ortho hip

Question 1

Surgical procedures to restore joint motion (hip function) and manage pain.

Damaged sections of the hip are removed.

New sections are constructed of metal, ceramic and hard plastic.

Answer 1

Hemiarthroplasty & Total Hip Arthroplasty (THA)

Question 2

Most often for hip fracture.

Answer 2

Hemiarthroplasty

Question 3

Hemiarthroplasty involves replacing what portion of the hip joint?

Answer 3

ball!

Question 4

hip socket

Answer 4

acetabulum

Question 5

covers the surface of the femoral head and the inside of the acetabulum

About ½” thick

Made of tough, slick material-allows surfaces to slide

Answer 5

articular cartilage

Question 6

Blood supply can be damaged with hip fracture:
Avascular necrosis (AVN) which can lead to

Answer 6

death of femoral head; bone can not maintain itself

Question 7

Total Hip Arthroplasty (THA) replace the

Answer 7

Replace the acetabulum and the femoral head.

Question 8

Total Hip Arthroplasty (THA)

Answer 8

Surgery performed to relieve arthritis pain or repair hip fracture.

Considerable improvement in function

Question 9

Total Hip Arthroplasty (THA) is one of the most….

Answer 9

One of the most cost effective and successful interventions in medicine

Reliable relief of pain
in patients suffering with hip osteoarthritis or inflammatory arthritis

Question 10

Quality of life (QOL) improvement from THA

Answer 10

THA can offer the osteoarthritis or inflammatory arthritis patient tremendous improvement in:
Pain, energy levels, sleep, social, and sexual function

Oxygen demands on activity
Walking ability

Overall quality of life

Most improvements seen within three months of surgery
Functional gains allow independence

Question 11

Conditions That may Lead to a THA

Answer 11

Osteoarthritis (age related wear and tear)
Rheumatoid arthritis
Osteonecrosis (avascular necrosis: AVN)
Injury 
Infection
Fracture 
Bone tumors

Question 12

THA Indications

Answer 12

Dull ache pain to groin and buttock areas pain (especially at night) is the principal indication
post op relief as early as 1 week

Functional limitations
walking and particularly walking upstairs become difficult
bending at hips, putting on shoes, pedicure, etc.
Stiffness

Hip stiffness
Ankylosing spondylitis:
Abnormal stiffening/immobility of the joint due to fusion of the bones can leave patients with tremendous functional disability in the absence of pain.

Disability in this group can be caused by back pain
Pain in the knees or the
opposite hip (why do you suppose this occurs? Why the opposite knee?)
Disability imposed by the stiff hip

Question 13

Other THA Indications (continued)

Answer 13

Age and radiographic change

Age
most hip replacements performed in patients between 60 - 80 years old
some surgeons consider age over 80 as a contraindication
however, patients who are elderly that underwent THA have greater life expectancy

Radiographic change
severity of the radiographic changes of arthritis within the hip joint may or may not be an indication
severity of symptoms a more important indicator

Question 14

The Hip Replacement Rehabilitation Team

Answer 14

Physician, Nurse, PT, OT

Question 15

OT role in hip replacment

Answer 15

Reviews total hip precautions with the patients related to daily activities (sitting, posture, sleeping, etc.)

Assesses, educates, trains the patient about the adaptive equipment that is available (elevated toilet seats, etc.)

Teaches adaptive ADL

Home modifications needed for safety

Question 16

Anterior vs. Posterior Hip Replacement: Differ in location of the incisions:

Answer 16

Anterior: Incision in the front of the hip
Posterior: Incision on the side and back of the hip

Question 17

Anterior vs. Posterior Hip Replacement: Muscles affected: muscles must be pushed to the side or cut to access the hip’s ball and socket joint:

Answer 17

Anterior: Surgery pushes muscles aside to get to hip joint; it is a natural separation, minimal or no muscle cutting.
Posterior: Muscles and other soft tissue is cut

Question 18

Anterior vs. Posterior Hip Replacement: Technical ease of surgery:

Answer 18

Anterior: Limited view of the hip; more challenging.
Posterior: Better view of the hip.

