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PHYSICAL THERAPY > Total Hip Arthroplasty > Flashcards

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
Q

PT Patient Mgmt

A
  1. Pathology
  2. Impairment
  3. Functional Limitation
  4. Disability
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26
Q

THA: Post-THA Impairments

A
  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
Q

THA: Functional Limitations

A
  1. Gait
  2. Transfers / Bed mobility
  3. Stair negotiation
  4. Driving
  5. ADL’s

*2yrs post THA

28
Q

THA: Disabilities

A
  1. Self-care
  2. Social activities
  3. Sports
  4. Work
29
Q

PT Patient Mgmt

A
  1. Pathology
  2. Impairment
  3. Functional Limitation
  4. Disability
30
Q

THA: Post-THA Impairments

A
  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
Q

THA: Functional Limitations

A
  1. Gait
  2. Transfers / Bed mobility
  3. Stair negotiation
  4. Driving
  5. ADL’s
32
Q

THA: Disabilities

A
  1. Self-care
  2. Social activities
  3. Sports
  4. Work
33
Q

THA: PT Treatment Goals

A
  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
Q

THA: Outcome Measures

A

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
Q

SF-36

A

Outcome measure for THA:

Pt self-reporting quality of life measures

36
Q

MODEMS

A

Outcome Measure for THA:

Musculoskeletal Outcome Data Eval and Mgmt System

37
Q

Oxford Scale

A

Outcome Measure for THA

38
Q

WOMAC

A

Outcome Measure for THA:

Western Ontario and McMaster University Index

39
Q

THA Satisfaction Predictors

A
  1. Active
  2. Live-in support
  3. Increased PLOF
  4. Outlook
40
Q

THA Research

A
  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
Q

THA Phase I:

Preoperative Training Session

A 
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
Q

THA Phase IIA:

Hospital (Acute Care)

A

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
Q

THA: Postoperative Day One

A

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
Q

TED Hose

A

(Thromboembolic Disease) Hose

45
Q

THA: Postoperative Day Two

A
  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
Q

THA Phase IIB:

Hospital (AC)

A 
Days 3-7
Goals:
  1. Promote transfers + gait independence (ADs)
  2. Reinforce THA PRECAUTIONS
  3. Discharge
47
Q

THA: Postoperative Day Three

A

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
Q

THA Phase III:

Return to Home

A

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
Q

THA Home Care Phase:

Assessment / Requirements

A
  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
Q

THA: Outpatient Rehab

A
  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
Q

THA: Outpatient Rehab

A
  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
Q

THA: After Rehab Intervention

A
  1. Surgeon determines return-to-work date
  2. Heavy manual labor not permitted
  3. High-impact sports not permitted
51
Q

THA: After Rehab Intervention

A
  1. Surgeon determines return-to-work date
  2. Heavy manual labor not permitted
  3. High-impact sports not permitted
52
Q

THA: Complications

A
  1. Persistent thigh pain
    • 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
Q

THA: Complications

A
  1. Persistent thigh pain
    • 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
Q

DME

A

(Durable Medical Equipment)

Be sure pt has everything needed to improve at home - DOCUMENT

53
Q

DME

A

(Durable Medical Equipment)

Be sure pt has everything needed to improve at home - DOCUMENT

54
Q

Palsy

A

Paralysis accompanied by uncontrollable movements and tremors

54
Q

Palsy

A

Paralysis accompanied by uncontrollable movements and tremors

55
Q

THA: Revisions

A
  1. Aseptic loosening rate 2-fold higher than women
  2. Younger = Increase rate of acetabular/femoral
    component failure
55
Q

THA: Revisions

A
  1. Aseptic loosening rate 2-fold higher than women
  2. Younger = Increase rate of acetabular/femoral
    component failure
56
Q

s/p

A

(Status Post)

56
Q

s/p

A

(Status Post)

PHYSICAL THERAPY (13 decks)

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