Hip Flashcards
Coxa Valga
angle >140 degrees
Normal femur head angle
126-139 degrees
Anterversion
shaft of femur is rotated medially due to an increase in the torsion of the femoral neck
Anterversion could result in:
genu valgium and pes planus
Retroversion
shaft of the femur is rotated laterally due to a decrease in torsion of the femoral neck
Slouched posture results in shortened:
rectus femoris and hamstring
Slouched posture results in general limitation of:
hip rotation
Slouched posture results in:
- weak, stretched iliposas,
- weak and shortened posterior portion of gleutus medium
- Weak, poorly developed gluteus maximus
Hip flexors during gait
- control hip extension at end of swing stance
- contract concentrically to initiate swing
Hip extensors during gait
- control flexor moment at initial foot contact
- gluteus maximus initiates hip extension
Hip abductors
- control lateral pelvic tilt during swinging of the opposite leg
- lateral shifting of the trunk occurs over the weak side during stance when the opposite leg swings
Flat back posture:
shortened rectus femoris, IT band and gluteus maximus
Associated LE compensations of slouched posture
hip extension, medial rotation of the femur, genu recurvatum, genu varum, pes valgus
Genu valgum
knock knees
genu varum
bowleggedness
Painful hip syndromes/overuse syndromes
- tendinitis or muscle pull
- trochanteric bursitis
- psoas bursitis
- ischiogluteal bursitis
Common impairment
- pain
- gait deviations
- imbalance in muscle flexibility and strength
- decreased muscular endure
Post operative risks of THA
-DVT, pneumonia, infection
Anterior THA Approach (Smith-Peterson)
- incision made anterior and distal to the ASIS
- no muscles are detached
- rectus femoris and sartorius are retracted medially to access joint
Traditional Anterolateral THA Approach (Watson-Jones)
- incision centered over the greater trochanter
- anterior 1/3 of gluteus medius and minimus is released and reattached
- enternal rotators usually left intact
- potentially jeopardizes superior gluteal nerve
- anterior capsulotomy and repair
Minimally Invasive or Muscle Sparing Anterolateral THA Approach
- incision from anterior tubercle of greater trochanter toward 6cm posterior of ASIS
- no muscles are detached
Lateral or Tranctrochanteric THA Approach
- osteotomy of greater tochanter at insertion of gluteus medius and minimus
- anterior capsulotomy and dislocation
- greater trochanter and reattched and wired in place at completion
- allows for good visualization of anterior and posterior hip and full view of acetabulum
Posterolateral THA approach
-does not affect the gluteal med
Posterior THA Approach
highest rate of dislocation
Hip joint resurfacing
- femoral head is not removed, but is trimmed and capped with smooth metal covering
- damaged bone and cartilage within socket is removed and replaced with a metal shell
Hip joint resurfacing advantages
- easier to revise
- decreased risk of hip dislocation
- more normalized gait
- greater hip ROM
Hip joint resurfacing disadvantages
- femoral neck fracture
- metal ion risk
- more difficult operation
- larger incision required than THA
Inflammatory phase of healing for bone:
1-7 days
Soft Callus formation for bone
2-3 weeks
Hard callus formation for bone
3-4 months
Remodeling for bone
up to one year s/p injury or surgery
Inflammatory phase for tendon/ligament
3-5 days
Proliferative for tendon/ligament
3-21 days (tissue is at its weakest)
Remodeling phase for ligaments and tendons
ligaments start at 21 days, tendons are closer to day 42
In what phase is the tissue the weakest?
proliferative phase because new fibers are not organized
Maximum protection phase
- decrease post-op pain
- educate patient on precautions
- incision care
- DVT prevention
- CPM/AAROM
- muscle setting exercises at immobilized joint
- AROM and resistive ROM to unoperated areas
- functional mobility
Moderate protection/controlled motion phase
- exercise program:adjustments as needed
- restore joint mobility: AAROM or AROM within limits of pain
- establishing a mobile scar: gentle massage
- Strengthen-Improve joint stability: Multiple angle isometrics; alternating isometrics and rhythmic stabilization procedures, dynamic exercise against light resistance in open and closed chain positions, light functional activities with operated limb
Minimum Protection/Return to Function Phase
- Prevent reinjury: Identify unsafe activities
- Restore full joint and soft tissue mobility
- Maximize muscle performance, dynamic stability, and neuromuscular control
- Acquire or relearn specific motor skills
- Progressive balance, coordination, strengthening and task specific/functional activities
Common THA precautions
no hip flexion past 90 degrees
- no adduction
- no rotation
Anterior/Anterolateral/ Minimally Invasive or Muscle Sparing Anterolateral THA Approach Precautions
- no hip extension, ER, adduction
- WBAT immediately after surgery
- able to walk with walker much easier
- progress to cane within 2-3 weeks
- more rapid recovery and normalized gait compared to anteriorlateral approach
- no hip precautions
Direct Lateral or Transgluteal THA Approach Precautions
- no hip abduction
- weakness of hip abductors
- possible pelvic obliquity
- delayed recovery of symmetrical gait
Transtrochanteric THA Approach Precautions
- no active hip abduction for 6 weeks post-op
- extended period of NWB
- increased pain compared to other approaches
- more patient dissatisfaction
- higher rates of post op limp due to gluteal nerve injury or avulsion of gluteal flap
Posterior/Posterolateral THA Approach Precautions
- Highest risk of dislocation
- Possible earlier recovery of normalized gait
- walkers for almost the first 4 – 6 weeks
- progress to cane for the next 3-4 weeks
- walk independently at about 10 weeks
- return to normal activities about 3 months.
- no hip flexion past 90 degrees, no rotation, no adduction
Hip joint resurfacing precautions
- no hip flexion past 90 degrees
- no hip IR
- No hip adduction
Coxa Vara
angle less than 125 degrees
Posterior THA Approach
- gluteus maximus divided in line with its fibers
- short external rotators and pirifromis released and reattached
- posterior capsule incised and repaired
Posterolateral THA Approach
- incision at the posterior 1/3 of greater trochanter & extends for 10 cm to a point 2 fingerbreadths below PSIS
- short external rotators & piriformis released and reattached
- posterior capsule incised and repaired
- most commonly used
- higher rate of dislocation
Direct Lateral or Transgluteal THA Approach
Longitudinal division of the TFL
Up to ½ of proximal insertion of gluteus medius and minimus released and reattached
Longitudinal splitting of vastus lateralis
Capsulotomy and repair
Provides better access to femur than anterior or anterolateral approaches
Avoids need for trochanteric osteotomy while still providing good access to joint.