Question 19

Anterior vs. Posterior Hip Replacement: Post-operative status:

Answer 19

Anterior: Less pain; faster recovery, fewer post-surgical precautions

Question 20

Potential disadvantages of anterior hip replacement:

Answer 20

Obese or very muscular people are sometimes not candidates

Technically demanding for the surgeon

Question 21

Posterior Approach: Total Hip Replacement provides better…

Answer 21

Approach is from the posterior aspect

Better visibility of the joint for more precise placement of implants

More invasive than anterior approach

Question 22

Total Hip Replacement (Posterior) Precautions

Answer 22

Keep toes pointed forward and slightly out (do not rotate the leg too far; no internal rotation)

Move leg or knee forward, don’t move leg back

Keep your knees apart; don’t cross legs/midline (some people even say don’t cross at ankles- that is more so they are not tempted to cross at the knee).

Maintain 90 degrees of hip flexion

Question 23

Tools to maintain 90 degrees

Answer 23

Keep knees below level of hip joint while standing or seated
Avoid low seats, deep soft seat cushions, low beds, rocking chairs
Use elevated toilet seat (if needed to keep hip at 90)
Do not reach for tub controls (bathtub)
Do not sit on the tub floor
Do not bend, squat to wash legs and feet (use long handle brushes)

Question 24

Preparing home for THA post-op recovery

Answer 24

Arrange furniture for safe maneuvering with a cane, walker, or crutches
Minimize use of stairs
Place items you use frequently within easy reach to avoid reaching up or bending down
Remove throw rugs or area rugs, secure electrical cords to reduce fall risk
A good chair has a firm cushion and has a higher seat height
Shower chair, grab bar, and raised toilet seat in the bathroom
Use assistive devices such as a long-handled shoehorn, a long-handled scrub brush, reacher, dressing aids

Question 25

Post-op Activity Guide

Answer 25

Follow doctor’s instructions about use of ambulatory aids (cane, walker, or crutches) and weight bearing schedule full weight bearing may be allowed immediately, or may be delayed by several weeks, depending on procedure Sleeping instructions may include avoiding certain sleeping positions or to sleep with a pillow between your legs for a length of time

Question 26

Torn Anterior Cruciate Ligament is located and controls what?

Answer 26

ACL: Located in the center of the knee | Controls rotation and forward movement of the tibia (shin bone)

Question 27

ACL Tear Causes

Answer 27

Get hit very hard on the side of your knee, such as during a football tackle Overextend your knee joint Quickly stop moving and change direction while running, landing from a jump, or turning Basketball, football, soccer, lacrosse and skiing are common sports linked to ACL tears Avulsion fracture: More common in children, caused by knee hyperextesion; separation of the tibial attachment of the ACL

Question 28

Types of ACL injury

Answer 28

Grade 1 Sprain Ligament is mildly damaged Slightly stretched, but is still able to help stabilize the knee. Grade 2 Sprain Stretches the ligament to the point where it becomes loose, often referred to as a “partial tear”. Grade 3 Sprain Most common ACL injury Commonly referred to as a complete tear of the ligament Ligament split into two pieces, and unstable knee joint

Question 29

Torn ACL mechanism of injury

Answer 29

Typically torn in noncontact deceleration that produces a valgus twisting injury e.g., when landing on the leg and quickly pivoting in the opposite direction Other forces can disrupt ACL with minimal injury to other structures are: Hyperextension Marked internal rotation of tibia on femur Pure deceleration

Question 30

ACL and Patellofemoral DisordersGender differences

Answer 30

Rate of ACL injury 2 to 8 times higher in females than males who participate in the same sports. Patellofemoral disorders can be divided into 3 categories: Patellofemoral pain Patellofemoral instability Patellofemoral arthritis Current studies do not answer the question of whether patellofemoral pain is more prevalent in females however, clinicians have observed that anterior knee pain is more common among females

Question 31

Gender differences: females have a

Answer 31

narrow intercondylar notch and a wider Q (quad angle)

Question 32

ACL Surgical Treatment

Answer 32

Rebuilding the ligament most ACL tears cannot be “sutured back” together to restore knee stability, the ACL must be reconstructed with a tissue graft graft acts as a scaffolding for new ligament to grow on Graft sources common source - patellar tendon, hamstring tendons sometimes quadriceps tendon, or allograft (cadaver) graft

Question 33

Post ACL Reconstruction Exercise and Activity Instructions (example)

Answer 33

Begin the ROM exercises once awake Important to achieve full knee extension and flexion Goal is to achieve a range of motion of 0 to 90 degrees 1-week post op. Straight leg raises. Crutches for 6 weeks (some protocols say 2-3 weeks) Keep knee straight while resting (no pillows under knee –why would this be important?) PT rehab after 1-2 weeks No swimming or running for 6 months

Question 34

Meniscus Tear

Answer 34

Shock absorber Helps optimize force across the knee Protects the cartilage at the end of the femur

Question 35

Meniscus tears are..

