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Total Hip Arthroplasty Flashcards

1
Q

THA / THR

A

(Total Hip Arthroplasty/Replacement)
Removal of diseased hip joint and replacing it with an artificial / prosthetic one.

Successful outcome based on:

  1. Pt selection
  2. Type of implant
  3. Method of fixation
  4. Surgical technique
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2
Q

LOS

A

(Length of Stay)

*THA < 5 days

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3
Q

WBAT

A

(Weight Bearing As Tolerated) = 100% weight during amb

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4
Q

POD

A

(Post-Operative Day)

*THA: mobilize POD 1, 2 is too long

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5
Q

THA Goals

A
  1. Eradicate persistent pain
  2. Increase ROM
  3. Improve functional mobility
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6
Q

THA Surgical Indications

A
  1. Osteoarthritis (OA) *most common tx
  2. Rheumatoid Arthritis
  3. Avascular Necrosis (AVN)
  4. Abnormal muscle tone from cerebral palsy
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7
Q

OA

A

(Osteoarthritis)
Surgical indication of THA

Characterized by:

  1. Pain
  2. Stiffness –> reduced function
  3. Reduced ROM + crepitus
  4. Tenderness
  5. Boney enlargement
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8
Q

AVN

A

(Avascular Necrosis)

Surgical indication of THA

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9
Q

THA Contraindications

A
  1. Inadequate bone mass
  2. Inadequate periarticular support
  3. Serious medical risk factors
  4. Signs of infexn (= delayed healing)
  5. Lack of pt motivation to observe precautions and
    complete rehab
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10
Q

Contraindication

A

Reason to withhold a medical tx bc it may be harmful to the pt

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11
Q

THA Surgical Procedures

A
  1. Spinal / Epidural anesthesia
  2. Spinal / epidural and psoas muscle block for
    enhanced post-op control
  3. PCA pump for 24-48hrs
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12
Q

PCA Pump

A

(Patient-Controlled Analgesia)

Form of implanted drug delivery

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13
Q

THA Types and Components

A
  1. Noncemented (preferred but least stable)
  2. Cemented (allows WB immediately after surgery
  3. Hybrid

Acetabular Shell
Liner
Femoral Head
Femoral Stem

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14
Q

NWB

A

(Non weight bearing)

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15
Q

PWB

A

(Partial weight bearing) = 30-50% weight during amb

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16
Q

FWB

A

(Full weight bearing)

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17
Q

TDWB

A

(Touch Down Weight Bearing) = 20% weight during amb;

WB onto metatarsal heads instead of heel

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18
Q

THA Surgical Approaches and Analgesia Choices

A

Incision > 10 cm

  1. Posterolateral
  2. Anterolateral
  3. Anterior
  4. Transtrochanteric
    - ——————-
  5. PCA Pump
  6. Femoral Nerve Sheath Block (FNB)*
  7. Continuous epidural analgesia
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19
Q

Lateral Decubitus Postion

A

Side-lying

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20
Q

THA: Posterolateral Approach

A

(B/w glute max and med)

Adv:

  • Faster ambulation
  • Spares abductors (Hip Abd Pillow ~30*)
    • -> facilitates congruency
  • Wide exposure / visualization

Disadv:

  • Antalgic gait
  • Higher rates of dislocation
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21
Q

THA: Anterolateral Approach

A

(B/w glute med and TFL)

Adv:

  • Visibility minus posterior dislocation
  • No hip abd pillows needed

Disadv:

  • Increased heterotropic bone formation
  • Increased blood loss
  • Longer operative times

PRECAUTIONS, AVOID:

  1. Hip ER*
  2. Hip Flexion
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22
Q

THA: PRECAUTIONS

A

AVOID:

  1. Hip IR
  2. Hip Adduction
  3. Hip Flexion
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23
Q

THA: Anterior Approach

A 
Adv:
  -Minimally invasive --> no cutting of muscles or  
    tendons
  -Less soft tissue damage
  -Less blood loss

Disadv:
-More technically demanding

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24
Q

THA: Transtrochanteric Approach

A

Disadv:

-Post op limp (gluteal nerve or flap avulsion)

