Age Related Joint Changes Flashcards
how would you explain to a pt what ARJC is
wearing down of articular cartilage
less shock absorption
prevalence of ARJC in the hip
most common cause of hip pain
up to 25% of adults
risk factors for hip ARJC
> 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
what happens with articular cartilage
thinning of articular cartilage
subchondral bone penetration
decreased GAGs
osteophytes
symptoms of hip ARJC
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
observation of ARJC in the hip
asymmetrical gait/trendelenburg gait/or lateral pelvic tilt with walking
weight shift in standing
ROM signs for ARJC
more than 3 planes of motion restricted
inconclusive capsular pattern
combined motion and resisted testing for ARJC
consistent block
pain/weak with abduction
stress test/accessory motion for ARJC
+ compression
relief with distraction
accessory motion = hypomobile
CPRs (>3 present) for ARJC in the hip
pain with squat
pain with hip flx
pain with hip ext
IR<25
+ SCOUR and FABER
better at ruling in
OA combined results for ARJC
hip pain
IR<15
IR pain
AM stiffness <60 min
>50 years old
better at ruling out; ruled out of ALL absent
what are the functional performance tests for ARJC
6 min walk test
timed up and go
impaired balance like berg
PT Rx for ARJC at hip
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
PT Rx MT for ARJC at the hip
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
MET for ARJC at hip
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
MD Rx for ARJC
insufficient evidence with supplements and hyaluronic acid injections
total hip arthroplasty (THA)
describe the anterolateral approach for a THA
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
describe the posterolateral approach for a THA
larger view but trauma occurs to the anti gravity mm
more common
purposes of pre-OP PT
assistive devices
planning for recovery (i.e. initial HEP)
expectation management
1-2 sessions
cost reduction vs no pre op PT
surgical considerations for THA
cut capsule/extra lig
forcep and cut adj structures
dislocate and replace hip
close capsule
full range under anesthesia
what happens with prosthetics in a THA
acetabulum is rasped out and the head of the femur is cut off
metals, ceramics, plastic
prosthesis is fixated- cemented
complications with THA
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
what is a hemiarthroplasty
replace head without replacing acetabulum
typically for the non-arthritic pt like the legg calve perthes disease
PT Rx for THA
same as ARJD Rx but dont have to be concerned with cartilage integrity since there is no cartilage
traditional precautions for THA
avoid hip flex past 90
avoid hip add past neutral
avoid RT
-IR past neutral with posterolateral incision
-ER past neutral with anterolateral incision
what are the more recent precautions of an anterior approach
no precautions = no increased incidence of dislocation
only 4 out of 2600 hips
dislocations at average of 5 days and no later than 12