Answer 35

Among the most common knee injuries Contact sports athletes are at higher risk, however, anyone at any age can tear a meniscus Menisci tear in different ways, noted by how they look, as well as where the tear occur

Question 36

Meniscus tears caused by

Answer 36

Squat and twisting the knee can cause a tear Also direct force on the knee, e.g., a tackle Older people are more likely to have degenerative meniscus tears Cartilage weakens and wears thin over time

Question 37

Meniscus tears - Treatment

Answer 37

Depend on the type of tear, size, and location Outside 1/3 has rich blood supply A tear in this "red" zone may heal on its own, or can often be repaired with surgery, e.g. longitudinal tear Inner 2/3 of the meniscus lacks a blood supply so cannot heal these are complex tears are often in thin, worn cartilage. pieces cannot grow back together, so tears in this zone usually surgically trimmed away

Question 38

Hip Fractures

Answer 38

Very serious injury for elderly Rank in the top 10 of all impairments worldwide in terms of loss for people 50+ years old Most often caused by a simple fall often resulting in long-term functional impairment nursing home admission increased mortality Incidence of hip fracture is 17 to 22% for 50-year-old women, 6 to 11% for men

Question 39

Hip Fractures Contributing Factors

Answer 39

body size, decreased strength, inactivity impaired cognition, impaired perception and vision environmental circumstances, chronic illnesses, drugs, etc

Question 40

Hip Fractures

Answer 40

90+% of hip fractures caused by falling most often by falling sideways onto the hip Large proportion of fall deaths are due to complications following a hip fracture 20% of hip fracture patients die within a year of their injury linked to pulmonary embolism, infections, and heart failure

Question 41

Hip Fractures - 3 Major Types

Answer 41

``` Specific location of the fracture: femoral neck intertrochanteric subtrochanteric fractures ```

Question 42

Femoral neck fracture

Answer 42

fractures of the femoral neck can entirely disrupt the blood supply to the femoral head resulting in major healing complications such as fracture nonunion or avascular necrosis or death of the femoral head bone tissue

Question 43

Intertrochanteric hip fractures

Answer 43

Occur outside of the joint capsule and are therefore extracapsular involve bone with good local blood supply However, complicated by the pull of muscle attachments, which can pull fracture out of alignment Healing complications may include shortening of the length of the femur or malunion

Question 44

Subtrochanteric fractures

Answer 44

Blood supply to subtrochanteric region not as good as the intertrochanteric region heals more slowly subject to competing muscular forces on the femur that tend to pull the fractured fragments out of alignment

Question 45

Hip Fracture Medical Treatment

Answer 45

Treatment typically includes surgery and hospitalization Short term goal of surgical treatment is to stabilize the hip fracture enough to withstand early mobilization and weight bearing which prevents complications due to prolonged bed rest and aids in fracture healing

Question 46

Hip Fracture Treatment

Answer 46

Many hip fractures are treated with internal fixation But if optimal realignment of the fracture is not possible or practical, then a partial or THA is considered Frequently followed by admission to a nursing home and extensive rehabilitation

Question 47

Hip Fractures (Risk factors)

Answer 47

Women sustain 75% of all hip fractures White women are much more likely to sustain hip fractures than are African-American or Asian women In both men and women, hip fracture rates increase exponentially with age 85 and older are 10 to 15 times more likely to sustain hip fractures than are those age 60 to 65 Osteoporosis increases risk

Question 48

Hip Fracture Prevention

Answer 48

Take adequate calcium and vitamin D Do weight bearing exercise Get screened and treated for osteoporosis Fall prevention strategies: Exercise regularly to increase leg strength and improve balance Dr. should identify medications that cause dizziness, drowsiness, and interactions Have vision checked regularly to maximize vision Home safety improvements - reduce tripping hazards, grab bars strategically placed where needed, stair railings, and improve lighting

Question 49

study questions

Answer 49

at end of ppt!