Hip Surgery & Rehab Flashcards
What is arthroscopy?
Any surgery performed through portals and using an endoscope
What is considered prior to hip arthroscopy?
- History (symptoms, impairments)
- Examination of the hip (complete examination, medical imaging)
- Interpretation/diagnosis
- Intervention plan
What are ultrasounds, MRIs and CT scans used for in the hip?
- Ultrasound: Tendinopathies
- MRI: Labrum tears esp. in acetabulum, soft tissue lesions
CT: 3D image of bone
What conditions are associated with hip arthroscopy?
- Femoral acetabular labrum (FAI): neck of femur impinging on acetabular labrum
- Labral tears
- Debride hyaline cartilage lesions
- Extra-articular pathology: Glut med tears, chronic IT band snapping syndrome, snapping psoas syndrome
What are the different types of femoral acetabular impingement (FAI):
- Controlled action motion (CAM) impingement: Bump on femoral head/neck
- Pincer impingement: Overgrowth on acetabular side
- Mixture of both
What types of patients will commonly need debriding of hyaline cartilage lesions?
Patients with OA
What types of patients commonly get pincer FAI?
Young people, approx 20-35 years (not associated with OA)
What is the common clinical presentation of FAI?
- Groin pain
- Pain on high flexion activities, e.g. crouching
- Weight-bearing activities e.g. running, jumping
What is FABER?
Flexion, abduction, external rotation
What does the FABER position help diagnose?
- Labral tear
- OA
- Greater trochanteric pain syndrome
What is FADIR?
Flexion, adduction, internal rotation
What does the FADIR position help diagnose?
Labral tear, FAI
What is a negative consequence of debriding an acetabular labral tear of the hip?
Accelerates OA
How do surgeons increase visibility in a hip arthroscopy?
Inflate the joint with water
How is an osteoplasty used for FAI?
- Femur: to reshape femoral head/neck treat CAM
- Acetabulum: Reshape the acetabular rim to improve pincer impingement
- Results in improved ROM & function
What is micro fracture or abrasion chondroplasty?
- Debride bad hyaline cartilage
- Drill small holes in bone
- Causes inflammatory response, bringing fibroblasts to area
- Fibrocartilage is laid down in the area
What are the 2 positions a hip arthroscopy can be performed in?
- Supine: Easier operating room setup, but more difficult on obese patient
- Lateral: More complex room setup, requires special table attachment to position the leg, provides excellent access
What is the surgical procedure of a hip arthroscopy?
- Portals penetrate TFL, glut med or sartorius & rec fem
- Anterolateral portal established, then anterior portal
- Avoid injury to femoral cutaneous nerve
- Central compartment: Loose bodies, cartilage injuries etc
- Peripheral compartment: Labrum, acetabular rim, femoral neck
What are the common restrictions for hip arthroscopy rehab?
- AROM/PROM
- Weight-bearing status
- Cannot flex hip past 90 degrees
What are some of the issues that complicate decisions about hip arthroscopies?
- OA
- Tendinopathies
- Bursitis
- Core strength
What needs to be considered during hip arthroscopy rehab?
- Pain control is important for mobilisation
- Maintaining WB status is important for protecting healing structures
- Sudden stiffness/mechanical signs: Check complications, may be re-injury, rapid onset OA, avascular necrosis etc
What is involved in the initial postoperative exam for hip arthroscopies?
- Bulky dressing & abduction pillow
- May be in outpatient surgery centre or hospital
- Overnight stay may be considered
- Post op care based on surgery specifics
- Patients can use passive motion machine, crutches or walker
What are the 5 main things that need to be covered in a post-op exam?
- Chest/respiratory exam
- DVT: Check pain, swelling, redness in calves
- Mobility
- Other joints
- Surgical site/limb
What is the purpose of a hip open reduction internal fixation (ORIF)?
To stabilise a fracture by realigning the fragments under GA & open incision, then fixation with hardware
