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SPRING MSK II - Exam 2 > Pelvis and Hip - Age Related Joint Changes & THA > Flashcards

Pelvis and Hip - Age Related Joint Changes & THA Flashcards

1
Q

What is age related joint changes?

A

Structure breaking down, becoming disorganized, thinning, fissuring, bones takes on more load

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2
Q

What are some functional questionnaires for age-related joint changes?

A
  • Western Ontario and McMaster Universities Osteoarthritis Index
  • Lower Extremity Functional Scale
  • Harris Hip Score
  • Hip OA/THA - HOOS (hip dysfunction and OA Outcome Score)
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3
Q

What is the prevalence of age-related joint changes in the hip?

A
  • MOST common cause of hip pain
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4
Q

What percentage of adults have age-related joint changes in the hip?

A

up to ~25%

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5
Q

What are risk factors for age-related joint changes in the hip

A
  • 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
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6
Q

What can predict subsequent age-related joint changes in those with hip disease?

A

LBP

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7
Q

What are symptoms of age-related joint changes?

A
  • 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
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8
Q

What is the C-sign of pain?

A

groin, lateral hip and buttock, may even refer to knee

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9
Q

What are signs of age related joint changes in observation?

A
  • Like FAIS plus…
  • asymmetrical gait- trendelenberg gait or lateral pelvic tilt while walking
  • weight shift in standing
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10
Q

What are signs in ROM of age-related joint changes in the hip?

A
  • Like FAIS plus…
  • ≥ 3 planes of motion restricted (high spec)
  • capsular pattern of restriction NOT consistent in hip, inconclusive
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11
Q

What does Dutton indicate with ROM?

A

IR > Flx > abd = ext

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12
Q

What will we find with combined motion in the hip with age-related joint changes?

A

consistent block

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13
Q

What will we find with resisted/MMT with age-related joint changes in the hip?

A
  • pain and possible weakness with ABD (high spec)
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14
Q

What will we find with stress tests with age-related joint changes in the hip?

A
  • compression possibly positive
  • distraction possible relieving
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15
Q

What will we find with accessory motion with age-related joint changes in the hip?

A
  • hypomobility
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16
Q

What are some special tests for age-related joint changes in the hip?

A
  • OA CPR
  • OA combined results
  • Impaired Functional Performance testing
  • Impaired Balance Tests
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17
Q

What are the tests with OA CPR? (Is it present?)

A
  1. hip pain with squatting
  2. lateral hip pain with hip flexion
  3. hip pain with hip extension
  4. IR ≤ 25˚
  5. Positive scour and FABER
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18
Q

What are the tests with OA combined results? (is it NOT present?)

A
  1. hip pain
  2. hip IR ≤ 15˚
  3. IR pain
  4. AM stiffness ≤ 60 minutes
  5. 50 years of age
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19
Q

What are some functional performance testing that can be impaired with age-related joint changes in the hip?

A
  • 6 min walk test
  • TUG
    etc.
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20
Q

What are some tests that will show impaired balance with age-related joint changes in the hip?

A

Berg Balance Scale, etc.

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21
Q

What do we need to accomplish with treatment of ARJC in the hip? How?

A
  • Integrity of Cartilage
  • Mobility
    > regular, easy, frequent movements then strength elements as tolerated
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22
Q

Is it okay to have more symptoms with age-related joint changes in the hip?

A

NO

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23
Q

What is the PT rx for age-related joint changes?

A
  • POLICED
  • Modalities for pain/inflammation
    > no more than 2 weeks, only short term pain influence
24
Q

What can we use an AD for with age-related joint changes in the hip?

A
  • to minimize/avoid limping
25
Q

What can we educate the patient on with age-related joint changes in the hip?

A
  • limit hip flexion < 90˚
    > avoid low seats and sit on a wedge
    > no knee to chest stretched
  • weight management
26
Q

What are JM for with age-related joint changes in the hip?

A

cartilage integrity and mobility

27
Q

What techniques must be used with JM for arjc in the hip?

