Chapter 28: Orthoses in total joint replacement

Question 1

Hip dislocation rates are higher in patients with what other factors?

Answer 1

History of dislocation
Poor abductors or adductor spasticity
Patient with anterior wall wakness or global instability
Acetabular transplants
Patient with two or more surgeries on the affected side.

Question 2

What type of hip dislocation occurs 85% of the time?

Answer 2

Posterior dislocation

Question 3

Posterior dislocation involves what actions?

Answer 3

Hip flexion
Adduction
Internal rotation

Question 4

What activities usually are associated with posterior dislocation of the hip?

Answer 4

Sitting and reaching toward the univolved side. 
Exiting a vehicle
Reaching for an object on the floor
Learning over to apply shoes
Rising from a low chair
Toilet seat or soft cushion.

Question 5

Anterior dislocation of the hip is associated with what movements?

Answer 5

External rotation

Extension

Question 6

What activities usually are associated with anterior dislocation of the hip?

Answer 6

Reaching up on a high shelf
Extending hips and trunk to move back into bed
Reaching behind the body while standing to put on a coat
Lying in bed with hips extended
Also with patients with hip dysplasia with excessive femoral anteversion.

Question 7

For a hip orthosis for posterior dislocations. What ROM should the hip be held at?

Answer 7

10-20 degrees of abduction
0-70 degrees of flexion
Another suggestion is
0-10 degrees flexion, externally rotated
15-20 degree abduction

Question 8

For a hip orthosis for anterior dislocations, what ROM should the hip be held at?

Answer 8

Block extension past -40 degrees
Flexion is blocked at 70Degrees
Another suggestion is
Flexion: 20-30 degrees
Internal rotation: 0-10 degrees
Abduction: 20 degrees

Question 9

What orthosis is usually attached to a HpO for an anterior dislocation of the hip?

Answer 9

A KAFO because the patient has global instability due to acetabular insufficiency and it will provide rotational control.

Question 10

When should a prophylactic orthosis be suggested in patients who are recovering from hip arthroplasty?

Answer 10

Patient’s with hip dysplasia
Poor bone quality
Patients unable to follow hip precautions.

Question 11

Which patient’s are at risk of recurrent dislocations at the hip?

Answer 11

patient’s with neuromuscular disease
Parkinson disease
Spasticity secondary to cerebral palsy or cerebrovascular accident
Or sensory neuropathy

Question 12

Patient’s who have undergone acetabular transplants should be placed in which orthosis and at what angles?

Answer 12

HKAFO
Restricted extension and flexion to (-40 to 70) degrees
Neutral hip alignment (no hip abduction or adduction)
Free knee ankle joints

Question 13

For elderly patients who are confused, and have had surgery for hip dislocation, what orthosis should be prescribed?

Answer 13

Knee immobilizer, so they can’t flex their knee and it prevents them from flexing their hip

Question 14

What orthosis is suggested for a fracture of the femural neck?

Answer 14

Pelvic band and KAFO to control rotation to the floor.

Question 15

What are common neurological complications from hip replacement surgery?

Answer 15

Femoral and sciatic nerve palsies. Motor deficits may resolve or be permanent.

Question 16

When their is injury to the peroneal portion of the sciatic nerve after hip replacement surgery what can be seen in the patient?

Answer 16

Decreased ankle dorsiflexion during swing

Question 17

When there is injury to the femoral nerve after hip replacement surgery, what can be seen in the patient?

Answer 17

Quadriceps, resulting in knee flexion instability.

Question 18

For patient’s with extreme weakness of the quads because of neuromuscular disease, what orthosis can be used?

Answer 18

A stance phase KAFO with free knee motion during swing or a double upright KAFO with appropriate locking mechanisms.
A KAFO with drop or bail locks, which requires circumduction.
A KAFO with posterior offset knee joints (more agile patients and those with more active knee extension may prefer this.)