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25
PT Patient Mgmt
1. Pathology 2. Impairment 3. Functional Limitation 4. Disability
26
THA: Post-THA Impairments
1. Increased pain during mobility activities 2. Strength deficits in hip musculature 3. Decreased ROM 4. Decreased balance / proprioception 5. Decreased functional activity tolerance *2yrs post THA
27
THA: Functional Limitations
1. Gait 2. Transfers / Bed mobility 3. Stair negotiation 4. Driving 5. ADL's *2yrs post THA
28
THA: Disabilities
1. Self-care 2. Social activities 3. Sports 4. Work
29
PT Patient Mgmt
1. Pathology 2. Impairment 3. Functional Limitation 4. Disability
30
THA: Post-THA Impairments
1. Increased pain during mobility activities 2. Strength deficits in hip musculature 3. Decreased ROM 4. Decreased balance / proprioception 5. Decreased functional activity tolerance
31
THA: Functional Limitations
1. Gait 2. Transfers / Bed mobility 3. Stair negotiation 4. Driving 5. ADL's
32
THA: Disabilities
1. Self-care 2. Social activities 3. Sports 4. Work
33
THA: PT Treatment Goals
1. Reduce Pain 2. Increased strength / flexibility 3. Restore mobility 4. Teach adherence to precautions 5. Address ADL's 6. Educate pt and family
34
THA: Outcome Measures
Need for: - Clinical research - Quality care 1. MODEMS 2. Oxford Scale 3. WOMAC 4. SF-36 5. Harris Hip Score 6. FIM 7. HQ-12-Item Hip Questionnaire 8. Visual Analogue Scale 9. TUG 10. Six Minute Test
35
SF-36
Outcome measure for THA: Pt self-reporting quality of life measures
36
MODEMS
Outcome Measure for THA: | Musculoskeletal Outcome Data Eval and Mgmt System
37
Oxford Scale
Outcome Measure for THA
38
WOMAC
Outcome Measure for THA: | Western Ontario and McMaster University Index
39
THA Satisfaction Predictors
1. Active 2. Live-in support 3. Increased PLOF 4. Outlook
40
THA Research
1. Pre-op Education -Less pain / med use -Dec LOS / fear and anxiety 2. Pre-op exercise 3. Early transfer to inpatient rehab -faster achievement of goals 4. WB Exercise -^muscle strength, postural stability, self-perceived function 5. Treadmill BW Support -restores symmetrical indep walking 6. Hip Exercises more stressful to hip than walking 7. Bent knee functional activities put most stress on hips 8. Inactive = less wear Active = dec fall risk, ^ bone density & prosthesis fixation
41
THA Phase I: | Preoperative Training Session
``` Days 1-2 Goals: 1. Pt education -Precautions -Complications -Special needs 2. Increase pt independence in exercises -Ankle pumps -Quad sets -Glute sets -Supine hip / knee flexion (heel slides up 45*) -Hip IR to neutral ```
42
THA Phase IIA: | Hospital (Acute Care)
Days 1-2, begin day of surgery when conscious Goals: 1. Prevent complications 2. Increase muscle contraxn / control 3. Help pt sit for 30 min 4. PRECAUTIONS 5. Pulmonary hygiene + LE exercise initiation
43
THA: Postoperative Day One
Be aware of : 1. Frequency 2. Surgical approach 3. Medically cleared 4. Special precautions + WB status 5. PT Assessment 6. PRECAUTIONS (6 weeks) 7. Supine exercises 8. Transfer training 9. Gait training as tolerated
44
TED Hose
(Thromboembolic Disease) Hose
45
THA: Postoperative Day Two
1. Review day 1 tx 2. Maintain ROM 3. Exercise progression 4. Gait training + AD 5. WB Status (Cemented vs non-cemented?) 6. Short term goals 7. Gait deviation?
46
THA Phase IIB: | Hospital (AC)
``` Days 3-7 Goals: 1. Promote transfers + gait independence (ADs) 2. Reinforce THA PRECAUTIONS 3. Discharge ```
47
THA: Postoperative Day Three
Discharge Criteria: 1. State / demonstrate THA PRECAUTIONS 2. Indep with transfers 3. Indep with exercise program 4. Indep with normalized gait on level surfaces --> 100ft with LRAD 5. Indep on stairs *Acute --> inpatient rehab, SNF, home care
48
THA Phase III: | Return to Home
Weeks 1-6 Goals: 1. Increase pt indep with gait / transfers 2. Evaluate safety of home 3. Plan return of pt to work or activities
49
THA Home Care Phase: | Assessment / Requirements
1. Closed-kinetic chain exercises 2. Amb with AD (RW to straight cane) -Cane discontinued after 3-4 weeks 3. Progress to amb safely with normalized gait on uneven surfaces 4. Pts allowed to drive 3-4weeks after surgery
50
THA: Outpatient Rehab
1. Referred for lingering gait probs 2. Referred bc didn't meet home care status requirements at time of discharge 3. Encourage indep with home exercise program
50
THA: Outpatient Rehab
1. Referred for lingering gait probs 2. Referred bc didn't meet home care status requirements at time of discharge 3. Encourage indep with home exercise program
51
THA: After Rehab Intervention
1. Surgeon determines return-to-work date 2. Heavy manual labor not permitted 3. High-impact sports not permitted
51
THA: After Rehab Intervention
1. Surgeon determines return-to-work date 2. Heavy manual labor not permitted 3. High-impact sports not permitted
52
THA: Complications
1. Persistent thigh pain 2. + Trendelenberg sign (weak glute med) 3. Rubor + swelling at sight --> infexn 4. DVT 5. Leg length discrepancy 6. Component malalignment 7. Improper implant fixation to surrounding bone 8. Nerve palsy 9. Prosthetic hip dislocation
52
THA: Complications
1. Persistent thigh pain 2. + Trendelenberg sign (weak glute med) 3. Rubor + swelling at sight --> infexn 4. DVT 5. Leg length discrepancy 6. Component malalignment 7. Improper implant fixation to surrounding bone 8. Nerve palsy 9. Prosthetic hip dislocation
53
DME
(Durable Medical Equipment) | Be sure pt has everything needed to improve at home - DOCUMENT
53
DME
(Durable Medical Equipment) | Be sure pt has everything needed to improve at home - DOCUMENT
54
Palsy
Paralysis accompanied by uncontrollable movements and tremors
54
Palsy
Paralysis accompanied by uncontrollable movements and tremors
55
THA: Revisions
1. Aseptic loosening rate 2-fold higher than women 2. Younger = Increase rate of acetabular/femoral component failure
55
THA: Revisions
1. Aseptic loosening rate 2-fold higher than women 2. Younger = Increase rate of acetabular/femoral component failure
56
s/p
(Status Post)
56
s/p
(Status Post)

PHYSICAL THERAPY (13 decks)

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