Hip and Knee

Question 1

What is OA

Answer 1

wear and tear injury caused by doing too much which leads to cartilage loss

Question 2

Risk factors for OA

Answer 2

age 40+
Female
overweight
prior joint injury - ACL injury, CAM morphology
hard physical work
overuse in spare time
family history of OA

Question 3

Diagnosis of OA

Answer 3

Risk factors
Symptoms: use related pain, functional limitations, morning stiffness

Clinical findings: crepitus, restricted movement, bony enlargement

Question 4

Treatments for OA

Answer 4

First line: education, exercise and weight control
Second line: pharmacological pain relief, aids
Third line treatment: surgery

Question 5

Comorbidities for OA

Answer 5

diabetes
hypertension
CVD
renal failure
GI bleeding
Depression
physical impairment limiting activity - obesity

Question 6

Electrotherapy/Estim for knee OA without comorbidities

Answer 6

Inappropriate

Question 7

core treatments for OA

Answer 7

land and water based exercise
weight management
strength training
self management and education

Question 8

Do we want to prescribe COX1 or COX2 selective NSAIDs particiularly in those with co-morbidities

Answer 8

COX2 - avoids problems like GI bleeding, hypertension and CV risk which may be problems with NSAIDs that act on COX1

Question 9

Indications for Total Hip Replacement

Answer 9

Pain - OA, arthritis, avascular necrosis
Limited success with conservative management
Trauma (falls)

Question 10

Considerations for THR

Answer 10

Type of replacement: THR, long stem, short stem, joint resurfacing

Type of approach

Type of fixation

Question 11

Education for THR

Answer 11

Expectations: WBAT day 1, DC, progression over inpatient management)
hip precautions,
exercises,
patient concerns

Question 12

Hip precautions

Answer 12

No hip flexion greater than 90 degs - dont bring knees above waist

don’t turn legs in or out

don’t cross legs over

depend on approach - which muscles are weaker

risk of dislocation

Question 13

Day 1 post THR

Answer 13

education
pain control
transfer from bed to chair
Walk WBAT
Sit out of bed for 30 mins
exercises: iso quads/glutes, ankle pumps

Question 14

Total knee replacement indication

Answer 14

Increased pain and reduced function due to knee OA (reduced exercise tolerance, difficulty with stairs, increased risk of falls, slow gait speed)

due to arthritis, trauma, tumour, avascular necrosis

Question 15

Contraindication for TKR

Answer 15

active infection in body
non-functioning extensor mechanism
chronic lower extremity ischemia

Question 16

Recommendations for TKR

Answer 16

low to moderate intensity/impact exercise - walk, swim, etc to maintain strength

avoid activities such as running, contact sport and heavy lifting -> meant to help patient return to normal activity not high intensity sports

Question 17

Causes for Hip #

Answer 17

trauma
tumour
Paget’s disease
stress #

Question 18

risk factors for Hip #

Answer 18

Osteoporosis
Family history
low body weight
Smoker