Surgical Considerations - Total Hip Arthroplasty Flashcards
What are some Pathologies that require Total Hip Arthoplasty?
- Osteoarthritis (Most Common)
- Rheumatoid Arthritis
- Displaced Femoral Neck Fx
- Aseptic (Avascular) Necrosis
What are the type different types of procedures for THA?
- Hemiarthroplasty
- Total Arthroplasty (Most common hip procedure in the adult population)
What are the different approaches for Total Hip Arthroplasty?
- Posterior/posterolateral
- Direct Lateral
- Anterolateral
- Direct Anterior
- Transtrochanteric
With the Posterolateral THA, what are the two methods of Fixation?
- Cemented
- Non-Cemented
With Posterolateral THA, what is the Cemented method of Fixation?
This allows for very early post-op weight bearing and postentially shortens the length of rehab
- This is the most used method and primarily used for patients aged 60 and above
With Posterolateral THA, what is the Non-cemented method of Fixation?
This uses implants that allow osseus growth into a porous or textured surface of the implant
- This is used with patients under 60 and who are physcially active
What are the characteristics of the Posterolateral THA approach?
- Interval between Glute Max and Med are split
- In order to dislocate the hip posterolateral, the piriformis and short ERs are transected near their insertion and the capsule is incised
- The Glute Max tendon may also need to be released to achieve posterolateral dislocation and to allow room for the insertion of the artifical components
After a Posterolateral THA, what are the post-op restrictions?
The release of the posterior structures is associated with the high incidence of instability that could result in subluxation and/or dislocation
Post-op Restrictions:
- NO hip flexion past 90°
- NO hip adduction past neutral
- NO hip IR past neurtral
Post-Lumbar Surgery, what should the Subjective Exam focus on?
- Red/Yellow flag screening
-Intake and OM - Understanding of the full scope of the surgery
-Surgical approach
-What are the restrictions from the surgeon? - What was their prior level of function?
- What level of activity do they need/want to get back to?
What are the structure(s) affected by surgery?
Primary, secondary, tertiary
- Primary: Vertebra of the L-spine; IVD
- Secondary: Nerve roots and immediate surrounding tissues
- Tertiary: Surround tissues disrupted by surgery to access the primary tissues
Post-THA, What does the Physical Examination entail?
- Integumentary Exam
- Hip AROM/PROM
- Muscle Performance Testing (if allowed)
- Palpation
Post-THA, with the Physical Examination, when should an Integumentary Exam take place and what is expected?
- Before and after treament
- We expect to find redness, erythema and maybe eccymosis around incision.
- Signs to look out for are signs of necrosis, excessive tenderness or edema, increased heat and drainage; which indicated infection and/or delayed healing
The most common complication from surgery is infection and/or wound complications
Post-THA, with the Physical Examination, what is done during Hip AROM/PROM?
Precautions should be followed
- All directions will be limited due to post-op pain and stiffness
Post-THA, with the Physical Examination, what takes place during Muscle Performance Testing?
This may or may not be done based on patient presentation; if performed it will be done at a submaximal level
- If allowed, patient is expected to be weak
Post-THA surgery, with the Physical Examination, What is expected during palpation?
- TTP of Hip flexors, Glute Med., Piriformis and TFL
Muscle guarding can be a large contributor
What is the Prognosis for an Post-op THA?
This will vary based on:
- Natural History (The bodys ability to heal its self over time; co-morbilities may affect healing times and/or quality)
- Primary tissue healing times (Bone and/or tendon)
- Age
- Bone/tissue quality
- Social determinants of health (SDOH)
With the 1st phase of rehab what is the rehab focus?
Pt will being therapy the day after surgery while still in the hospital, Acute SOH. The primary mechanisms of pain is nocicpetive but they may also have peripheral neuropathic pain, secondary to nerve root irritation. The goal of this phase is to protect the surgical procedure, pain and swelling control and return to basic ADL’s independently
With the 2nd phase of rehab what is the rehab focus?
Pt will be in the subacute SOH with nociceptive pain but with less severity and irritability. The goal of this phase is to progress lumbar AROM, increase strength and normalize lumbar and LE movement patterns
With the 3rd phase of rehab what is the rehab focus?
Pt should have minimal to no pain symptoms, pt will be in the chronic SOH. The goal of this phase is to return to all of their normal daily activities and progress towards higher level activities
With Phase 1, What are the Precautions, Goals, and Interventions?
Treatment approach is to control pain, modulate post-op symptoms and regain ROM
Precautions
- NO Hip Flexion > 90°
- NO Hip Adduction past midline
- NO Hip IR
- Weight bearing as directed
Goals
- Increase functional mobility
- Normalize gait pattern
Interventions
- Manual Therapy
-Manual PROM
-Gentle soft tissue massage
- Exercises
-AROM
-Isometrics
-Walking
- Education on pain management and post-op precautions
With Post-Op THA, what is the Critera to Progress from Phase 1 to Phase 2?
- Well controlled pain
- Ability to ambulate with or without an AD device
- Improve LE strength
With Phase 2, What are the Precautions, Goals, and Interventions?
Treatment approach is to increase LE and core strengthening and endurance
Precautions
- Continue from Phase 1
Goals
- Normalize gait pattern
- Independent with ADLs
- Increase strength and mobility
Interventions
- Manual Therapy
-Contiue PROM as needed
- Exercises:
-LE and core strengthening exercises
-Balance exercises
-Stationary bike
With Post-Op THA, what is the Critera to Progress from Phase 2 to Phase 3?
- Demonstrate normal gait pattern
- Proper muscle activation during exercise
- Limited to no pain with ADLs
With Phase 3, What are the Precautions, Goals, and Interventions?
Treatment approach is to regain full active ROM and increase functional strength to return to most of their activities
Precautions
- Continue from Phase 1
Goals
- Normal strength and ROM
- Independent with HEP
- Return to activities
Interventions
- Manual Therapy: As needed
- Exercises:
-Progressive strengthening of LE and core
-Continue balance training
-Endurance training
- Interventions should be specific to the patients activities