A
  • thrust techniques and stretches need to be incorporated in addition to non-thrust techniques and ADDED TO EXERCISE
28
Q

What can JM do for age-related joint changes in the hip?

A
  • better than usual care out to 1 year
  • moderate support
29
Q

What is MET for with age-related joint changes in the hip?

A
  • mobility, cartilage integrity, and muscle function
30
Q

What is MET effective for with age-related joint changes in the hip?

A
  • improving pain and function
    > better than usual care out to 1 year
31
Q

What can be beneficial with MET for age-related joint changes in the hip?

A
  • aerobic component
  • including trunk and hip anti-gravity muscle groups
  • balance training as WBing is tolerated
32
Q

How often should we do MET for age-related joint changes in the hip?

A

1-5x. a week for 6-12 weeks

33
Q

What is there insufficient evidence with for age-related joint changes in the hip?

A
  • chondrotinin and Glucosamine supplements
  • hyaluronic acid injections - synvisc
34
Q

What is the pre-op PT purposes for a Total Hip Arthroplasty?

A
  • assistive devices
  • planning for recovery, such as initial HEP
  • expectation management
35
Q

How many sessions is pre-op PT for a THA?

A

usually 1-2 sessions

36
Q

What is positive about pre-op PT for THA?

A

Cost reduction vs. no pre-op PT

37
Q

What are the incisions for THAs relative to?

A

The greater trochanter

38
Q

What kind of approaches are there for THAs?

A
  • anterolateral approach
  • posterolateral approach
39
Q

What should we know about the anterolateral approach for THA?

A
  • no trauma to anti-gravity musculature but smaller view
  • mini / smaller incision with same components so takes more MD skill
40
Q

What should we know about the posterolateral approach for THAs?

A
  • larger view but trauma to anti-gravity muscles
  • more common
41
Q

What are surgical considerations with THAs?

A
  • cut capsule/extra-capsular ligaments
  • forces and cut adjacent structures
  • dislocate and replace hip
  • stitch capsule and cut muscles
  • full range under anesthesia
42
Q

What prosthetics are used with THAs?

A
  • acetabulum is rasped out and the head of the femur is cut off
  • metals, ceramics, plastics
43
Q

How are the prosthetics fixated?

A

Cemented

44
Q

What are some complications with THAs?

A
  • arthroplasty related readmission: heterotrophic ossification (1-5%)
45
Q

What is arthroplasty related readmission: heterotrophic ossification?

A
  • formation of bone in abnormal locations due to disease and/or direct trauma
  • AKA as myositis ossificans if bone grows into muscle
46
Q

Why are painful PROM/JM with abrupt end feels contraindicated with THA?

A

bone on bone

47
Q

What is a hemiarthroplasty of the hip?

A
  • replace head without replacing acetabulum
48
Q

Wha kind of patient is a hemiarthrplasty usually used for?

A

non-arthritic patient like with Legg-Calve-Perthes disease

49
Q

What are we NOT trying to improve with MET after a THA?

A

Cartilage integrity

50
Q

What are traditional precautions after a THA?

A
  • avoid hip flexion last 90˚
  • avoid hip adduction past neutral
  • avoid rotation
51
Q

What kind of rotation was thought to have been needed to be avoided after a THA with traditional precautions?

A
  • IR past neutral with a posterolateral incision
  • ER past neutral with anterolateral incision
52
Q

Why were these THA traditional precautions initially implemented?

A

due to dislocation concerns

53
Q

What percentage of THAs dislocate?

A

less than .5%

54
Q

With recent research, what precautions are there with an anterior approach THA?

A
  • no precautions, no increased incidence of dislocations
55
Q

How many dislocations were there with an anterior approach THA with no precautions?

A
  • 4/2600 hips
  • at an average of 5 days and no later than 12 days
56
Q

What should we know with dislocations with THAs of either approach?

A
  • greater in precaution group
  • no precaution group progressed faster with function
57
Q

What is the prognosis with a THA?

A

6-8 months post-op physical functioning had generally recovered to about 80% of that of controls

SPRING MSK II - Exam 2 (6 decks)

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