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PTA Ortho: Exam 3 Hip/Ankle > Hip > Flashcards

Hip Flashcards

1
Q

How is articular cartilage nourished?

hypomobility

A

through joint movement and compression

Forces in excess of 1/2 of body weight are needed to fully compress the femoral head into congruent contact with acetabulum

Researchers hypothesize that 5-25% of our time is spent in unilateral LE wtb activities where the load is sufficient to nourish the articular cartilage
- Lower loads and infrequent high joint forces may be inadequate to maintain the flow of nutrients to the cartilage

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2
Q

Inadequate Joint Forces- hypomobility

continued

A
  • decreased activity lowers the amount of nutrition to cartilage and make it vulnerable to injury and deterioration
  • low activity levels are associated with hip OA, and moderate activity can be preventative for OA

Find ways to decrease pain while increasing activity

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3
Q

Pelvic factures

How? Mortality rate? Stable?

A
  • Falls
  • Mortality as high as 20%
  • Can have stable or unstable fractures
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4
Q 
Instability- pelvic fracture 
Type A: 
Instability- pelvic fracture 
Type B: 
Instability- pelvic fracture 
Type C: 
Don't need to mem./have awareness
A

Stable vertically and rotationally

Vertically stable but rotationally unstable

Both vertically and rotationally unstable

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5
Q

What if the pelvic ring gets disrupted

A

won’t be able to bear weight initially

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6
Q

Clinical presentation of pelvic fractures

A

-Significant pain and discomfort
-Transitional movements are difficult and painful to perform
-Will want to remain in bed, reluctant to move
>Can lead to respiratory and circulatory compromise

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7
Q

Clinical management of pelvic fractures- If stable

A

-treat conservatively
Acute care:
-OOB as early as possible
-1st week:
>Premed. for treatment
>Ambulation with walker, functional activities
>Gentle strengthening ex.: isometrics, closed chain exercises

6-8 weeks in conservatively managed client

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8
Q

IMPORTANT REHAB CONSIDERATIONS:

Strengthening

A

Stable: avoid SLR and emphasis on hip abd.

Unstable: NO open chain exercises

*be careful of long lever arm pulling

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9
Q

Clinical management of pelvic fractures- if unstable

A 
-ORIF
>Limited wtb for 3 months
    -Type B TTWB x 6 wks
    -Type C NWB for 6 weeks
>Isometric exercises
>Wheelchair management/gait training
>Functional activities
>Week 12 increase aggressiveness of strengthening

4-6 months

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10
Q

Hip fractures- 90% falls

A

66% is fall to the side so work on lateral weight shifts, balance reactions lateral

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11
Q

Hip fracture patients at risk of this cycle

A

Fear of falling along with post-fracture pain and muscle weakness contribute to relative immobility and lead to a deterioration of balance, more muscle weakness, and an increase in the likelihood of subsequent fractures

-bring up Wolff’s law

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12
Q

Intercapsular Hip Fracture -Femoral neck

A

-Femoral neck
>47% of all fractures
>Usual cause is trauma
>Displaced or nondisplaced
>Risk of avascular necrosis
&raquo_space;Decreased blood supply to femoral head leading to necrosis
&raquo_space;>THA, goes from healing to not healing and then goes into “OR” for surgery

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13
Q

Intercapsular Hip Fracture - Fixation

A

-ORIF
>Screws
-Hemiarthroplasty (THA)
>Replace femoral head

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14
Q

Extracapsular- Trochanteric or intertrochanteric

A

-Usual cause is trauma
-49% of fractures
-Stable or unstable
-Very little risk of avascular necrosis
>.4%

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15
Q

Extracapsular- Fixation

A

May need traction intirially to realign bony segments

ORIF with plate and compression screws

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16
Q

Hip Fractures Clinical Presentation

A
  • Most likely surgically reduced and fixated
  • Will have dressing and staples
  • May have drain
  • May have TED hose
  • May have compression pumps
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17
Q

Hip Fractures Clinical Management- Acute

A

NEED early mobility and WB

  • Isometric exercise
  • Ankle pumps
  • AAROM
  • Bed mobility training
  • Begin gait skills from side of bed following wtb. precs.
  • Transfers
  • Standing balance activities
  • Establish discharge parameters
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18
Q

Hip Fractures Clinical Management-Subacute

A

-Increase gait independence
-Advance asst. device
-Increase standing balance ex.
-Standing exercises
>flexion, abduction, adduction, toe raises, partial squats, extension , knee flexion

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19
Q

What are the typical discharge parameters? hip fractures

A
  • Independent in all bed mobility
  • Able to ambulate 100 feet in hall independently with appropriate assistive device
  • Independent in car, toilet and tub transfers; or family trained in how to assist
  • Patient able to negotiate stairs and curbs safely with/without assistance
20
Q

Timeframe for healing hip fractures

A
  • 6-8 weeks
  • May be in acute care 2-3 days
  • May discharge to skilled care facility for further therapy, or may discharge home and have home health
  • If therapy still needed after home health, will transfer care to outpatient therapy setting
21
Q

Research shows for hip fractures:

