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human conditions > ortho hip > Flashcards

ortho hip Flashcards

1
Q

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.

A

Hemiarthroplasty & Total Hip Arthroplasty (THA)

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2
Q

Most often for hip fracture.

A

Hemiarthroplasty

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3
Q

Hemiarthroplasty involves replacing what portion of the hip joint?

A

ball!

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4
Q

hip socket

A

acetabulum

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5
Q

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

A

articular cartilage

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6
Q 
Blood supply can be damaged with hip fracture:
Avascular necrosis (AVN) which can lead to
A

death of femoral head; bone can not maintain itself

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7
Q

Total Hip Arthroplasty (THA) replace the

A

Replace the acetabulum and the femoral head.

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8
Q

Total Hip Arthroplasty (THA)

A

Surgery performed to relieve arthritis pain or repair hip fracture.

Considerable improvement in function

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9
Q

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

A

One of the most cost effective and successful interventions in medicine

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

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10
Q

Quality of life (QOL) improvement from THA

A

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

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11
Q

Conditions That may Lead to a THA

A 
Osteoarthritis (age related wear and tear)
Rheumatoid arthritis
Osteonecrosis (avascular necrosis: AVN)
Injury 
Infection
Fracture 
Bone tumors
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12
Q

THA Indications

A

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

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13
Q

Other THA Indications (continued)

A

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

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14
Q

The Hip Replacement Rehabilitation Team

A

Physician, Nurse, PT, OT

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15
Q

OT role in hip replacment

A

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

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16
Q

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

A

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

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17
Q

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:

A

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

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18
Q

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

A

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

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19
Q

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

A

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

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20
Q

Potential disadvantages of anterior hip replacement:

A

Obese or very muscular people are sometimes not candidates

Technically demanding for the surgeon

21
Q

Posterior Approach: Total Hip Replacement provides better…

A

Approach is from the posterior aspect

Better visibility of the joint for more precise placement of implants

More invasive than anterior approach

22
Q

Total Hip Replacement (Posterior) Precautions

A

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

23
Q

Tools to maintain 90 degrees

A

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)

24
Q

Preparing home for THA post-op recovery

A

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

25
Q

Post-op Activity Guide

A

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

26
Q

Torn Anterior Cruciate Ligament is located and controls what?

A

ACL: Located in the center of the knee

Controls rotation and forward movement of the tibia (shin bone)

27
Q

ACL Tear Causes

A

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

28
Q

Types of ACL injury

A

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

29
Q

Torn ACL mechanism of injury

A

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

30
Q

ACL and Patellofemoral DisordersGender differences

A

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

31
Q

Gender differences: females have a

A

narrow intercondylar notch and a wider Q (quad angle)

32
Q

ACL Surgical Treatment

A

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

33
Q

Post ACL Reconstruction Exercise and Activity Instructions (example)

A

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

34
Q

Meniscus Tear

A

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

35
Q

Meniscus tears are..

A

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

36
Q

Meniscus tears caused by

A

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

37
Q

Meniscus tears - Treatment

A

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

38
Q

Hip Fractures

A

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

39
Q

Hip Fractures Contributing Factors

A

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

40
Q

Hip Fractures

A

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

41
Q

Hip Fractures - 3 Major Types

A 
Specific location of the 
fracture: 
femoral neck 
intertrochanteric 
subtrochanteric fractures
42
Q

Femoral neck fracture

A

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

43
Q

Intertrochanteric hip fractures

A

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

44
Q

Subtrochanteric fractures

A

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

45
Q

Hip Fracture Medical Treatment

A

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

46
Q

Hip Fracture Treatment

A

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

47
Q

Hip Fractures (Risk factors)

A

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

48
Q

Hip Fracture Prevention

A

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

49
Q

study questions

A

at end of ppt!

human conditions (28 decks)

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