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Conditions 1 > Hip > Flashcards

Hip Flashcards

1
Q

Hip bones

A

Femur

  • head
  • neck
  • trochanters (x2)

Pelvis

  • acteabulum
  • ischium
  • pubis
  • illium
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2
Q

Hip ligaments (x3)

A
  • ischiofemoral
  • iliofemoral
  • pubofemoral
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3
Q

Anterior-Medial Hip Muscles (x5)

A
  • Iliopsoas
  • rectus femoris
  • adductors
  • tensors fascial latae
  • sartorius
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4
Q

Posterior-Lateral Hip Muscles (x2)

A

gluteal muscles

hamstrings

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5
Q

Main causes for Hip fractures

A

90% due to falls

70yrs and up = falls
50yrs and under = serious accidents
- fall from height
- car accidents

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6
Q

Risk Factors Hip fractures (x6)

A
  • body size characteristics
  • inactivity
  • weakness
  • impaired cognition
  • chronic illnesses = osteoporosis
  • gender = female
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7
Q

Consequences from hip fractures (x2)

A
  • 20-37% mortality w/in first yr
  • 50% longstanding disability
  • mortality higher for the elderly
    • pneumonia, due to increased immobility
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8
Q

Acute management (x2)

A
  • analgesic to control pain

- surgery

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9
Q

Types of fractures (x2)

A
  • Intracapsular

- Extracapsular (intertrochanteric or subtrochanteric)

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10
Q

Intracapasular fracture

A
  • Subcapital (below femoral head) fracture
  • blood supply to femoral head may be disrupted
  • lead to avascular necrosis
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11
Q

Extracapsular fracture

A
  • intertrochanteric or subtrochanteric

- may be subject to pull of hip muscles on bony attachment. Can pull fracture out of alignment = risks of malunion

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12
Q

Surgical management (x3)

A
  • ORIF = Open reduction and internal fixation
  • hemiarthoplasty
  • hip arthoplasty
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13
Q

Femoral head fractures (x2)

A 
Nondisplaced = multiple parallel pins or screws
Displaced = hemiarthoplasty or arthroplasty
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14
Q

Intertrochanteric fracture

A
  • dynamic hip screw and lateral side plate
    OR
  • interlocking nail fixation
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15
Q

Subtrochanteric fracture

A

Interlocing nail fixation

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16
Q

Post-Op Complications (x5)

A
  • infection
  • DVT
  • chronic pain
  • avascular necrosis (more w/ femoral neck #)
  • non-union (more w/ femoral neck # or w/ unstable #)
17
Q

Post-Op management

A 
# healing = 12-15 wk
Rehab time = 15-20 wk
aim for early post-op WB
18
Q

Post-Op surgeon considerations (x5)

A
  • age
  • bone quality
  • # location and pattern
  • Type of implant used for fixation
  • degree of stability achieved w/ surgery
19
Q

WB considerations

A

Ranges: NWB, TTWB/FeWB, WBAT

  • undisplaced # w/ screws
  • stable intertrochanteric # w/ dynamic hip screw
  • subtrochanteric # w/ intramedullary nail
20
Q

Activities that creat forces or WB on hip (x5)

A
  • rolling
  • sitting up
  • PROM
  • active exercises
  • bridging
21
Q

Goal of early exercise is to prevent complications such as … (x4)

A
  • DVT
  • pulmonary complications
  • pressure sores
  • de-conditioning
22
Q

Maximum protection phrase exercise

A
  • up to 6 wks
  • begin exercises on the first day post-op
  • ROM: 2-4wk 80-90 degress of active hip F w/ the knee F
  • improve strength UE+LE
  • AAROM, PROM hip and knee
  • Resistance exercise - delayed until 6wk to allow soft tissue to heal
23
Q

Moderate - Minimum Protection phrase exercise

A
  • after 6wks
  • soft tissue has healed
  • bone healing is apparent
  • ambulation 2ww
  • PWB -> FWB
  • exercise @ home: flexibility of shortened muscles, improve strength and endurance in LE for functional activities, improve standing balance and posture, improve cardiorespiratory endurance, maximize ADL independence
24
Q

Reasons for hip arthroplasty (x5)

A
  • severe hip pain that limits functional activity
  • severe decreased ROM
  • instability or deformity of hip
  • failure of previous surgery
  • failure of conservative management
25
Q

Causes of hip pain (x4)

A
  • osteoarthritis
  • rheumatoid arthritis
  • hip #
  • avascular necrosis
26
Q

Who is appropriate of Hip arthropasty?

A
  • over 60yr (THR lasts 20yrs)
  • no systemic infections
  • no joint infections
  • no significant bone loss
  • no severe limitations of muscles around joint
27
Q

Pre-op management. what the team will be teaching/assessing prior to surgery (x7)

A
  • level of pain
  • ROM
  • muscle strength
  • postoperative precautions
  • functional training
  • assistive devices
  • early postoperative exercises
28
Q

Components (x2)

A
  • femoral

- Acetabular

29
Q

Types of fixations (x3)

A
  • cemented
  • cementless (allows osseous ingrowth
  • hybrid (usually acetabular component)
30
Q

Cemented fixation (pros&cons, beneficial cl)

A

Pros

  • allows from early WB
  • shortened rehab time
  • least expensive

Cons

  • loosening of prosthetic over time, usually actetabular
  • recurrence of hip pain

Beneficial to Cl

  • elderly
  • poor bone stock
  • osteoprosis
31
Q

Uncemented fixation (pros&cons, beneficial cl)

A

Pros

  • less loosening of prosthetic overtime
  • allows from more physical activity

Cons

  • longer time of NWB/PWB
  • increased rehab time 3-6 months
  • most expensive

Beneficial Cl

  • young
  • healthy
  • active
  • good bone quality
32
Q

Hybrid Fixations reasoning

A
  • used for acetabular loosening
  • initial surgeries long-term results seem to indicate similar to cemented
  • costs more that cemented, but less that uncemented
33
Q

Surgical Approach

A

Posterolateral

  • gluteus maximus split
  • glut med and vastuc lateralis spared
  • capsule cut on posterior surface
  • hip is dislocated posteriorly
34
Q

Post-Op Considerations (WB & ROM)

A

WB = depends on type of surgery and surgeon

  • cemented: WBAT immediately
  • uncemented: NWB or PWB for @ least 6 wks

ROM = depends on surgical approach

  • ROM restrictions ~6wks
  • decrease risk of dislocation
  • no hip F past 90
  • no ADduction post neutral
  • no internal rotation
35
Q

ADL Activities

A
  • t/f to sound leg
  • avoid low chairs/bed
  • use a raised toilet seat
  • avoid bending to pick up objects
  • no bath
  • lead w/ good leg upstairs, bad down
  • avoid twisting when standing
36
Q

MAX protection phase Post-op

A

4-6 wks
prevent : vascular and pulmonary complications, prevent post-op dislocation or subluxation, F contracture of the operated hip

achieve: indpt. functional mobility prior to discharge - bed mobility, t/f, ADL’s, ambulation w/ a.d.

maintain - functional strength and endurance in UE and unoperated LE

exercise - AAROM operated LE w/in protected range

37
Q

Mod-Minimum protection phase Post-op

A

6-12wk
regain: strength and endurance of operated leg, functional ROM of operated hip, correct gait

improve: cardiorespirtory endurance, balance

maximize ADL independnce

progress WB during ambulation

Conditions 1 (8 decks)

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