Total Hip

Question 1

What’s the main reason to have a THA?

Answer 1

Pain due to 
OA
RA
AVN
Trauma
Hip fracture
Bone tumor
Hip dysplaisa

Question 2

What are some indications for a THA?

Answer 2

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

Question 3

How old is the average age for THA?

Answer 3

Age is 60-75 years old

Question 4

What are some absolute contraindications for THA?

Answer 4

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

Question 5

What are some relative contraindications?

Answer 5

Obesity
Cognitive deficits (don't understand precautions)

Question 6

What are some outcomes for THA?

Answer 6

Overall health related quality of life
Functional status
decreased pain (immediate most of the time)

Question 7

How can you optimize the outcomes?

Answer 7

Prophylactic antibiotic therapy (prevent infections)
Anticoagulants in the perioperative period
Fixation techniques (lowered incidence of mechanical loosening)

Question 8

What are some Pre-operative considerations?

Answer 8

Need to have an HEP (similar to TKA just more hip exercises)

Teach hip precautions

Question 9

What is the most common surgical technique?

Answer 9

Posterior Lateral Approach
Compromises hip ERs
Spares ABD

Question 10

Which surgical technique has a risk for posterior dislocation?

Answer 10

Posterior lateral approach (biggest risk)

Anterior Lateral approach

Question 11

What happens with the Anterior Lateral Approach for THA?

Answer 11

Compromises glut med

capsule w/ hip ER reflected

Question 12

What happens with the anterior approach for THA?

Answer 12

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

Question 13

What’s the most important piece of the prosthesis components when it comes to longevity of THA?

Answer 13

The liner

Question 14

What are some post-op pt considerations?

Answer 14

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)

Question 15

What are some positions to avoid with posterior-lateral approach?

Answer 15

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

Question 16

What are some positions to avoid with anterior approach?

Answer 16

Hip extension
Hip abduction
Hip ER

Question 17

What are safe positions for ADLs?

Answer 17

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

Question 18

Can understanding your hip precautions be a discharge criteria in acute/home rehab?

Answer 18

Yes

Question 19

What are some WB restrictions?

Answer 19

Typically WBAT per MD orders

Consider size and upper extremity strength with assistive device

Question 20

What are some things you want to work on with rehab?

Answer 20

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

Question 21

Name some exercises for THA.

Answer 21

Bridges
SLR
Heel raises
high marching
single leg balance
clamshells

Question 22

What do you want to look out for in the return to activity phase?

Answer 22

It’s similar to TKA - avoid high impact activities

Full golf swing breaks precautions - 4-6 months of healing should be sufficient

Question 23

What are some common things that happen with THA?

Answer 23

Knee pain
Hamstrings, adductors, rectus cross both joints
Change in alignment or leg length will affect length tension

Question 24

What do you want to focus on as PT’s to the patient when it comes to leg length discrepancies?

Answer 24

QL tightness or flexibility
TFL ITB tightness
Low back pain
Educate patient on HEP

Question 25

What happens if the hip dislocates?

Answer 25

Symptoms popping or slipping snesation

MEDICAL EMERGENCY

Question 26

What increases the risk of dislocation?

Answer 26

Rare-highest risk first 1-4 week after surgery, occurs within first 3 months
Revisions
Weak periarticular muscles
Cognitively impaired (don’t follow precautions

Question 27

What are some other complications for THA besides dislocations?

Answer 27

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

Question 28

What are some of the complication rates for THA?

Answer 28

Fracture-most common of femoral shaft

Vascular and Neurologic complications (.25%)

Question 29

What’s the biggest concern when it comes to longevity of the device?

Answer 29

Osteolysis or loosening

-Happens more likely at acetabulum than femur

Question 30

What are some problems for revisions?

Answer 30

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

Question 31

What are some alternatives to THA?

Answer 31

Hip resurfacing

• faster recovery
• can run on it