Age Related Joint Changes

Question 1

how would you explain to a pt what ARJC is

Answer 1

wearing down of articular cartilage

less shock absorption

Question 2

prevalence of ARJC in the hip

Answer 2

most common cause of hip pain

up to 25% of adults

Question 3

risk factors for hip ARJC

Answer 3

> 50

previous injury

possibly preceded by FAI up to 10 years ago

increasing BMI

occupational activities (i.e. deep squats/stairs)

NOT sport or PA; these can be protective

Question 4

what happens with articular cartilage

Answer 4

thinning of articular cartilage
subchondral bone penetration
decreased GAGs
osteophytes

Question 5

symptoms of hip ARJC

Answer 5

AM stiffness <30min

less tolerant to WBing activities and sitting with possible limp

C-sign of pain in groin, lateral hip, and butt; may even refer to the knee

may be nociplastic

Question 6

observation of ARJC in the hip

Answer 6

asymmetrical gait/trendelenburg gait/or lateral pelvic tilt with walking

weight shift in standing

Question 7

ROM signs for ARJC

Answer 7

more than 3 planes of motion restricted

inconclusive capsular pattern

Question 8

combined motion and resisted testing for ARJC

Answer 8

consistent block

pain/weak with abduction

Question 9

stress test/accessory motion for ARJC

Answer 9

+ compression
relief with distraction
accessory motion = hypomobile

Question 10

CPRs (>3 present) for ARJC in the hip

Answer 10

pain with squat
pain with hip flx
pain with hip ext
IR<25
+ SCOUR and FABER

better at ruling in

Question 11

OA combined results for ARJC

Answer 11

hip pain
IR<15
IR pain
AM stiffness <60 min
>50 years old

better at ruling out; ruled out of ALL absent

Question 12

what are the functional performance tests for ARJC

Answer 12

6 min walk test

timed up and go

impaired balance like berg

Question 13

PT Rx for ARJC at hip

Answer 13

POLICED

modalities for pain/inflammation no more than 2 weeks; short term influence

assistive device to minimize/avoid limping

pt edu on weight management and possibly limiting hip flexion

Question 14

PT Rx MT for ARJC at the hip

Answer 14

JM for cartilage integrity and mobility

thrust techniques and stretches need to be incorporated in addition to non-thrust techniques and added to exercise

better than usual care out 1 year

moderate support

Question 15

MET for ARJC at hip

Answer 15

primary focus on mobility, cartilage integrity, and muscle function

aerobic component beneficial

include trunk and hip antigravity muscle groups

balance training as WBing is tolerated

1-5x/wk for 6-12 wks

Question 16

MD Rx for ARJC

Answer 16

insufficient evidence with supplements and hyaluronic acid injections

total hip arthroplasty (THA)

Question 17

describe the anterolateral approach for a THA

Answer 17

position of incision is relative to greater trochanter

no trauma to anti gravity mm

smaller view

small incision with same components; takes more skill

more prominent vascular structures

Question 18

describe the posterolateral approach for a THA

Answer 18

larger view but trauma occurs to the anti gravity mm

more common

Question 19

purposes of pre-OP PT

Answer 19

assistive devices

planning for recovery (i.e. initial HEP)

expectation management

1-2 sessions

cost reduction vs no pre op PT

Question 20

surgical considerations for THA

Answer 20

cut capsule/extra lig

forcep and cut adj structures

dislocate and replace hip

close capsule

full range under anesthesia

Question 21

what happens with prosthetics in a THA

Answer 21

acetabulum is rasped out and the head of the femur is cut off

metals, ceramics, plastic

prosthesis is fixated- cemented

Question 22

complications with THA

Answer 22

arthroplasty related readmission- heterotopic ossification

formation of bone in abnormal location due to disease and/or direct trauma

aka myositis ossification if bone grows into muscle

painful PROM/JM with abrupt end feels are contraindicated

Question 23

what is a hemiarthroplasty

Answer 23

replace head without replacing acetabulum

typically for the non-arthritic pt like the legg calve perthes disease

Question 24

PT Rx for THA

Answer 24

same as ARJD Rx but dont have to be concerned with cartilage integrity since there is no cartilage

Question 25

traditional precautions for THA

Answer 25

avoid hip flex past 90
avoid hip add past neutral
avoid RT
-IR past neutral with posterolateral incision
-ER past neutral with anterolateral incision

Question 26

what are the more recent precautions of an anterior approach

Answer 26

no precautions = no increased incidence of dislocation

only 4 out of 2600 hips

dislocations at average of 5 days and no later than 12