Hip: DDx 2

Question 1

Altman’s criteria for hip OA:

hip pain and either:

Answer 1

• hip IR ≤ 15˚
• pain with hip IR
• morning stiffness ≤ 60 minutes
• age > 50

OR

• hip IR < 15˚ and an ESR ≤ 45 mm/hr

Question 2

Altman’s criteria for hip OA: if no ESR obtained, what is substituted?

Answer 2

hip flexion ≤ 115˚

Question 3

Altman’s criteria for hip OA: sensitivity of (%)

Answer 3

86%

Question 4

Altman’s criteria for hip OA: specificity (%)

Answer 4

75%

Question 5

Altman’s criteria for hip OA: (+) LR

Answer 5

3.4

Question 6

Altman’s criteria for hip OA: sensitivity of 86%, specificity of 75%, and +LR of 3.4 for the dx of hip OA with this as the reference standard

Answer 6

radiographs

Question 7

treatment for hip OA: manual therapy interventions to improve ROM, decrease pain, and improve ability to complete exercise

Answer 7

joint mobilizations

• LAD
• lateral distraction
• MWM

Question 8

treatment for hip OA: use these to address muscular weakness and functional limitations

Answer 8

• exercise

- progressive loading

Question 9

treatment for hip OA: When conservative non-invasive care is not successful, several surgical options are available, including…

Answer 9

• arthrodesis
• arthroscopic techniques
• resurfacing techniques
• THA

Question 10

PT for THA: this has been shown to decrease post-acute care services including services provided in SNFs, home health care, and in patient rehabilitation

Answer 10

preoperative physical therapy

Question 11

PT for THA: these are reliable predictors of ambulation ability following THA

Answer 11

preoperative hip abductor and knee extension strength

Question 12

THA precautions: restricted motions for posterolateral approach

Answer 12

• flexion
• adduction
• IR

Question 13

THA precautions: restricted motions for anterolateral approach

Answer 13

extension

Question 14

THA precautions: dislocation precautions that may be implemented after surgery

Answer 14

• high toilet seat
• restricted hip motion in ADLs
• reacher or grabber
• abduction pillow
• high chair

Question 15

THA precautions: restricted motions

Recent investigators found that patient receiving an anterolateral THA (with/without) precautions returned earlier to side sleeping, driving, riding in automobiles, and work activities sooner than those (with/without) precautions, maintaining a higher level of satisfaction throughout the rehabilitation process

Answer 15

without

with

Question 16

AVN: typically occurs in which age group?

Answer 16

30-50

Question 17

AVN: typically occurs in (males/females)

Answer 17

males

Question 18

AVN: s/s

Answer 18

• decreased ROM in a capsular pattern
• antalgic gait
• 50% with sharp pain
• 50% with PAER

Question 19

AVN: s/s

radiographic findings

Answer 19

flattening followed by collapse of femoral head

Question 20

AVN: interventions

Answer 20

• protected WB
• PT
• surgery if PT fails

Question 21

AVN: If child, begin with conservative management based on stage

Answer 21

• bedrest with traction of joint in hip abduction
• serial casting
• functional orthoses that allow WB with hip in abd/IR

Question 22

AVN: PT focus on strengthening of this muscle group

Answer 22

abduction

Question 23

AVN: why focus on hip abduction strengthening?

Answer 23

containment

Question 24

AVN: surgical procedures for children

Answer 24

• Saltar procedure
• Chiari procedure
• medial/lateral wedge derotation osteotomy followed by PWB

Question 25

AVN: medial/lateral femoral wedge derotation osteotomy followed by PWB for how long?

Answer 25

3-6 mos and PT

Question 26

AVN: surgical procedures for adults

Answer 26

• core decompression
• osteotomy
• arthroplasty

followed by PT