker

- don’t always notice a cane

Question 26

THA and OP therapy

Answer 26

• difficult to show a reason for them to get OP therapy

- most would benefit from balance, proprioception, gait, strength, etc.

Question 27

What is the minimum velocity for safe community ambulation?

Answer 27

90-100 ft. per minute

Question 28

Why is there a minimum velocity for safe community ambulation?

Answer 28

• crossing street
• getting out of a house on fire
• efficiency of gait (momentum vs. muscle actions)