Pelvis and Hip - Age Related Joint Changes & THA Flashcards
What is age related joint changes?
Structure breaking down, becoming disorganized, thinning, fissuring, bones takes on more load
What are some functional questionnaires for age-related joint changes?
- Western Ontario and McMaster Universities Osteoarthritis Index
- Lower Extremity Functional Scale
- Harris Hip Score
- Hip OA/THA - HOOS (hip dysfunction and OA Outcome Score)
What is the prevalence of age-related joint changes in the hip?
- MOST common cause of hip pain
What percentage of adults have age-related joint changes in the hip?
up to ~25%
What are risk factors for age-related joint changes in the hip
- over 50 years of age
- previous joint injury such as labral tears
- may be preceded by FAIS by ~10 years but not always
- Increasing BMI
- Occupational activity such as deep squats or stairs
- NOT exposure to sport or physical activity which may be protective
What can predict subsequent age-related joint changes in those with hip disease?
LBP
What are symptoms of age-related joint changes?
- like FAIS plus …
- AM stiffness > 30 mins
- less tolerant to WBing activities and sitting with possible limping
- C-sign of pain
- may be nociplastic pain
What is the C-sign of pain?
groin, lateral hip and buttock, may even refer to knee
What are signs of age related joint changes in observation?
- Like FAIS plus…
- asymmetrical gait- trendelenberg gait or lateral pelvic tilt while walking
- weight shift in standing
What are signs in ROM of age-related joint changes in the hip?
- Like FAIS plus…
- ≥ 3 planes of motion restricted (high spec)
- capsular pattern of restriction NOT consistent in hip, inconclusive
What does Dutton indicate with ROM?
IR > Flx > abd = ext
What will we find with combined motion in the hip with age-related joint changes?
consistent block
What will we find with resisted/MMT with age-related joint changes in the hip?
- pain and possible weakness with ABD (high spec)
What will we find with stress tests with age-related joint changes in the hip?
- compression possibly positive
- distraction possible relieving
What will we find with accessory motion with age-related joint changes in the hip?
- hypomobility
What are some special tests for age-related joint changes in the hip?
- OA CPR
- OA combined results
- Impaired Functional Performance testing
- Impaired Balance Tests
What are the tests with OA CPR? (Is it present?)
- hip pain with squatting
- lateral hip pain with hip flexion
- hip pain with hip extension
- IR ≤ 25˚
- Positive scour and FABER
What are the tests with OA combined results? (is it NOT present?)
- hip pain
- hip IR ≤ 15˚
- IR pain
- AM stiffness ≤ 60 minutes
- 50 years of age
What are some functional performance testing that can be impaired with age-related joint changes in the hip?
- 6 min walk test
- TUG
etc.
What are some tests that will show impaired balance with age-related joint changes in the hip?
Berg Balance Scale, etc.
What do we need to accomplish with treatment of ARJC in the hip? How?
- Integrity of Cartilage
- Mobility
> regular, easy, frequent movements then strength elements as tolerated
Is it okay to have more symptoms with age-related joint changes in the hip?
NO
What is the PT rx for age-related joint changes?
- POLICED
- Modalities for pain/inflammation
> no more than 2 weeks, only short term pain influence
What can we use an AD for with age-related joint changes in the hip?
- to minimize/avoid limping
What can we educate the patient on with age-related joint changes in the hip?
- limit hip flexion < 90˚
> avoid low seats and sit on a wedge
> no knee to chest stretched - weight management
What are JM for with age-related joint changes in the hip?
cartilage integrity and mobility
What techniques must be used with JM for arjc in the hip?
- thrust techniques and stretches need to be incorporated in addition to non-thrust techniques and ADDED TO EXERCISE
What can JM do for age-related joint changes in the hip?
- better than usual care out to 1 year
- moderate support
What is MET for with age-related joint changes in the hip?
- mobility, cartilage integrity, and muscle function
What is MET effective for with age-related joint changes in the hip?
- improving pain and function
> better than usual care out to 1 year
What can be beneficial with MET for age-related joint changes in the hip?
- aerobic component
- including trunk and hip anti-gravity muscle groups
- balance training as WBing is tolerated
How often should we do MET for age-related joint changes in the hip?
1-5x. a week for 6-12 weeks
What is there insufficient evidence with for age-related joint changes in the hip?
- chondrotinin and Glucosamine supplements
- hyaluronic acid injections - synvisc
What is the pre-op PT purposes for a Total Hip Arthroplasty?
- assistive devices
- planning for recovery, such as initial HEP
- expectation management
How many sessions is pre-op PT for a THA?
usually 1-2 sessions
What is positive about pre-op PT for THA?
Cost reduction vs. no pre-op PT
What are the incisions for THAs relative to?
The greater trochanter
What kind of approaches are there for THAs?
- anterolateral approach
- posterolateral approach
What should we know about the anterolateral approach for THA?
- no trauma to anti-gravity musculature but smaller view
- mini / smaller incision with same components so takes more MD skill
What should we know about the posterolateral approach for THAs?
- larger view but trauma to anti-gravity muscles
- more common
What are surgical considerations with THAs?
- cut capsule/extra-capsular ligaments
- forces and cut adjacent structures
- dislocate and replace hip
- stitch capsule and cut muscles
- full range under anesthesia
What prosthetics are used with THAs?
- acetabulum is rasped out and the head of the femur is cut off
- metals, ceramics, plastics
How are the prosthetics fixated?
Cemented
What are some complications with THAs?
- arthroplasty related readmission: heterotrophic ossification (1-5%)
What is arthroplasty related readmission: heterotrophic ossification?
- formation of bone in abnormal locations due to disease and/or direct trauma
- AKA as myositis ossificans if bone grows into muscle
Why are painful PROM/JM with abrupt end feels contraindicated with THA?
bone on bone
What is a hemiarthroplasty of the hip?
- replace head without replacing acetabulum
Wha kind of patient is a hemiarthrplasty usually used for?
non-arthritic patient like with Legg-Calve-Perthes disease
What are we NOT trying to improve with MET after a THA?
Cartilage integrity
What are traditional precautions after a THA?
- avoid hip flexion last 90˚
- avoid hip adduction past neutral
- avoid rotation
What kind of rotation was thought to have been needed to be avoided after a THA with traditional precautions?
- IR past neutral with a posterolateral incision
- ER past neutral with anterolateral incision
Why were these THA traditional precautions initially implemented?
due to dislocation concerns
What percentage of THAs dislocate?
less than .5%
With recent research, what precautions are there with an anterior approach THA?
- no precautions, no increased incidence of dislocations
How many dislocations were there with an anterior approach THA with no precautions?
- 4/2600 hips
- at an average of 5 days and no later than 12 days
What should we know with dislocations with THAs of either approach?
- greater in precaution group
- no precaution group progressed faster with function
What is the prognosis with a THA?
6-8 months post-op physical functioning had generally recovered to about 80% of that of controls
