Hip Arthroplasty Flashcards
indications for an arthroplasty
hip OA, RA, some fx, osteonecrosis, tumors
what is the difference between a cemented and non-cemented arthroplasty
cemented is porous and can be loose in the clinic, more of a mirror image of bone
what is a primary THA
replacement of femoral stem and acetabulum
- acetabular cup, head & neck of femur
hemiarthroplasty
- replacement of femoral stem
- typically used when ORIF is not possible or likely to be successful
components of hemiarthroplasty
- head & neck of femur
- bipolar vs unipolar
hip resurfacing arthroplasty
- RA, osteoarthropy
- replacement of acetabulum and articular surface of femoral head
- typically used for young, active patients
components of hip resurfacing arthroplasty
acetabular cap or femoral cap
revision arthroplasty
- replacement of pre-existing components
- indicated with complications of initial procedure (recurrent dislocations, infxn, fixation loss, etc.)
who is more likely to get a revision arthroplasty
males 3x more
hip precautions for revision
typically global precautions - anterior and posterior
surgical approach for posterior hip replacement
- incision posterior to greater trochanter
- TFL incised, glute max split, short ER detached
what is the advantage of posterior hip approach
hip abductors are not disrupted
disadvantage for posterior hip approach
higher risk of dislocation
post-op precautions limiting for ADLs
posterior hip approach dislocation precautions
no flexion >90 deg
no adduction past neutral
no IR past neutral
direct lateral surgical approach
incision along greater trochanter
release of anterior glute med and min
advantaages for direct lateral approach
decreased risk for dislocation
disadvantages for direct lateral approach
prolonged hip abductor weakness
greater risk for HO
direct lateral dislocation precautions
varies
avoid active hip abduction
anteriolateral procedure approach
accessed btw TFL & glut med
direct anterior procedure approach
accessed btw TFL & rectus femoris/sartorius tendons
advantages of anterior & anteriolateral
ADLs less affected by dislocation precautions
decreased risk for dislocation
disadvantages for anterior & anteriolateral
prolonged hip abd weakness if anterior glut med released for access
post op precautions for anterior & anteriolateral
no hyperextension
no ER past neutral
transtrochanteric surgical procedure
lateral incision
osteotomy of greater trochanter
advantages of transtrochanteric
preserves attachment of hip abd
disadvantages of transtrochanteric
WB limitations until bony union
risk for non-union
prolonged hip abd weakness
post-op precautions for transtrochanteric
no active hip abd WB restrictions (TDWB or PWB)
what is a potential post-op complication for THA
DVT
PE
Well’s criteria for DVT
- predict extremity for DVT
values for Well’s criteria for DVT
/= 3: high probability of DVT
potential post-op complications
infection, dislocation, hardware failure, mechanical loosening, fx, nerve injury, vascular injury, leg length, discrepancy
what are some outcome predictors that increases prognosis
- lower pre-op WOMAC scores
- pre-op knee extensor strength
- TUG score <10 at 14 wks post-op
- younger age
- male sex
what are some outcome predictors that decreases prognosis
- greater number of comorbidities
- higher BMI
- increased age
- female sex
predictors for long term use of AD
- greater age >69yrs
- female sex
- high BMI
- depression
