Total Hip Arthroplasty Flashcards
What are the indications for Total Hip Arthroplasty?
Severe OA or RA
AVN
Fx of femoral neck
Development dysplasia
Tumors
LCP or SCFE
What is the pre-surgical phase of THR?
Discuss post-op rehab
Assess Functional status
Discuss Goals of the patient
Instruct in post - op exercises
Demonstration of Ambulance w/ AD
What is the WB status after a THR that used cemented?
WB immediately after surgery
What is the WB status after a THR that is non cemented?
Not WB for 6-12 wks
What is the WB status after a THR that uses hybrid approach?
Immediately WB
What are the post-op precaution after a THA that uses a posterolateral approach?
No flexion > 90°
No adduction across midline
No IR of hip
What are the post-op precaution after a THA that uses a anterolateral approach?
No Extension
No adduction across midline
No ER of hip
What are some post - op precautions regardless of the approach used for THA?
No sleeping on affected hip
Abduction pillow/wedge
How is the anterolateral approach done?
Surgery happens in the interval b/w TFL & rectus femoris/ sartorius
How is the posterolateral approach done?
Gluteus Maximus split & takedown deep ER
Posterior capsule & tendons repaired
Post-op what is the benefits of anterolateral approach?
Lower rate of posterior hip dislocation
Less pain
Fewer narcotics
Better function at 90 days
Post - op what is the downside of posterolateral appraoch?
Rehab progression is delayed secondary to decreased muscle function
What are the contraindications to the posterolateral approach?
Dementia
Stroke
Seizure disorder
What are the ROM goals post - op?
Advance rapidly most often
Most will achieve extension to neutral, flexion to 90°
What is the ROM goals post - op at 6 weeks?
No hip flexion > 90°
Combined 160° of flexion/ abduction/ & ER
What are the post - Op instructions?
AD instruction to minimize adverse effects of bed rest
Positional avoidance
Deep Breathing/ diaphragmatic & coughing exercises
Ankle pumps to decrease risk of DVT
what is covered in the THR post-surgical phase education?
Education (ADL)
- Raised toilet seat
- THR precautions
- Seat level higher than knees
- Stay upright = avoid bending over to pick things up
- Slip shoes on = no tying
What else is covered in THR post-surgical phase?
Assess Functional Profile
Ambulation
AROM/ PROM
Strengthening
Maximize Function
What are some THR complication?
Thromboemboletic event - DVT
Dislocation of hip
Leg Length Inequality
Infection
Loosening
What is the primary reason for revision uncemented THA?
Loosening due to bone loss
What is the primary reason for revision Cemented THA?
Autoimmune response = bone loss
What are some conditions that may lear to THR?
LCP Disease
AVN
Fx
What are some treatment options for Legg-Calve-Perthes Disease?
Reduce WB deforming forces
Crutch Ambulation
Aquatic Therapy, cycling
Gentle ROM/ strengthening
Pt often immobilized in femoral abduction & slight IR
What is the name of the brace used in patients with Legg-Calve-Perthes disease?
Scottish- Rite Orthosis
What are some risk factors for AVN?
Excessive steroid use
alcohol abuse
excessive radiation
trauma
What is the treatment option for AVN?
Usually requires surgery (decompression/ bone grafting/ THA)
What is the treatment for hip fractures?
WB restrctions
Gait training w/ AD
Gentle progressive ROM
PRE (submit isometrics, concentrics)
Balance training
