LE Fx & Arthoplastys

Question 1

Hip Fx Overview

Answer 1

Most are d/t falls
60+ age group
W>M
Osteoporosis

Question 2

THR Arthroplasty Overview

Answer 2

OA, RA, avascular necrosis, hip dysplasia, hip Fx
Joint replacement surgery where all/part of hip is replaces w/ artifical device
(Stem, ball, cup)

Question 3

Anterior Approach

Answer 3

Decreased risk of posterior dislocation

Preferable in those w/ muscle imbalance

Question 4

Posterior Approach

Answer 4

Unstable in flexion and IR & ADD
Restricted WB for varying amount of time
Hip precautions for 6-12 weeks

Question 5

Post Op for Anterior Approach

Answer 5

OOB day 1 w/ pt. 
2 day hospital stay 
Extensive pain control protocol
WBAT
No extremes of motion (- / & no more that 90 of ER) 
DVT risk (scuds/teds) 
Blood thinners (BID) 
D/C to home w/ walker or crutches->cane

Question 6

Anterior Approach (Precautions/Diff. from Posterior)

Answer 6

No pillow (encourages flexion) 
No elevated toilet seat 
You can cross legs (don't encourage d/t circulation) 
You can / (not at the same time as ER) 
All pt. stop at 90 degrees of ER 
You can shower

Question 7

NWB
TDWB
PWB
WBAT

Answer 7

Non-WB
Touchdown WB
Partial WB (Toetouch)
WB as tolerated

Question 8

Considerations for Arthoplastys

Answer 8

Severity 
Location 
Surgical Approach 
Fixation device/prosthesis 
Bone integrity 
Weight of pt. 
Cognitive Status (adhearing to precautions)

Question 9

Role of OT

Answer 9

BADL's (Toileting LE dressing) 
IADL's 
Transfers (tub, toilet, chair, bed, car) 
Bed Mobility (may not be able to lay on surgical leg) 
Endurance building 
Standing balance 
Education (fall prevention) 
Family training 
Equipment (ADL/DME)

Question 10

Standard Hip Precautions

Answer 10

No hip flexion beyond 90 degrees 
No leg crossing 
No stand pivot 
No hip rotation 
No hip ABD

Question 11

Equipment

Answer 11

LH reachers, sock aid, LH bath sponge, LH shoehorn
Elastic shoe laces, w/c cushion, raised toilet seat
Tub bench/seat, grab bars, walker basket/bag (kitchen tasks)
Portable phone for falls.

Question 12

Knee Arthoplasty Reason & Types

Answer 12

Advanced Arthritis

Conforming - bone cement, cementless

Question 13

Knee Artho Overview (Notes)

Answer 13

Short OT services
ADL Teaching, DME, Mobility
Provide Break between PT/OT bc rehab is painful

Question 14

TKR Rehabilitation

Answer 14

Mobility (Right away) Transfers 
Self-care 
Proper WB (decreased compensation- facilitate a normal gait pattern) 
Home Assessment 
ROM (CPM) 
Balance (WS) 
Endurance