Total Hip Flashcards
What’s the main reason to have a THA?
Pain due to OA RA AVN Trauma Hip fracture Bone tumor Hip dysplaisa
What are some indications for a THA?
AVN or arthritis Paget's disease Legg-Calve-Perthes disease JRA Slipped capital femoral epiphysis - growth plate slips Congenital hip dysplasia Anemia Alcoholism Steroids Idiopathic
How old is the average age for THA?
Age is 60-75 years old
What are some absolute contraindications for THA?
Active local, or systemic infection
Insufficient bone stock (repeated revisions)
Insufficient muscle control
Other medical conditions that increase risk of preoperative complications or death
Poor outcomes are related to comorbitities
What are some relative contraindications?
Obesity Cognitive deficits (don't understand precautions)
What are some outcomes for THA?
Overall health related quality of life
Functional status
decreased pain (immediate most of the time)
How can you optimize the outcomes?
Prophylactic antibiotic therapy (prevent infections)
Anticoagulants in the perioperative period
Fixation techniques (lowered incidence of mechanical loosening)
What are some Pre-operative considerations?
Need to have an HEP (similar to TKA just more hip exercises)
Teach hip precautions
What is the most common surgical technique?
Posterior Lateral Approach
Compromises hip ERs
Spares ABD
Which surgical technique has a risk for posterior dislocation?
Posterior lateral approach (biggest risk)
Anterior Lateral approach
What happens with the Anterior Lateral Approach for THA?
Compromises glut med
capsule w/ hip ER reflected
What happens with the anterior approach for THA?
No muscles are cut (goes between TFL and glut med)
No hip precautions (just avoid extremes and end ROM)
Short term recovery may be faster but long term isn’t any different
What’s the most important piece of the prosthesis components when it comes to longevity of THA?
The liner
What are some post-op pt considerations?
Longer surgery time - (posterolateral approach is the longest)
There’s going to be an increased blood loss (delirium more common)
Usually WBAT post-op (if not due to fracture)
What are some positions to avoid with posterior-lateral approach?
Greatest Risk -hip flexion -Hip ADD -Hip IR Don't bend at hip beyond 90 degrees Don't cross legs beyond midline Don't turn foot inward
What are some positions to avoid with anterior approach?
Hip extension
Hip abduction
Hip ER
What are safe positions for ADLs?
Stay between knees (like a frog)
Women- avoid standing and shaving legs in shower, avoid crossing legs
Sitting in front seat of car- avoid reaching begin to back seat
Can understanding your hip precautions be a discharge criteria in acute/home rehab?
Yes
What are some WB restrictions?
Typically WBAT per MD orders
Consider size and upper extremity strength with assistive device
What are some things you want to work on with rehab?
Scar massage
Flexibility-ER, and ABD
Progressive exercises- isometrics > active, Abd, ERs, Extensors
Gait training and stair climbing
4-6 weeks post-op - WB restrictions lifted, hip precautions lifted
Return to function
Name some exercises for THA.
Bridges SLR Heel raises high marching single leg balance clamshells
What do you want to look out for in the return to activity phase?
It’s similar to TKA - avoid high impact activities
Full golf swing breaks precautions - 4-6 months of healing should be sufficient
What are some common things that happen with THA?
Knee pain
Hamstrings, adductors, rectus cross both joints
Change in alignment or leg length will affect length tension
What do you want to focus on as PT’s to the patient when it comes to leg length discrepancies?
QL tightness or flexibility
TFL ITB tightness
Low back pain
Educate patient on HEP
What happens if the hip dislocates?
Symptoms popping or slipping snesation
MEDICAL EMERGENCY
What increases the risk of dislocation?
Rare-highest risk first 1-4 week after surgery, occurs within first 3 months
Revisions
Weak periarticular muscles
Cognitively impaired (don’t follow precautions
What are some other complications for THA besides dislocations?
New or recurrent pain pain w/ walking pain w/ rising from sitting Weakness in leg Decreased movement at hip joint Decreased ability to stand on the leg Redness and/or tenderness over the joint Gradual or sudden shortening of the leg Infections Wear of joint surface bone wear loosening of imlant
What are some of the complication rates for THA?
Fracture-most common of femoral shaft
Vascular and Neurologic complications (.25%)
What’s the biggest concern when it comes to longevity of the device?
Osteolysis or loosening
-Happens more likely at acetabulum than femur
What are some problems for revisions?
Complex and costly
Requires technical expertise (less bone stock)
Considerations include
-bone stock
-age of patient
-functional demands of pt
-reason for failure of the primary procedure
What are some alternatives to THA?
Hip resurfacing
- faster recovery
- can run on it