A

further gains after 4 months small possibility

regular rehab programs offered post-fracture have been shown to be helpful but not enough to restore previous functional activity

  • an extended exercise program is promising strategy to improve patient’s functional capacities
  • studies show need for higher intensity training: high intensity is associated with greater strength improvement among older population compared to low/mod exercise
22
Q

THR: reasons for it

A

severe OA, RA, Bone cancer, hip fracture

23
Q

Pre-operative planning for THR

A

Attend pre-op joint class
PT consult
Home assessment
Blood donations (might need 2-3 units in surgery)

24
Q

Uncemented prosthesis

A
  • Bone to grow into the prosthesis
  • Used to limit weight bearing initially, now WBAT
  • Used in younger patients
25
Q

Cemented prosthesis

A

Used in older patients
Sets quickly
WBAT

26
Q

Revisions for THR:

A

Reasons:
Infection from prosthesis
Avascular necrosis
Loosening of components

Following revisions:
Rehabilitation is more conservative
Limited weight bearing for longer period of time
May be in brace

27
Q

What structures are involved in Anterior THR approach and precautions

A

TFL, Glute med

Avoid simultaneous hip extension and external rotation

28
Q

What structures are involved in Lateral THR approach and precautions

A

Glute med, Greater trochanter

Avoid simultaneous hip flexion, adduction and internal rotation

29
Q

What structures are involved in posterolateral THR approach and precautions

A

TFL, Glute med, Ext. Rotators

Avoid simultaneous hip flexion, adduction and internal rotation

*most common/p. exam

30
Q

Mini procedure

A
  • Uses anterior, anterior lateral or direct lateral approach

- Techniques used to get into the joint is different but the prosthesis is the same

31
Q

Pros vs Cons of Mini

A 
Pros
< Incision (less than)
< Pain
< Blood loss
< Hospitalization
< Rehabilitation
< Work time loss
Cons: 
< Visual field
> Surgery time (greater)
> Trauma
> Risk of infection
> Nerve damage
> Fracture rate
32
Q

When is D/C for Mini hip

A

day of surgery

33
Q

What happens in 1-2 weeks of mini hip

A

Outpatient PT

34
Q

What happens in week 1 of mini hip

A

D/c assistive device, resume driving

35
Q

What happens in week 2 of mini hip

A

Return to work, precautions discontinued

36
Q

What happens in week 3 of mini hip

A

Walk 1/2 mile

37
Q

Precautions – functional activities

A

Avoid excessive trunk or hip flexion while putting on shoes or socks
Avoid Rolling in bed without a pillow between knees
Avoid crossing legs,
Do not sit like a lady – avoid keeping legs together in sitting
Avoid sitting in low chairs or soft chairs
Avoid leaning forward to pull up sheets or blankets or to reach items on bedside tray
Avoid lying on operated side unless cleared by MD

38
Q

What does rehab involve?

A

education, reconditioning, gait training

39
Q

Treatment:

A
  • Will begin the afternoon of surgery or the next morning
  • Usually will be seen BID during the week and QD on weekends
  • Usually have short acute care stays and discharge to home with home health, to skilled nursing facilities or acute rehab to complete rehabilitation
40
Q

what is involved in the acute recovery phase?

A

–post op days 0-5

  1. Maintain strict THA precautions
  2. Begin isometrics and straight plane isotonic exercises
  3. Begin reconditioning exercises to unaffected extremities
  4. Begin transfers to the unaffected side
  5. Begin assisted ambulation on level surfaces
  6. Use appropriate dressing and toileting equipment
41
Q

Weeks 1-2 post op?

A
  1. Maintain strict THA precautions
  2. Add light resistance to the exercise program
  3. Begin working on speed as well as control
  4. Begin isotonic exercise in standing posture if FWB
  5. Emphasize independence in bed mobility and transfers
  6. Ambulate in all directions with appropriate device
  7. Emphasize independence in basic ADL with device
42
Q

Weeks 3-6 post op?

A
  1. Maintain strict THA precautions
  2. Progress resistive exercise when appropriate
  3. Stretch out hip flexors and achilles tendon
  4. Teach car transfers
  5. Advance wtb. per MD order
  6. Ambulate for progressive distance and speed
  7. Emphasize independence in basic ADL with device
43
Q

Weeks 6-12 post op?

A
  1. Maintain THA precautions but less strictly *
  2. Return to driving, sexual activity, part time work
  3. Continue progressive resistive exercise
  4. Begin developmental sequence with THA precautions
  5. Begin high level gait activities
  6. Proprioceptive and balance activities
  7. Normalize gait pattern on all surfaces
  8. Work on ambulation velocity and maneuvering ability
  9. Begin instrumental ADL, wean off assistive device
44
Q

Timeframe for driving?

A

3-6 weeks

45
Q

Timeframe for returning to work part-time?

A

6 weeks

46
Q

What activities are allowed at 8 weeks

A

Lie on operated side,Sleep w/o pillow btwn legs, Use regular toilet

playing golf or bowling 12-16wks

PTA Ortho: Exam 3 Hip/Ankle (1 decks)

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